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Sample records for sorahsns continuing medical

  1. Archives: Continuing Medical Education

    African Journals Online (AJOL)

    Items 51 - 88 of 88 ... Archives: Continuing Medical Education. Journal Home > Archives: Continuing Medical Education. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives. 51 - 88 of 88 ...

  2. Continuing Medical Education

    African Journals Online (AJOL)

    Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 25, No 9 (2007) >. Log in or Register to get access to full text downloads.

  3. Continuing Medical Education

    African Journals Online (AJOL)

    A review article willintroduce readers to the educational subject matter, along with one-page summarises (in print) of additional articles that may be accessed in full online. We will continue to offer topical and up-to-date CME material. Readers are encouraged to register with samj.org.za to receive future notifications of new ...

  4. Effectiveness of continuing medical education.

    Science.gov (United States)

    Marinopoulos, Spyridon S; Dorman, Todd; Ratanawongsa, Neda; Wilson, Lisa M; Ashar, Bimal H; Magaziner, Jeffrey L; Miller, Redonda G; Thomas, Patricia A; Prokopowicz, Gregory P; Qayyum, Rehan; Bass, Eric B

    2007-01-01

    Despite the broad range of continuing medical education (CME) offerings aimed at educating practicing physicians through the provision of up-to-date clinical information, physicians commonly overuse, under-use, and misuse therapeutic and diagnostic interventions. It has been suggested that the ineffective nature of CME either accounts for the discrepancy between evidence and practice or at a minimum contributes to this gap. Understanding what CME tools and techniques are most effective in disseminating and retaining medical knowledge is critical to improving CME and thus diminishing the gap between evidence and practice. The purpose of this review was to comprehensively and systematically synthesize evidence regarding the effectiveness of CME and differing instructional designs in terms of knowledge, attitudes, skills, practice behavior, and clinical practice outcomes. We formulated specific questions with input from external experts and representatives of the Agency for Healthcare Research and Quality (AHRQ) and the American College of Chest Physicians (ACCP) which nominated this topic. We systematically searched the literature using specific eligibility criteria, hand searching of selected journals, and electronic databases including: MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Abstracts of Reviews of Effects (DARE), PsycINFO, and the Educational Resource Information Center (ERIC). Two independent reviewers conducted title scans, abstract reviews, and then full article reviews to identify eligible articles. Each eligible article underwent double review for data abstraction and assessment of study quality. Of the 68,000 citations identified by literature searching, 136 articles and 9 systematic reviews ultimately met our eligibility criteria. The overall quality of the literature was low and consequently firm conclusions were not possible. Despite this, the

  5. Communicating with adolescents | Campbell | Continuing Medical ...

    African Journals Online (AJOL)

    Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 25, No 5 (2007) >. Log in or Register to get access to full text downloads.

  6. Learning Styles in Continuing Medical Education.

    Science.gov (United States)

    Bennet, Nancy L.; Fox, Robert D.

    1984-01-01

    Synthesizes literature on cognitive style and considers issues about its role in continuing medical education research, including whether it should be used as a dependent or independent variable and how it may be used in causal models. (SK)

  7. VIRTUAL ENVIRONMENT FOR CONTINUING MEDICAL EDUCATION

    Directory of Open Access Journals (Sweden)

    Sorana D. BOLBOACA

    2007-01-01

    Full Text Available The rapid development of communication and information technologies lead to the changes in continuing medical education by offering the possibility to move up-to-date medical information through Internet to the physicians. The main goal of this study was to create a virtual space for continuing medical education. In this context, a number of computer-assisted tools for instruction, evaluation and utilization in daily activity have been developed and integrated into a unitary system. The main imposed specifications of the system were accessibility, integrity, availability, and security.This report describes the characteristics of tables design and organization, and of system integration. The security level was imposed for assuring the accessibility of each physician to medical information useful in his or her activity and the knowledge database development.

  8. Colorectal cancer screening | Schneider | Continuing Medical ...

    African Journals Online (AJOL)

    Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 27, No 5 (2009) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should ...

  9. More about ... Immunology | Singh | Continuing Medical Education

    African Journals Online (AJOL)

    Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 30, No 8 (2012) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should ...

  10. CONTINUING MEDICAL EDUCATION: CLOSING THE GAP ...

    African Journals Online (AJOL)

    drclement

    ABSTRACT. Continuing medical education (CME) has long been recognized as the key to updating and maintaining the knowledge and skill of health professionals.CME activities are well advocated, accepted and regulated in the developed world with sanctions for non-participation. In developing countries, including West ...

  11. Screening for diabetic retinopathy | Rice | Continuing Medical ...

    African Journals Online (AJOL)

    Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 31, No 4 (2013) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should ...

  12. Learning Styles and Continuing Medical Education.

    Science.gov (United States)

    Van Voorhees, Curtis; And Others

    1988-01-01

    The Gregorc Style Delineator--Word Matrix was administered to 2,060 physicians in order to gain a better understanding of their participation in continuing medical education. The study showed that 63 percent preferred the concrete sequential learning style. Different style preferences may account for some of the apparent disparity between…

  13. Online Continuing Medical Education in Saudi Arabia

    Science.gov (United States)

    Alwadie, Adnan D.

    2013-01-01

    As the largest country in the Middle East, Saudi Arabia and its health care system are well positioned to embark on an online learning intervention so that health care providers in all areas of the country have the resources for updating their professional knowledge and skills. After a brief introduction, online continuing medical education is…

  14. Continuing medical education in radiation oncology

    International Nuclear Information System (INIS)

    Chauvet, B.; Barillot, I.; Denis, F.; Cailleux, P.E.; Ardiet, J.M.; Mornex, F.

    2012-01-01

    In France, continuing medical education (CME) and professional practice evaluation (PPE) became mandatory by law in July 2009 for all health professionals. Recently published decrees led to the creation of national specialty councils to implement this organizational device. For radiation oncology, this council includes the French Society for Radiation Oncology (SFRO), the National Radiation Oncology Syndicate (SNRO) and the Association for Continuing Medical Education in Radiation Oncology (AFCOR). The Radiation Oncology National Council will propose a set of programs including CME and PPE, professional thesaurus, labels for CME actions consistent with national requirements, and will organize expertise for public instances. AFCOR remains the primary for CME, but each practitioner can freely choose an organisation for CME, provided that it is certified by the independent scientific commission. The National Order for physicians is the control authority. Radiation oncology has already a strong tradition of independent CME that will continue through this major reform. (authors)

  15. Business continuity after catastrophic medical events: the Joplin medical business continuity report.

    Science.gov (United States)

    Carlton, Paul K; Bringle, Dottie

    2012-01-01

    On May 22, 2011, The St Johns Mercy Medical Center in Joplin, MO, was destroyed by an F-5 tornado. There were 183 patients in the building at that time in this 367-bed Medical Center. The preparation and response were superbly done and resulted in many lives saved. This report is focused on the reconstitution phase of this disaster response, which includes how to restore business continuity. As 95 percent of our medical capacity resides in the private sector in the United States, we must have a proper plan for how to restore business continuity or face the reality of the medical business failing and not providing critical medical services to the community. A tornado in 2007 destroyed a medical center in Sumter County, GA, and it took more than 365 days to restore business continuity at a cost of $18M. The plan executed by the Mercy Medical System after the disaster in Joplin restored business continuity in 88 days and cost a total of $6.6M, with all assets being reusable. The recommendation from these lessons learned is that every county, state, and Federal Emergency Management Agency region has a plan on the shelf to restore business continuity and the means to be able to do so. The hard work that the State of Missouri and the Mercy Medical System did after this disaster can serve as a model for the nation in how to quickly recover from any loss of medical capability.

  16. Role of State Medical Boards in Continuing Medical Education

    Science.gov (United States)

    Johnson, David A.; Austin, Dale L.; Thompson, James N.

    2005-01-01

    The evaluation of physician competency prior to issuing an initial medical license has been a fundamental responsibility of medical boards. Growing public expectation holds that medical boards will ensure competency throughout a physician's career. The Federation of State Medical Boards (FSMB) strongly supports the right of state medical boards to…

  17. [Internet-based continuing medical education: as effective as live continuing medical education].

    Science.gov (United States)

    Maisonneuve, Hervé; Chabot, Olivier

    2009-10-01

    E-learning consists in using new multimedia and Internet technologies to improve the quality of learning activities by facilitating access to resources and services, as well as exchanges and remote collaboration. The Internet is used for adult education in most professional domains, but its use for continuing medical education is less developed. Advantages are observed for teachers (e.g., permanent updating, interactive links, illustrations, archiving, and collective intelligence) and for the learners (e.g., accessibility, autonomy, flexibility, and adaptable pace). Research and meta-analyses have shown that e-CME is as effective as live events for immediate and retained learning. English-language educational medical websites that grant CME credits are numerous; few such French-language sites can currently grant credits. Accreditation of websites for CME, in its infancy in Europe, is common in North America.

  18. Judicious Use of Simulation Technology in Continuing Medical Education

    Science.gov (United States)

    Curtis, Michael T.; DiazGranados, Deborah; Feldman, Moshe

    2012-01-01

    Use of simulation-based training is fast becoming a vital source of experiential learning in medical education. Although simulation is a common tool for undergraduate and graduate medical education curricula, the utilization of simulation in continuing medical education (CME) is still an area of growth. As more CME programs turn to simulation to…

  19. [Continuing medical education in gastroenterology and recertification in Peru].

    Science.gov (United States)

    Castillo Contreras, Ofelia; Soriano Álvarez, César

    2017-01-01

    The field of action of gastroenterology has been expanded due to technological development and the advent of new sub-specialties, such as gastroenterology oncology. Currently, there is no standardization of medical training programs in gastroenterology in our country. The health system and education are changing, so medical practice and competency assessment for medical certification and recertification should reflect these changes. On the other hand, the quality of a specialized unit, service or medical department is directly related to the quality of human resources. Lifelong learning is reflected in continuing medical education (CME). The goal of CME should be to achieve changes in staff conduct, through continuous improvement in daily practice. This requires knowing the social, institutional and individual needs and developing new, more flexible and individualized CME programs. Recertification at fixed intervals should be abandoned in favor of a model that promotes continuous professional development based on health needs and with curricular materials that support competency assessments.

  20. Ethical decisions in endof- life care | Norval | Continuing Medical ...

    African Journals Online (AJOL)

    Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 21, No 5 (2003) >. Log in or Register to get access to full text downloads.

  1. Do Continuing Medical Education Articles Foster Shared Decision Making?

    Science.gov (United States)

    Labrecque, Michel; Lafortune, Valerie; Lajeunesse, Judith; Lambert-Perrault, Anne-Marie; Manrique, Hermes; Blais, Johanne; Legare, France

    2010-01-01

    Introduction: Defined as reviews of clinical aspects of a specific health problem published in peer-reviewed and non-peer-reviewed medical journals, offered without charge, continuing medical education (CME) articles form a key strategy for translating knowledge into practice. This study assessed CME articles for mention of evidence-based…

  2. Judicious use of simulation technology in continuing medical education.

    Science.gov (United States)

    Curtis, Michael T; DiazGranados, Deborah; Feldman, Moshe

    2012-01-01

    Use of simulation-based training is fast becoming a vital source of experiential learning in medical education. Although simulation is a common tool for undergraduate and graduate medical education curricula, the utilization of simulation in continuing medical education (CME) is still an area of growth. As more CME programs turn to simulation to address their training needs, it is important to highlight concepts of simulation technology that can help to optimize learning outcomes. This article discusses the role of fidelity in medical simulation. It provides support from a cross section of simulation training domains for determining the appropriate levels of fidelity, and it offers guidelines for creating an optimal balance of skill practice and realism for efficient training outcomes. After defining fidelity, 3 dimensions of fidelity, drawn from the human factors literature, are discussed in terms of their relevance to medical simulation. From this, research-based guidelines are provided to inform CME providers regarding the use of simulation in CME training. Copyright © 2012 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

  3. The medical-industrial complex, professional medical associations, and continuing medical education.

    Science.gov (United States)

    Schofferman, Jerome

    2011-12-01

    Financial relationships among the biomedical industries, physicians, and professional medical associations (PMAs) can be professional, ethical, mutually beneficial, and, most importantly, can lead to improved medical care. However, such relationships, by their very nature, present conflicts of interest (COIs). One of the greatest concerns regarding COI is continuing medical education (CME), especially because currently industry funds 40-60% of CME. COIs have the potential to bias physicians in practice, educators, and those in leadership positions of PMAs and well as the staff of a PMA. These conflicts lead to the potential to bias the content and type of CME presentations and thereby influence physicians' practice patterns and patient care. Physicians are generally aware of the potential for bias when industry contributes funding for CME, but they are most often unable to detect the bias. This may because it is very subtle and/or the educators themselves may not realize that they have been influenced by their relationships with industry. Following Accreditation Council for Continuing Medical Education guidelines and mandating disclosure that is transparent and complete have become the fallback positions to manage COIs, but such disclosure does not really mitigate the conflict. The eventual and best solutions to ensure evidence-based education are complete divestment by educators and leaders of PMAs, minimal and highly controlled industry funding of PMAs, blind pooling of any industry contributions to PMAs and CME, strict verification of disclosures, clear separation of marketing from education at CME events, and strict oversight of presentations for the presence of bias. Wiley Periodicals, Inc.

  4. Vichy France and the continuity of medical nationalism.

    Science.gov (United States)

    Evleth, D

    1995-04-01

    This paper reviews the rise of medical nationalism and protectionism in France from the end of the nineteenth century through to the 1940s, with an emphasis on the Vichy period. It presents this nationalism as part of a continuity, showing its beginnings well before the coming of the Vichy government, its extremes under this government, and its continuation after the fall of the Vichy government, although retreating from its more extreme positions.

  5. Who Is Driving Continuing Medical Education for Family Medicine?

    Science.gov (United States)

    Klein, Douglas; Allan, G. Michael; Manca, Donna; Sargeant, Joan; Barnett, Carly

    2009-01-01

    Introduction: Considerable time and money are invested in continuing medical education (CME) for family physicians (FPs) but the effectiveness is uncertain. The participation of FPs as coordinators and teachers is not well known. The goal of this project was to describe the role of FPs in organizing and teaching CME events that are accredited for…

  6. Continuing Medical Education - Vol 27, No 1 (2009)

    African Journals Online (AJOL)

    Continuing Medical Education - Vol 27, No 1 (2009). Journal Home > Archives > Vol 27, No 1 (2009). Log in or Register to get access to full text downloads. ... Addiction treatment · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. R Meyer ...

  7. Opioid use in palliative care | Hosking | Continuing Medical Education

    African Journals Online (AJOL)

    Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 21, No 5 (2003) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Opioid use in palliative care. M Hosking. Abstract.

  8. The Academic Curriculum of Medical Radiation Technologists: Continuous Development

    International Nuclear Information System (INIS)

    Sergieva, K.; Gagova, P.; Bonninska, N.

    2016-01-01

    Full text: The purpose is to present the activities of Department of Radiation technologists at Medical College Sofia in knowledge management (KM) in human health applications and namely: continuous development of academic curriculum (AC) for medical radiation technologists (MRT) in sense of the conference motto “Nuclear Knowledge Management: Challenges and Approaches”. Our challenge is to realize, in practice, the important role of MRT professionals in healthcare. They are the front line in the patient safety and the last person with the patient before exposure. The existing AC has been periodically peer-reviewed: in 2011, 2014, and ongoing reviews, with the aim to guarantee that we are providing knowledge, skills and competencies that meet modern requirements for the training of radiation technologists. The AC compromises both academic and clinical education. The clinical component occurs throughout the academic course, accenting the role of MRT in radiology, radiotherapy and nuclear medicine. The approach of continuously developing the AC will meet the stringent requirements recently published by IAEA, with the goal that radiological medical practitioners, medical physicists, medical radiation technologists and other health professionals with specific duties in relation to protection and safety for patients in a given radiological procedure are specialized in the appropriate area. (author

  9. An Architecture for Continuous Data Quality Monitoring in Medical Centers.

    Science.gov (United States)

    Endler, Gregor; Schwab, Peter K; Wahl, Andreas M; Tenschert, Johannes; Lenz, Richard

    2015-01-01

    In the medical domain, data quality is very important. Since requirements and data change frequently, continuous and sustainable monitoring and improvement of data quality is necessary. Working together with managers of medical centers, we developed an architecture for a data quality monitoring system. The architecture enables domain experts to adapt the system during runtime to match their specifications using a built-in rule system. It also allows arbitrarily complex analyses to be integrated into the monitoring cycle. We evaluate our architecture by matching its components to the well-known data quality methodology TDQM.

  10. Electronic conferencing for continuing medical education: a resource survey.

    Science.gov (United States)

    Sternberg, R J

    1986-10-01

    The use of electronic technologies to link participants for education conferences is an option for providers of Continuing Medical Education. In order to profile the kinds of electronic networks currently offering audio- or videoteleconferences for physician audiences, a survey was done during late 1985. The information collected included range of services, fees, and geographic areas served. The results show a broad diversity of providers providing both interactive and didactic programming to both physicians and other health care professionals.

  11. ELearning acceptance in hospitals: continuing medical education of healthcare professionals

    OpenAIRE

    Bachmann, Larissa; Cantoni, Lorenzo

    2009-01-01

    ELearning provides healthcare professionals an interesting alternative of participating to Continuing Medical Education (CME) activities. It offers the possibility to attend courses at a distance, and it allows creating personal learning schedules without needing to leave the job or the family. Hospitals can choose to organize CME activities for their employees and therefore may also opt to offer eLearning activities. The research studies eLearning acceptance in the CME of healthcare p...

  12. Do continuing medical education articles foster shared decision making?

    Science.gov (United States)

    Labrecque, Michel; Lafortune, Valérie; Lajeunesse, Judith; Lambert-Perrault, Anne-Marie; Manrique, Hermes; Blais, Johanne; Légaré, France

    2010-01-01

    Defined as reviews of clinical aspects of a specific health problem published in peer-reviewed and non-peer-reviewed medical journals, offered without charge, continuing medical education (CME) articles form a key strategy for translating knowledge into practice. This study assessed CME articles for mention of evidence-based information on benefits and harms of available treatment and/or preventive options that are deemed essential for shared decision making (SDM) to occur in clinical practice. Articles were selected from 5 medical journals that publish CME articles and are provided free of charge to primary-care physicians of the Province of Quebec, Canada. Two individuals independently scored each article with the use of a 10-item checklist based on the International Patient Decision Aid Standards. In case of discrepancy, the item score was established by team consensus. Scores were added to produce a total article score ranging from 0 (no item present) to 10 (all items present). Thirty articles (6 articles per journal) were selected. Total article scores ranged from 1 to 9, with a mean (+/- SD) of 3.1 +/- 2.0 (95% confidence interval 2.8-4.3). Health conditions and treatment options were the items most frequently discussed in the articles; next came treatment benefits. Possible harms, the use of the same denominators for benefits and harms, and methods to facilitate the communication of benefits and harms to patients were almost never described. No significant differences between journals were observed. The CME articles evaluated did not include the evidence-based information necessary to foster SDM in clinical practice. Peer-reviewed and non-peer-reviewed medical journals should require CME articles to include this type of information.

  13. Continuing medical education and burnout among Danish GPs

    DEFF Research Database (Denmark)

    Brøndt, Anders; Sokolowski, Ineta; Olesen, Frede

    2008-01-01

    BACKGROUND: There has been minimal research into continuing medical education (CME) and its association with burnout among GPs. AIM: The aim of this study was to investigate the association between participating in CME and experiencing burnout in a sample of Danish GPs. DESIGN OF STUDY: Cross......-sectional questionnaire study. SETTING: All 458 active GPs in 2004, in the County of Aarhus, Denmark were invited to participate. METHOD: Data on CME activities were obtained for all GPs and linked to burnout which was measured using the Maslach Burnout Inventory - Human Services Survey. The relationship between CME...... activity and burnout was calculated as prevalence ratios (PR) in a generalised linear model. RESULTS: In total, 379 (83.5%) GPs returned the questionnaire. The prevalence of burnout was about 25%, and almost 3% suffered from 'high burnout'. A total of 344 (92.0%) GPs were members of a CME group...

  14. Continuing medical education in Brazil: what about obstetricians and gynecologists?

    Directory of Open Access Journals (Sweden)

    Nelson Sass

    Full Text Available CONTEXT: In Brazil, obstetricians and gynecologists are not required to submit to periodical evaluations to ascertain their professional competence in dealing with new concepts and therapies. OBJECTIVES: To evaluate the performance of a group of obstetricians and gynecologists on a written evidence-based obstetrics test and determine their opinions and use of systematic reviews. TYPE OF STUDY: Prospective cohort. SETTING: Brazilian Obstetrics and Gynecology Congress 2001. METHODS: 230 doctors agreed to participate in the study during a national obstetrics and gynecology congress. Participants took an individual anonymous written multiple-choice test with seven questions on clinical obstetrics, one question on the interpretation of a meta-analysis graph and two questions on their opinions and actual use of systematic reviews. Scores were analyzed and compared after grouping the participants according to year of graduation, residence training, doctoral program and faculty status. RESULTS: The general average score was 49.2 ± 17.4. The scores tended to decline as the years since graduation advanced. Doctors who graduated in the last five years had higher scores than those who graduated over 25 years ago (52.2 versus 42.9. The performance did not vary according to medical residence, postgraduate program or teaching status. While 98.2% considered systematic reviews relevant, only 54.9% said that they routinely used this source of information. DISCUSSION: The participants' average score was low, even though they were highly qualified and trained. Despite the limitations of the study, the results are worrisome. If motivated physicians participating in a national congress obtained such low scores, we can speculate that the results might be even worse among other doctors that do not attend these events. CONCLUSIONS: These findings suggest that Brazilian obstetricians and gynecologists could benefit from continuing medical education and raise questions

  15. Effective didactic skills training for teachers in continuing medical education

    International Nuclear Information System (INIS)

    Hofer, M.; Abanador, N.; Moedder, U.

    2005-01-01

    Purpose: To develop, test, evaluate and implement effective state-of-the-art teacher training in didactic skills and methods. The training concept should be designed and beneficial for medical teachers' postgraduate medical education (CME). Materials and methods: A 5-day workshop with 12 theoretical and 9 'hands-on' modules was designed and stepwise improved, according to the trainees' feedback. All trainees were trained in small groups (6 to 10 participants per workshop). The workshops consisted of mini-lectures, repeated micro teaching exercises and video-supported feedback concerning the following key-competencies: Communication of goals; methods to trigger interactivity; design of slides in power point presentations; effective feedback-techniques; and use of media, time-management, skills teaching, assessment methods (e.g. OSCE and others), evaluation and general presentation skills. The evaluation was based on two components: (A) trainees' scores in two objective structured teaching exercises (OSTEs) at the beginning and end of workshop, with the ratings of 15 to 20 external observers checked for significant trends (Pearson's X 2 test) in 17 givencriteria for high teaching effectiveness; (B) the trainees rated 20 teaching competencies in a retrospective 'pre-post-analysis' (self-assessment questionnaire) at the end of each workshop and after 6 to 12 months later. Results: The results revealed highly significant (p<0.01) improvements in 13 of 16 OSTE-criteria and in 12 of 13 items of the pre-post-analysis, predominantly estimated to be 'persistent'. Overall, trainees' feedback has been highly encouraging to continue and broaden the program. The discussion covers potential factors for the training success as well as pitfalls and the controversial issue of fees. (orig.)

  16. Improving continuing medical education by enhancing interactivity: lessons from Iran.

    Science.gov (United States)

    Faghihi, Seyed Aliakbar; Khankeh, Hamid Reza; Hosseini, Seyed Jalil; Soltani Arabshahi, Seyed Kamran; Faghih, Zahra; Parikh, Sagar V; Shirazi, Mandana

    2016-04-01

    Continuing Medical Education (CME) has been considered as a lifelong commitment for doctors to provide the optimal care for patients. Despite a long history of creating CME programs, outcomes are far from ideal. The present qualitative study aims to clarify the barriers affecting effectiveness of the CME programs in Iran based on the experiences of general practitioners. Sixteen general practitioners were recruited to participate in in-depth interviews and field observations concerning experiences with CME. The study was performed using a qualitative content analysis method. The codes, categories and themes were explored through an inductive process in which the researchers moved from specific to general. The participants' experiences identified a number of barriers, particularly insufficient interaction with the instructors; additional problems included the teachers' use of an undifferentiated approach; unreal and abstract CME; and ignorance of the diverse reasons to participate in CME. Based on the study results, there are multiple barriers to effective implementation of CME in Iran. The key barriers include insufficient interaction between the trainees and providers, which must be considered by other stakeholders and program designers. Such interactions would facilitate improved program design, invite more specific tailoring of the education to the participants, allow for more effective educational methods and set the stage for outcome evaluation from the learners actually applying their new knowledge in practice. Replication of these findings with another sample would improve confidence in these recommendations, but these findings are broadly consistent with findings in the educational literature on improving the efficacy of CME.

  17. Impact of Continued Biased Disenrollment from the Medic...

    Data.gov (United States)

    U.S. Department of Health & Human Services — Impact of Continued Biased Disenrollment from the Medicare Advantage Program to Fee-for-Service As reported in Impact of Continued Biased Disenrollment from the...

  18. Continuous professional training of medical laboratory scientists in ...

    African Journals Online (AJOL)

    Background. Training and re-training of healthcare workers is pivotal to improved service delivery. Objective. To determine the proportion of practising medical laboratory scientists with in-service training in Benin City, Nigeria and areas covered by these programmes. Methods. Medical laboratory scientists from Benin City ...

  19. 78 FR 18990 - Medical Professionals Recruitment and Continuing Education Programs

    Science.gov (United States)

    2013-03-28

    ... have experience hosting healthcare forums and meetings combining modern medicine and traditional... care by promoting education in the medical disciplines, honoring traditional healing principles and... and/or biomedical research. Foster forums where modern medicine combines with traditional healing to...

  20. Continuing medical education in Europe: towards a harmonised system.

    NARCIS (Netherlands)

    Costa, A.; Hemelryck, F. Van; Aparicio, A.; Gatzemeier, W.; Leer, J.W.H.; Maillet, B.; Hossfeld, D.K.

    2010-01-01

    One of the first reports on the state of medical education was published in 1910 in North America, with the support of the Carnegie Foundation, showing that the interest for this issue dates back at least a century. Doctors (and nurses) are among the few professionals who managed to avoid for a long

  1. Guidelines for Effective Teleconference Presentations in Continuing Medical Education.

    Science.gov (United States)

    Raszkowski, Robert R.; Chute, Alan G.

    Designing teleconference programs for the physician learner puts unique demands on the teleconferencing medium. Typically, physicians expect a 1-hour lecture presentation with high information density. To effectively present the medical content material in an audio medium, strategies which structure and organize the content material are necessary.…

  2. Continuing Medical Education - Vol 29, No 3 (2011)

    African Journals Online (AJOL)

    New developments in medical imaging to detect breast cancer: Breast cancer is still one of the most common cancers in women · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. CL Vaughan ...

  3. Continuing Medical Education - Vol 28, No 5 (2010)

    African Journals Online (AJOL)

    The collapsed football player: The sight of a football player lying on the ground, surrounded by coaches and medics, is not uncommon. EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. S Motaung, 198-201 ...

  4. 20 CFR 404.1597a - Continued benefits pending appeal of a medical cessation determination.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Continued benefits pending appeal of a... Continuing Or Stopping Disability § 404.1597a Continued benefits pending appeal of a medical cessation... continued pending reconsideration and/or a hearing before an administrative law judge on the disability...

  5. 20 CFR 416.993 - Medical evidence in continuing disability review cases.

    Science.gov (United States)

    2010-04-01

    ... evidence. Before deciding that your disability has ended, we will develop a complete medical history... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Medical evidence in continuing disability... SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Determining Disability and Blindness Continuing Or...

  6. Prototype Web-based continuing medical education using FlashPix images.

    OpenAIRE

    Landman, A.; Yagi, Y.; Gilbertson, J.; Dawson, R.; Marchevsky, A.; Becich, M. J.

    2000-01-01

    Continuing Medical Education (CME) is a requirement among practicing physicians to promote continuous enhancement of clinical knowledge to reflect new developments in medical care. Previous research has harnessed the Web to disseminate complete pathology CME case studies including history, images, diagnoses, and discussions to the medical community. Users submit real-time diagnoses and receive instantaneous feedback, eliminating the need for hard copies of case material and case evaluation fo...

  7. Proceedings [of the] Second National Conference of State Medical Association Representatives on Continuing Medical Education, October 13-15, 1970.

    Science.gov (United States)

    American Medical Association, Chicago, IL.

    The responsibility of organized medicine in the area of continuing education was the focus of this conference. Papers presented at the conference and summaries of workshop discussion groups comprise this document. The papers are: The Purpose of the Conference; Maintenance of Physician Competence; Motivation for Continuing Medical Education; Peer…

  8. Designing effective on-line continuing medical education.

    Science.gov (United States)

    Zimitat, Craig

    2001-03-01

    The Internet, and new information and communication technologies available through the Internet, provides medical educators with an opportunity to develop unique on-line learning environments with real potential to improve physicians' knowledge and effect change in their clinical practice. There are approximately 100 websites offering on-line CME courses in the USA alone. However, few of these CME courses appear to be based on sound educational principles or CME research and may have little chance of achieving the broader goals of CME. The majority of these courses closely resemble their traditional counterparts (e.g. paper-based books are now electronic books) and appear to be mere substitutions for old-technology CME resources. Whilst some CME providers add unique features of the Internet to enrich their websites, they do not employ strategies to optimize the learning opportunities afforded by this new technology. The adoption of adult learning principles, reflective practice and problem-based approaches can be used as a foundation for sound CME course design. In addition, knowledge of Internet technology and the learning opportunities it affords, together with strategies to maintain participation and new assessment paradigms, are all needed for developing online CME. We argue for an evidence-based and strategic approach to the development of on-line CME courses designed to enhance physician learning and facilitate change in clinical behaviour.

  9. [Continuing medical education: how to write multiple choice questions].

    Science.gov (United States)

    Soler Fernández, R; Méndez Díaz, C; Rodríguez García, E

    2013-06-01

    Evaluating professional competence in medicine is a difficult but indispensable task because it makes it possible to evaluate, at different times and from different perspectives, the extent to which the knowledge, skills, and values required for exercising the profession have been acquired. Tests based on multiple choice questions have been and continue to be among the most useful tools for objectively evaluating learning in medicine. When these tests are well designed and correctly used, they can stimulate learning and even measure higher cognitive skills. Designing a multiple choice test is a difficult task that requires knowledge of the material to be tested and of the methodology of test preparation as well as time to prepare the test. The aim of this article is to review what can be evaluated through multiple choice tests, the rules and guidelines that should be taken into account when writing multiple choice questions, the different formats that can be used, the most common errors in elaborating multiple choice tests, and how to analyze the results of the test to verify its quality. Copyright © 2012 SERAM. Published by Elsevier Espana. All rights reserved.

  10. Multidisciplinary Prerounding Meeting as a Continuous Quality Improvement Tool: Leveraging to Reduce Continuous Benzodiazepine Use at an Academic Medical Center.

    Science.gov (United States)

    Flannery, Alexander H; Thompson Bastin, Melissa L; Montgomery-Yates, Ashley; Hook, Corrine; Cassity, Evan; Eaton, Phillip M; Morris, Peter E

    2018-01-01

    Evidence-based medicine often has many barriers to overcome prior to implementation in practice, hence the importance of continuous quality improvement. We report on a brief (≤10 minutes) multidisciplinary meeting prior to rounds to establish a dashboard for continuous quality improvement and studied the success of this meeting on a particular area of focus: continuous infusion benzodiazepine minimization. This was a prospective observational study of patients admitted to the medical intensive care unit (MICU) of a large academic medical center over a 4-month period. A morning multidisciplinary prerounding meeting was implemented to report on metrics required to establish a dashboard for MICU care for the previous 24 hours. Fellows and nurse practitioners on respective teams reported on key quality metrics and other important data related to patient census. Continuous benzodiazepines were tracked daily as the number of patients per team who had orders for a continuous benzodiazepine infusion. The aim of this report is to describe the development of the morning multidisciplinary prerounding meeting and its impact on continuous benzodiazepine use, along with associated clinical outcomes. The median number of patients prescribed a continuous benzodiazepine daily decreased over this time period and demonstrated a sustained reduction at 1 year. Furthermore, sedation scores improved, corresponding to a reduction in median duration of mechanical ventilation. The effectiveness of this intervention was mapped post hoc to conceptual models used in implementation science. A brief multidisciplinary meeting to review select data points prior to morning rounds establishes mechanisms for continuous quality improvement and may serve as a mediating factor for successful implementation when initiating and monitoring practice change in the ICU.

  11. Relationship Between Attention-Deficit/Hyperactivity Disorder Care and Medication Continuity.

    Science.gov (United States)

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

    2016-04-01

    To describe the relationships between attention-deficit/hyperactivity disorder (ADHD) care practices and subsequent medication use. A retrospective cohort from a random sample of medical records in 50 pediatric practices with 188 providers, including 1,352 children who started ADHD medication, was studied. Independent variables included physician behaviors related to medication titration and monitoring of treatment response. Primary outcomes were number of days covered with ADHD medication during the first year of treatment and time from starting medicine to the first 30-day gap in medication supply. Multilevel modeling and Cox proportional hazards regression models were conducted. Children had an average medication supply of 217 days in the first year. Half experienced a 30-day gap in medication supply in the first 3 months. Nearly three-fourths had a medication adjustment in the first year with the first adjustment usually being a dosage change. The average time to the first medication adjustment was over 3 months. Physician's first contact with parents occurred in the first month of treatment for less than half, with the average time being over 2 months. Little variation related to ADHD care quality was accounted for at the physician level. Early titration and early contact were related to greater medication supply and continuity of treatment. Earlier physician-delivered ADHD care (e.g., contact with parent after starting medication and medication adjustment) is related to greater medication supply and continuity. It remains to be determined whether interventions that improve the quality of titration and monitoring practices for children with ADHD would also improve medication continuity. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  12. Developing Continuing Professional Education in the Health and Medical Professions through Collaboration

    Science.gov (United States)

    Tisdell, Elizabeth J.; Wojnar, Margaret; Sinz, Elizabeth

    2016-01-01

    This chapter focuses on how to negotiate power and interest among multiple stakeholders to develop continuing professional education programs as graduate study for those in the health and medical professions.

  13. Implementing a Course Review Process for a Continuous Quality Improvement Model for a Medical School Curriculum.

    Science.gov (United States)

    Ward, Cassandra S; Andrade, Amy; Walker-Winfree, Lena

    2018-01-01

    In 1901, Abraham Flexner, a research scholar at the Carnegie Foundation for the Advancement of Teaching, visited 155 medical schools in the United States and Canada to assess medical education. Flexner's recommendations became the foundation for the Liaison Committee on Medical Education accreditation, a voluntary, peer-reviewed quality assurance process to determine whether a medical education program meets established standards. The Meharry Medical College School of Medicine, a historically Black college/university (HBCU) established the Office of Curriculum Evaluation and Effectiveness in 2013 to ensure the consistent monitoring of the medical education program's compliance with accreditation standards. The motto and logo, LCME 24/7, highlight the school's emphasis on meeting accreditation standards. The school uses the 1994 Plan-Do-Study-Act Cycle for Learning and Improvement for continuous review of course content, outcomes, and evaluations. This process identifies strengths, challenges, and opportunities for innovative steps for continuous quality improvements to the curriculum.

  14. Application of International Videoconferences for Continuing Medical Education Programs Related to Laparoscopic Surgery

    OpenAIRE

    Huang, Ke-Jian; Cen, Gang; Qiu, Zheng-Jun; Jiang, Tao; Cao, Jun; Fu, Chun-Yu

    2014-01-01

    Background: Continuing medical education (CME) is an effective way for practicing physicians to acquire up-to-date clinical information. Materials and Methods: We conducted four CME seminars in 2007–2010 endorsed by the Chinese Medical Association Council on Medical Education. Overseas telelectures and live case demonstrations were introduced in each seminar via telemedicine based on a digital video transport system. Network stability and packet loss were recorded. An anonymous mini-...

  15. A Study to Determine the Correlation between Continuity of Care and Patient Medication Compliance

    Science.gov (United States)

    1984-08-01

    U (III FILE ’Y TO DETERMINE THE CORRELATION BETWEEN CONTINUITY OF CARE AND PATIENT MEDICATION COMPLIANCE IA Graduate Research Project Submitted to...43 APPENDIX A. PATIENT MEDICATION COMPLIANCE QUESTIONNAIRE . . . . . 45 B. COMPUTER CODED INPUT FORMAT . . . . . . . ...... 48 C. RESEARCH DATA...and that adhered to by the patient . This failure to comply with medical recommendations results in a waste of health resources, frustration to the

  16. Breaks in continuity of care and the rural senior transferred for medical care under regionalisation

    Directory of Open Access Journals (Sweden)

    H. Jay Biem

    2003-09-01

    Full Text Available Continuity of care, defined as the patient experiencing coherent care over time and place, is challenged when a rural senior with multiple medical problems is transferred to a regional hospital for acute care. From an illustrative case of an older patient with pneumonia and atrial fibrillation, we catalogue potential breaks in continuity of care. Optimal continuity of care is characterised not only by regular contact with the providers who establish collaboration with patients and their caregivers, but also by communication, co-ordination, contingency, convenience, and consistency. Because it is not possible to have the same providers continuously available (relational continuity, for continuity of care, there is a need for integrative system approaches, such as: (1 policy and standards, disease management programs, integrated clinical pathways (management continuity, (2 electronic health information systems and telecommunications technology (communication continuity. The evaluation of these approaches requires measures that account for the multi-faceted nature of continuity of care.

  17. [Scientific evaluation--the basis for quality assurance in continuing medical education].

    Science.gov (United States)

    Haffner, Christian; Giere, Wolfgang; Loch, Ernst-Gerhard; Rieck, Gisela

    2006-01-01

    Scientific evaluation is a fundamental tool of effective quality assurance of continuing medical education (CME). The analysis of the evaluation system of the CME academy of one the German Regional Medical Associations has revealed both the strengths and weaknesses of this system, thus enabling the installation of a model-like quality control system. Of utmost importance is the construction of an evaluation form that must be designed for good selectivity of the items, and the quality of the event should be well represented by the evaluating questions. For comparison purposes, the evaluation form should be standardized according to international evaluation standards. The standards of the German Society of Evaluation (DeGEval) and the guidelines and recommendations of the German Medical Association are both suitable orientational aids for the evaluation form and the evaluation process. The assessment process should also follow international standardised principles; it should be timely and subjective elements of interpretation should be eliminated, which is required for the evaluation of continuing medical education to achieve credibility. Furthermore, it is also a prerequisite that consequences may follow from the evaluation of continuing medical education and the continuity of the quality assurance process.

  18. Peer-to-Peer JXTA Architecture for Continuing Mobile Medical Education Incorporated in Rural Public Health Centers

    OpenAIRE

    Rajasekaran, Rajkumar; Sriman Narayana Iyengar, Nallani Chackravatula

    2013-01-01

    Objectives: Mobile technology helps to improve continuing medical education; this includes all aspects of public health care as well as keeping one?s knowledge up-to-date. The program of continuing medical and health education is intertwined with mobile health technology, which forms an imperative component of national strategies in health. Continuing mobile medical education (CMME) programs are designed to ensure that all medical and health-care professionals stay up-to-date with the knowled...

  19. The transformation of continuing medical education (CME in the United States

    Directory of Open Access Journals (Sweden)

    Balmer JT

    2013-09-01

    Full Text Available Jann Torrance Balmer Continuing Medical Education, University of Virginia School of Medicine, Charlottesville, VA, USA Abstract: This article describes five major themes that inform and highlight the transformation of continuing medical education in the USA. Over the past decade, the Institute of Medicine (IOM and other national entities have voiced concern over the cost of health care, prevalence of medical errors, fragmentation of care, commercial influence, and competence of health professionals. The recommendations from these entities, as well as the work of other regulatory, professional, academic, and government organizations, have fostered discussion and development of strategies to address these challenges. The five themes in this paper reflect the changing expectations of multiple stakeholders engaged in health care. Each theme is grounded in educational, politico-economic priorities for health care in the USA. The themes include (1 a shift in expectation from simple attendance or a time-based metric (credit to a measurement that infers competence in performance for successful continuing professional development (CPD; (2 an increased focus on interprofessional education to augment profession-specific continuing education; (3 the integration of CPD with quality improvement; (4 the expansion of CPD to address population and public health issues; and (5 identification and standardization of continuing education (CE professional competencies. The CE profession plays an essential role in the transformation of the US CPD system for health professionals. Coordination of the five themes described in this paper will foster an improved, effective, and efficient health system that truly meets the needs of patients. Keywords: continuing medical education, continued professional development, independence, competencies, CE professional

  20. Perceptions of Continuing Medical Education, Professional Development, and Organizational Support in the United Arab Emirates

    Science.gov (United States)

    Younies, Hassan; Berham, Belal; Smith, Pamela C.

    2010-01-01

    Introduction: This paper investigates the views of health care providers on continuous medical education (CME). To our knowledge, this is one of the first surveys to examine perspectives of CME in the United Arab Emirates (UAE). Methods: A 6-part questionnaire focused on the following areas of CME: the workshop leaders/trainers, the training…

  1. Effectiveness of e-learning in continuing medical education for occupational physicians

    NARCIS (Netherlands)

    Hugenholtz, Nathalie I. R.; de Croon, Einar M.; Smits, Paul B.; van Dijk, Frank J. H.; Nieuwenhuijsen, Karen

    2008-01-01

    Background Within a clinical context e-learning is comparable to traditional approaches of continuing medical education (CME). However, the occupational health context differs and until now the effect of postgraduate e-learning among occupational physicians (OPs) has not been evaluated. Aim To

  2. Marketing to Increase Participation in a Web-Based Continuing Medical Education Cultural Competence Curriculum

    Science.gov (United States)

    Estrada, Carlos A.; Krishnamoorthy, Periyakaruppan; Smith, Ann; Staton, Lisa; Korf, Michele J.; Allison, Jeroan J.; Houston, Thomas K.

    2011-01-01

    Introduction: CME providers may be interested in identifying effective marketing strategies to direct users to specific content. Online advertisements for recruiting participants into activities such as clinical trials, public health programs, and continuing medical education (CME) have been effective in some but not all studies. The purpose of…

  3. Disruptive Technologies: A Credible Threat to Leading Programs in Continuing Medical Education?

    Science.gov (United States)

    Christensen, Clayton M.; Armstrong, Elizabeth G.

    1998-01-01

    Disruptive technologies are simple convenient innovations that have triggered failures of some well-managed companies. They may threaten continuing medical-education programs so focused on leading-edge technology they lose sight of the very different educational needs of growing numbers of health care providers, who are turning to consultants, the…

  4. Continuing Medical Education for European General Practitioners in Doctor-Patient Relationship Skills and Psychosocial Issues.

    Science.gov (United States)

    Barker, L. Randol

    1998-01-01

    Most of the 23 European providers of continuing medical education (CME) surveyed reported programming on the doctor-patient relationship and psychosocial issues. Visits to programs in France, the Netherlands, and Spain identified the formats used most often in small group instruction, intensive individual learning, and national-level CME. (SK)

  5. Evaluating the Quantity and Quality of Continuing medical education Programs from the Viewpoint of General Medical Practitioners, Ilam Province

    Directory of Open Access Journals (Sweden)

    Mohsen Fatahi

    2015-07-01

    Full Text Available Background and purpose: The purpose of this research was to evaluate the quantity and quality of continuing medical education programs from the viewpoint of general medical practitioners in Ilam province.Methods: The research method was descriptive survey and the statistic sample was a group of 61 general medical practitioners who have been working in Ilam during 2010-2011 and were chosen by simple random sampling method. The data collection tool was a questionnaire with 50 items and reliability coefficient obtained using Cronbach's alpha which was 88%.Results: The findings showed that there is a meaningful/significant relationship between CME (Continuing Medical Education/retraining programs and improving GPs (General Practitioner clinical skills with reliability of 99% and this relationship is direct and positive (r=0.502. It means that increasing the quality and quantity of these programs has positive effect on improving general practitioners’ clinical skills. There was no meaningful/significant relationship between the method of teaching and GPs satisfaction (r=0.160. It means most of these practitioners were not satisfied with using training equipment, teaching methods, teachers' knowledge and manners. Also, there was no meaningful/significant relationship between teaching times and educational materials and GPs satisfaction (r=0.73 .It shows that the rate of GPs satisfaction from teaching times and educational materials is very low and there is little coherence between them. But there was a meaningful/significant relationship between GPs job requirements and educational materials with reliability of 95% (r=0.326. It means presenting suitable teaching materials and content related to GPs jobs requirements led to increase GPs desire to attend educational classes .There was no meaningful/significant relationship between time dedicated to each topic and improving GPs skills (r=0.096. So, findings indicate that there is no coincidence between

  6. Online nutrition and T2DM continuing medical education course launched on state-level medical association.

    Science.gov (United States)

    Hicks, Kristen K; Murano, Peter S

    2017-01-01

    The purpose of this research study was to determine whether a 1-hour online continuing medical education (CME) course focused on nutrition for type 2 diabetes would result in a gain in nutrition knowledge by practicing physicians. A practicing physician and dietitian collaborated to develop an online CME course (both webinar and self-study versions) on type 2 diabetes. This 1-hour accredited course was launched through the state-level medical association's education library, available to all physicians. Physicians (n=43) registered for the course, and of those, 31 completed the course in its entirety. A gain in knowledge was found when comparing pre- versus post-test scores related to the online nutrition CME ( P Online CME courses launched via state-level medical associations offer convenient continuing education to assist practicing physicians in addressing patient nutrition and lifestyle concerns related to chronic disease. The present diabetes CME one-credit course allowed physicians to develop basic nutrition care concepts on this topic to assist patients in a better way.

  7. Fabrication of continuous electrospun filaments with potential for use as medical fibres.

    Science.gov (United States)

    Mouthuy, Pierre-Alexis; Zargar, Nasim; Hakimi, Osnat; Lostis, Emilie; Carr, Andrew

    2015-05-19

    Soft tissue injuries represent a substantial and growing social and economic burden. Medical fibres are commonly used to repair these injuries during surgery. Patient's outcomes are, however, not promising with around 40% of surgical repairs failing within the first few months after surgery due to poor tissue regeneration. The application of nanofibrous filaments and yarns as medical fibres and scaffolds has been suggested to improve soft tissue regeneration and enhance the quality of the repair. However, due to a lack of robustness and reliability of the current fabrication methods, continuous nanofibrous filaments cannot be manufactured and scaled up in industrial settings and are not currently available for clinical use. We have developed a robust and automated method that enables the manufacture of continuous electrospun filaments and which has the potential to be integrated into existing textile production lines. The technology uses a wire guide to form submicrofibres in a dense, narrow mesh which can be detached as a long and continuous thread. The thread can then be stretched and used to create multifilament yarns which can imitate the hierarchical architecture of tissues such as tendons and ligaments. Electrospun polydioxanone yarns produced by this method showed improved cellular proliferation and adhesion when compared to medical monofilament fibres in current clinical use. In vivo, the electrospun yarns showed a good safety profile with mild foreign body reaction and complete degradation within 5 months after implantation. These results suggest that this filament collection method has the potential to become a useful platform for the fabrication of future medical textiles.

  8. Prototype Web-based continuing medical education using FlashPix images.

    Science.gov (United States)

    Landman, A; Yagi, Y; Gilbertson, J; Dawson, R; Marchevsky, A; Becich, M J

    2000-01-01

    Continuing Medical Education (CME) is a requirement among practicing physicians to promote continuous enhancement of clinical knowledge to reflect new developments in medical care. Previous research has harnessed the Web to disseminate complete pathology CME case studies including history, images, diagnoses, and discussions to the medical community. Users submit real-time diagnoses and receive instantaneous feedback, eliminating the need for hard copies of case material and case evaluation forms. This project extends the Web-based CME paradigm with the incorporation of multi-resolution FlashPix images and an intuitive, interactive user interface. The FlashPix file format combines a high-resolution version of an image with a hierarchy of several lower resolution copies, providing real-time magnification via a single image file. The Web interface was designed specifically to simulate microscopic analysis, using the latest Javascript, Java and Common Gateway Interface tools. As the project progresses to the evaluation stage, it is hoped that this active learning format will provide a practical and efficacious environment for continuing medical education with additional application potential in classroom demonstrations, proficiency testing, and telepathology. Using Microsoft Internet Explorer 4.0 and above, the working prototype Web-based CME environment is accessible at http://telepathology.upmc.edu/WebInterface/NewInterface/welcome.html.

  9. Expanding Educators' Contributions to Continuous Quality Improvement of American Board of Medical Specialties Maintenance of Certification.

    Science.gov (United States)

    Nora, Lois Margaret; Pouwels, Mellie Villahermosa; Irons, Mira

    2016-01-01

    The American Board of Medical Specialties board certification has transformed into a career-long process of learning, assessment, and performance improvement through its Program for Maintenance of Certification (MOC). Medical educators across many medical professional organizations, specialty societies, and other institutions have played important roles in shaping MOC and tailoring its overarching framework to the needs of different specialties. This Commentary addresses potential barriers to engagement in work related to MOC for medical school (MS) and academic health center (AHC) educators and identifies reasons for, and ways to accomplish, greater involvement in this work. The authors present ways that medical and other health professions educators in these settings can contribute to the continuous improvement of the MOC program including developing educational and assessment activities, engaging in debate about MOC, linking MOC with institutional quality improvement activities, and pursuing MOC-related scholarship. MS- and AHC-based educators have much to offer this still-young and continually improving program, and their engagement is sought, necessary, and welcomed.

  10. Continuing medical education effect on physician knowledge: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.

    Science.gov (United States)

    Bordage, Georges; Carlin, Brian; Mazmanian, Paul E

    2009-03-01

    Physicians are continuously engaging in continuing medical education (CME) activities. Whether CME activities actually improve their knowledge and whether multiple media, instructional techniques, and exposures are better than single experiences are questions that are still under discussion. The Johns Hopkins Evidence-based Practice Center for Healthcare Research and Quality conducted a systematic review of the effectiveness of CME (Agency for Healthcare Research and Quality Evidence Report) from which the guideline panel used 28 (+/- 2) studies to answer these questions about improvements in knowledge. The studies were selected based on the presence of an adequate control group from an initial pool of 136 studies on CME. Despite the heterogeneity of the studies reviewed and the low quality of the evidence, the results from the majority of the studies (79%) showed that CME activities were associated with improvements in physician knowledge. The evidence gathered about the use of media and instructional techniques and the frequency of exposure suggests that multimedia, multiple instructional techniques, and multiple exposures be used whenever possible in CME. Future studies of CME should include assessment of applied knowledge, and should incorporate programmatic and collaborative studies of CME.

  11. Continuing medical education, continuing professional development, and knowledge translation: improving care of older patients by practicing physicians.

    Science.gov (United States)

    Thomas, David C; Johnston, Bree; Dunn, Kathel; Sullivan, Gail M; Brett, Belle; Matzko, Marilyn; Levine, Sharon A

    2006-10-01

    Many community-based internists and family physicians lack familiarity with geriatrics knowledge and best practices, but they face overwhelming fiscal and time barriers to expanding their skills and improving their behavior in the care of older people. Traditional lecture-and-slide-show continuing medical education (CME) programs have been shown to be relatively ineffective in changing this target group's practice. The challenge for geriatrics educators, then, is to devise CME programs that are highly accessible to practicing physicians, that will have an immediate and significant effect on practitioners' behavior, and that are financially viable. Studies of CME have shown that the most effective programs for knowledge translation in these circumstances involve what is known as active-mode learning, which relies on interactive, targeted, and multifaceted techniques. A systematic literature review, supplemented by structured interviews, was performed to inventory active-mode learning techniques for geriatrics knowledge and skills in the United States. Thirteen published articles met the criteria, and leaders of 28 active-mode CME programs were interviewed. This systematic review indicates that there is a substantial experience in geriatrics training for community-based physicians, much of which is unpublished and incompletely evaluated. It appears that the most effective methods to change behaviors involved multiple educational efforts such as written materials or toolkits combined with feedback and strong communication channels between instructors and learners.

  12. Accreditation of Medical Education Programs: Moving From Student Outcomes to Continuous Quality Improvement Measures.

    Science.gov (United States)

    Blouin, Danielle; Tekian, Ara

    2018-03-01

    Accreditation of undergraduate medical education programs aims to ensure the quality of medical education and promote quality improvement, with the ultimate goal of providing optimal patient care. Direct linkages between accreditation and education quality are, however, difficult to establish. The literature examining the impact of accreditation predominantly focuses on student outcomes, such as performances on national examinations. However, student outcomes present challenges with regard to data availability, comparability, and contamination.The true impact of accreditation may well rest in its ability to promote continuous quality improvement (CQI) within medical education programs. The conceptual model grounding this paper suggests accreditation leads medical schools to commit resources to and engage in self-assessment activities that represent best practices of CQI, leading to the development within schools of a culture of CQI. In line with this model, measures of the impact of accreditation on medical schools need to include CQI-related markers. The CQI orientation of organizations can be measured using validated instruments from the business and management fields. Repeated determinations of medical schools' CQI orientation at various points throughout their accreditation cycles could provide additional evidence of the impact of accreditation on medical education. Strong CQI orientation should lead to high-quality medical education and would serve as a proxy marker for the quality of graduates and possibly for the quality of care they provide.It is time to move away from a focus on student outcomes as measures of the impact of accreditation and embrace additional markers, such as indicators of organizational CQI orientation.

  13. Defining quality criteria for online continuing medical education modules using modified nominal group technique.

    Science.gov (United States)

    Shortt, S E D; Guillemette, Jean-Marc; Duncan, Anne Marie; Kirby, Frances

    2010-01-01

    The rapid increase in the use of the Internet for continuing education by physicians suggests the need to define quality criteria for accredited online modules. Continuing medical education (CME) directors from Canadian medical schools and academic researchers participated in a consensus process, Modified Nominal Group Technique, to develop agreement on the most important quality criteria to guide module development. Rankings were compared to responses to a survey of a subset of Canadian Medical Association (CMA) members. A list of 17 items was developed, of which 10 were deemed by experts to be important and 7 were considered secondary. A quality module would: be needs-based; presented in a clinical format; utilize evidence-based information; permit interaction with content and experts; facilitate and attempt to document practice change; be accessible for later review; and include a robust course evaluation. There was less agreement among CMA members on criteria ranking, with consensus on ranking reached on only 12 of 17 items. In contrast to experts, members agreed that the need to assess performance change as a result of an educational experience was not important. This project identified 10 quality criteria for accredited online CME modules that representatives of Canadian organizations involved in continuing education believe should be taken into account when developing learning products. The lack of practitioner support for documentation of change in clinical behavior may suggest that they favor traditional attendance- or completion-based CME; this finding requires further research.

  14. Mental Health of Prisoners: Identifying Barriers to Mental Health Treatment and Medication Continuity

    Science.gov (United States)

    Connell, Nadine M.

    2014-01-01

    Objectives. We assessed mental health screening and medication continuity in a nationally representative sample of US prisoners. Methods. We obtained data from 18 185 prisoners interviewed in the 2004 Survey of Inmates in State and Federal Correctional Facilities. We conducted survey logistic regressions with Stata version 13. Results. About 26% of the inmates were diagnosed with a mental health condition at some point during their lifetime, and a very small proportion (18%) were taking medication for their condition(s) on admission to prison. In prison, more than 50% of those who were medicated for mental health conditions at admission did not receive pharmacotherapy in prison. Inmates with schizophrenia were most likely to receive pharmacotherapy compared with those presenting with less overt conditions (e.g., depression). This lack of treatment continuity is partially attributable to screening procedures that do not result in treatment by a medical professional in prison. Conclusions. A substantial portion of the prison population is not receiving treatment for mental health conditions. This treatment discontinuity has the potential to affect both recidivism and health care costs on release from prison. PMID:25322306

  15. Using electronic clinical practice audits as needs assessment to produce effective continuing medical education programming.

    Science.gov (United States)

    Klein, Doug; Staples, John; Pittman, Carmen; Stepanko, Cheryl

    2012-01-01

    The traditional needs assessment used in developing continuing medical education programs typically relies on surveying physicians and tends to only capture perceived learning needs. Instead, using tools available in electronic medical record systems to perform a clinical audit on a physician's practice highlights physician-specific practice patterns. The purpose of this study was to test the feasibility of implementing an electronic clinical audit needs assessment process for family physicians in Canada. A clinical audit of 10 preventative care interventions and 10 chronic disease interventions was performed on family physician practices in Alberta, Canada. The physicians used the results from the audit to produce personalized learning needs, which were then translated into educational programming. A total of 26 family practices and 4489 patient records were audited. Documented completion rates for interventions ranged from 13% for ensuring a patient's tetanus vaccine is current to 97% of pregnant patients receiving the recommended prenatal vitamins. Electronic medical record-based needs assessments may provide a better basis for developing continuing medical education than a more traditional survey-based needs assessment. This electronic needs assessment uses the physician's own patient outcome information to assist in determining learning objectives that reflect both perceived and unperceived needs.

  16. The transformation of continuing medical education (CME) in the United States.

    Science.gov (United States)

    Balmer, Jann Torrance

    2013-01-01

    This article describes five major themes that inform and highlight the transformation of continuing medical education in the USA. Over the past decade, the Institute of Medicine (IOM) and other national entities have voiced concern over the cost of health care, prevalence of medical errors, fragmentation of care, commercial influence, and competence of health professionals. The recommendations from these entities, as well as the work of other regulatory, professional, academic, and government organizations, have fostered discussion and development of strategies to address these challenges. The five themes in this paper reflect the changing expectations of multiple stakeholders engaged in health care. Each theme is grounded in educational, politico-economic priorities for health care in the USA. The themes include (1) a shift in expectation from simple attendance or a time-based metric (credit) to a measurement that infers competence in performance for successful continuing professional development (CPD); (2) an increased focus on interprofessional education to augment profession-specific continuing education; (3) the integration of CPD with quality improvement; (4) the expansion of CPD to address population and public health issues; and (5) identification and standardization of continuing education (CE) professional competencies. The CE profession plays an essential role in the transformation of the US CPD system for health professionals. Coordination of the five themes described in this paper will foster an improved, effective, and efficient health system that truly meets the needs of patients.

  17. Continuing medical education and pharmaceutical industry involvement: An evaluation of policies adopted by Canadian professional medical associations.

    Science.gov (United States)

    Shnier, Adrienne; Lexchin, Joel

    2017-01-01

    Professional medical associations (PMAs) play a crucial role in providing accredited continuing medical education (CME) to physicians. Funding from the pharmaceutical industry may lead to biases in CME. This study examines publicly available policies on CME, adopted by Canadian PMAs as of December 2015. Policies were evaluated using an original scoring tool comprising 21 items, two questions about PMAs' general and CME funding from industry, and three enforcement measures. We assessed 236 policies adopted by Canadian PMAs (range, 0 to 32). Medical associations received summative scores that ranged from 0% to 49.2% of the total possible points (maximum score = 63). Twenty-seven associations received an overall score of 0%. The highest mean scores were achieved in the areas of industry involvement in planning CME activities (mean: 1.1/3), presence of a review process for topics of CME activities (mean: 1.1/3), content review for balanced information (mean: 1.1/3), and responsibility of distribution of funds (mean: 1.0/3). The lowest mean scores were achieved in the areas of awards (mean: 0.0/3), industry personnel, representatives, and employees (mean: 0.1/3), distribution of industry-funded educational materials at CME activities (mean: 0.1/3), and distinction between marketing and educational materials (mean: 0.1/3). These results suggest that Canadian PMAs' publicly available policies on industry involvement in CME are generally weak or non-existent; therefore, the accredited CME that is provided to Canadian physicians may be viewed as open to bias. We encourage all Canadian medical associations to strengthen their policies to avoid the potential for industry influence in CME.

  18. Effective didactic skills training for teachers in continuing medical education; Effektive Didaktiktrainings fuer Dozenten von CME-Fortbildungen (Continuing Medical Education)

    Energy Technology Data Exchange (ETDEWEB)

    Hofer, M.; Abanador, N. [Medizindidaktisches Pilotprojekt, Medizinische Fakultaet der Heinrich-Heine-Univ. (HHU) Duesseldorf (Germany); Moedder, U. [Inst. fuer Diagnostische Radiologie, Universitaetsklinikum (UKD) Duesseldorf (Germany)

    2005-09-01

    Purpose: To develop, test, evaluate and implement effective state-of-the-art teacher training in didactic skills and methods. The training concept should be designed and beneficial for medical teachers' postgraduate medical education (CME). Materials and methods: A 5-day workshop with 12 theoretical and 9 'hands-on' modules was designed and stepwise improved, according to the trainees' feedback. All trainees were trained in small groups (6 to 10 participants per workshop). The workshops consisted of mini-lectures, repeated micro teaching exercises and video-supported feedback concerning the following key-competencies: Communication of goals; methods to trigger interactivity; design of slides in power point presentations; effective feedback-techniques; and use of media, time-management, skills teaching, assessment methods (e.g. OSCE and others), evaluation and general presentation skills. The evaluation was based on two components: (A) trainees' scores in two objective structured teaching exercises (OSTEs) at the beginning and end of workshop, with the ratings of 15 to 20 external observers checked for significant trends (Pearson's X{sup 2} test) in 17 givencriteria for high teaching effectiveness; (B) the trainees rated 20 teaching competencies in a retrospective 'pre-post-analysis' (self-assessment questionnaire) at the end of each workshop and after 6 to 12 months later. Results: The results revealed highly significant (p<0.01) improvements in 13 of 16 OSTE-criteria and in 12 of 13 items of the pre-post-analysis, predominantly estimated to be 'persistent'. Overall, trainees' feedback has been highly encouraging to continue and broaden the program. The discussion covers potential factors for the training success as well as pitfalls and the controversial issue of fees. (orig.)

  19. Marketing to increase participation in a Web-based continuing medical education cultural competence curriculum.

    Science.gov (United States)

    Estrada, Carlos A; Krishnamoorthy, Periyakaruppan; Smith, Ann; Staton, Lisa; Korf, Michele J; Allison, Jeroan J; Houston, Thomas K

    2011-01-01

    CME providers may be interested in identifying effective marketing strategies to direct users to specific content. Online advertisements for recruiting participants into activities such as clinical trials, public health programs, and continuing medical education (CME) have been effective in some but not all studies. The purpose of this study was to compare the impact of 2 marketing strategies in the context of an online CME cultural competence curriculum (www.c-comp.org). In an interrupted time-series quasi-experimental design, 2 marketing strategies were tested: (1) wide dissemination to relevant organizations over a period of approximately 4 months, and (2) Internet paid search using Google Ads (5 consecutive 8-week periods--control 1, cultural/CME advertisement, control 2, hypertension/ content advertisement, control 3). Outcome measures were CME credit requests, Web traffic (visits per day, page views, pages viewed per visit), and cost. Overall, the site was visited 19,156 times and 78,160 pages were viewed. During the wide dissemination phase, the proportion of visits requesting CME credit decreased between the first (5.3%) and second (3.3%) halves of this phase (p = .04). During the Internet paid search phase, the proportion of visits requesting CME credit was highest during the cultural/CME advertisement period (control 1, 1.4%; cultural/CME ad, 4.3%; control 2, 1.5%; hypertension/content ad, 0.6%; control 3, 0.8%; p advertisement periods. The incremental cost for the cultural advertisement per CME credit requested was US $0.64. Internet advertisement focusing on cultural competence and CME was associated with about a threefold increase in requests for CME credit at an incremental cost of under US $1; however, Web traffic changes were independent of the advertisement strategy. Copyright © 2011 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical

  20. Can outcome-based continuing medical education improve performance of immigrant physicians?

    Science.gov (United States)

    Castel, Orit Cohen; Ezra, Vered; Alperin, Mordechai; Nave, Rachel; Porat, Tamar; Golan, Avivit Cohen; Vinker, Shlomo; Karkabi, Khaled

    2011-01-01

    Immigrant physicians are a valued resource for physician workforces in many countries. Few studies have explored the education and training needs of immigrant physicians and ways to facilitate their integration into the health care system in which they work. Using an educational program developed for immigrant civilian physicians working in military primary care clinics at the Israel Defence Force, we illustrate how an outcome-based CME program can address practicing physicians' needs for military-specific primary care education and improve patient care. Following an extensive needs assessment, a 3-year curriculum was developed. The curriculum was delivered by a multidisciplinary educational team. Pre/post multiple-choice examinations, objective structured clinical examinations (OSCE), and end-of-program evaluations were administered for curriculum evaluation. To evaluate change in learners' performance, data from the 2003 (before-program) and 2006 (after-program) work-based assessments were retrieved retrospectively. Change in the performance of program participants was compared with that of immigrant physicians who did not participate in the program. Out of 28 learners, 23 (82%) completed the program. Learners did significantly better in the annual post-tests compared with the pretests (p educators, facing the challenge of integrating immigrant physicians to fit their health care system, may consider adapting our approach. Copyright © 2011 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

  1. Continuing medical education effect on physician knowledge application and psychomotor skills: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.

    Science.gov (United States)

    O'Neil, Kevin M; Addrizzo-Harris, Doreen J

    2009-03-01

    Recommendations for optimizing continuing medical education (CME) effectiveness in improving physician application of knowledge and psychomotor skills are needed to guide the development of processes that effect physician change and improve patient care. The guideline panel reviewed evidence tables and a comprehensive review of the effectiveness of CME developed by The Johns Hopkins Evidence-based Practice Center for the Agency for Healthcare Research and Quality (AHRQ Evidence Report). The panel considered studies relevant to the effect of CME on physician knowledge application and psychomotor skill development. From the 136 studies identified in the systematic review, 15 articles, 12 addressing physician application of knowledge and 3 addressing psychomotor skills, were identified and reviewed. Recommendations for optimizing CME were developed using the American College of Chest Physicians guideline grading system. The preponderance of evidence demonstrated improvement in physician application of knowledge with CME. The quality of evidence did not allow specific recommendations regarding optimal media or educational techniques or the effectiveness of CME in improving psychomotor skills. CME is effective in improving physician application of knowledge. Multiple exposures and longer durations of CME are recommended to optimize educational outcomes.

  2. 20 CFR 10.332 - What additional medical information will OWCP require to support continuing payment of benefits?

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false What additional medical information will OWCP require to support continuing payment of benefits? 10.332 Section 10.332 Employees' Benefits OFFICE OF... COMPENSATION UNDER THE FEDERAL EMPLOYEES' COMPENSATION ACT, AS AMENDED Medical and Related Benefits Medical...

  3. Continuing interprofessional education in geriatrics and gerontology in medically underserved areas.

    Science.gov (United States)

    Toner, John A; Ferguson, K Della; Sokal, Regina Davis

    2009-01-01

    There is a widening gap between the health care needs of older persons and the treatment skills of the health care professionals who serve them. This gap is especially severe in rural areas, where there is a shortage of and inadequate collaboration between health care professionals and poor access to services for older persons. There is also a special opportunity in rural areas, particularly those designated as "medically underserved," for continuing interprofessional education as a vehicle for retaining health care professionals who tend to leave medically underserved areas for more lucrative professional opportunities elsewhere. In collaboration with the Consortium of New York Geriatric Education Centers, the Columbia-New York Geriatric Education Center at the Stroud Center of Columbia University has developed the Program for Outreach to Interprofessional Services and Education (POISE). The purpose of POISE is to develop, implement, evaluate, and sustain interprofessional education and training for health care learners, while emphasizing improved access to health services for the geriatric population in medically underserved areas. The POISE model was designed as an effective approach to teaching the core geriatrics and gerontology curriculum endorsed by the national (U.S. Department of Health and Human Services) network of Geriatric Education Centers to health care learners in medically underserved areas of upstate New York. This article describes the adaptation and implementation of the POISE model.

  4. Ignatius of Loyola on medical education. Or: Should today's Jesuits continue to run health sciences schools?

    Science.gov (United States)

    Welie, Jos V M

    2003-01-01

    There are present 28 Jesuit colleges and universities in the United States, which together offer more than 50 health sciences degree programs. But as the Society's membership is shrinking and the financial risks involved in sponsoring health sciences education are rising, the question arises whether the Society should continue to sponsor health sciences degree programs. In fact, at least eight Jesuit health sciences schools have already closed their doors. This paper attempts to contribute to the resolution of this urgent question by reexamining Ignatius own views on health sciences education and, more specifically, his prohibition of the Society's sponsoring medical education. It concludes on the basis of an historical analysis of Ignatius' views that there is insufficient support for today's Jesuits to maintain their engagement in medical and health care education.

  5. Definition of information technology architectures for continuous data management and medical device integration in diabetes.

    Science.gov (United States)

    Hernando, M Elena; Pascual, Mario; Salvador, Carlos H; García-Sáez, Gema; Rodríguez-Herrero, Agustín; Martínez-Sarriegui, Iñaki; Gómez, Enrique J

    2008-09-01

    The growing availability of continuous data from medical devices in diabetes management makes it crucial to define novel information technology architectures for efficient data storage, data transmission, and data visualization. The new paradigm of care demands the sharing of information in interoperable systems as the only way to support patient care in a continuum of care scenario. The technological platforms should support all the services required by the actors involved in the care process, located in different scenarios and managing diverse information for different purposes. This article presents basic criteria for defining flexible and adaptive architectures that are capable of interoperating with external systems, and integrating medical devices and decision support tools to extract all the relevant knowledge to support diabetes care.

  6. Mining reflective continuing medical education data for family physician learning needs.

    Science.gov (United States)

    Lewis, Denice Colleen; Pluye, Pierre; Rodriguez, Charo; Grad, Roland

    2016-04-06

    A mixed methods research (sequential explanatory design) studied the potential of mining the data from the consumers of continuing medical education (CME) programs, for the developers of CME programs. The quantitative data generated by family physicians, through applying the information assessment method to CME content, was presented to key informants from the CME planning community through a qualitative description study.The data were revealed to have many potential applications including supporting the creation of CME content, CME program planning and personal learning portfolios.

  7. [The workplace-based learning: a main paradigm of an effective continuing medical education].

    Science.gov (United States)

    Lelli, Maria Barbara

    2010-01-01

    On the strength of the literature analysis and the Emilia-Romagna Region experience, we suggest a reflection on the workplace-based learning that goes beyond the analysis of the effectiveness of specific didactic methodologies and aspects related to Continuing Medical Education. Health education and training issue is viewed from a wider perspective, that integrates the three learning dimensions (formal, non formal and informal). In such a perspective the workplace-based learning becomes an essential paradigm to reshape the explicit knowledge conveyed in formal context and to emphasize informal contexts where innovation is generated.

  8. Expanding Continuous Quality Improvement Capacity in the Medical Intensive Care Unit: Prehealth Volunteers as a Solution.

    Science.gov (United States)

    Priest, Kelsey C; Lobingier, Hannah; McCully, Nancy; Lombard, Jackie; Hansen, Mark; Uchiyama, Makoto; Hagg, Daniel S

    2016-01-01

    Health care delivery systems are challenged to support the increasing demands for improving patient safety, satisfaction, and outcomes. Limited resources and staffing are common barriers for making significant and sustained improvements. At Oregon Health & Science University, the medical intensive care unit (MICU) leadership team faced internal capacity limitations for conducting continuous quality improvement, specifically for the implementation and evaluation of the mobility portion of an evidence-based care bundle. The MICU team successfully addressed this capacity challenge using the person power of prehealth volunteers. In the first year of the project, 52 trained volunteers executed an evidence-based mobility intervention for 305 critically ill patients, conducting more than 200 000 exercise repetitions. The volunteers contributed to real-time evaluation of the project, with the collection of approximately 26 950 process measure data points. Prehealth volunteers are an untapped resource for effectively expanding internal continuous quality improvement capacity in the MICU and beyond.

  9. [Evaluation of continuing medical training in private sector French cardiologists in 1999].

    Science.gov (United States)

    Thébaut, J F; Chabot, J M; Durand, J P; Childs, M; Assouline, S; Breton, C; Fraboulet, J Y; Sebaoun, A; Aviérinos, C

    2001-09-01

    The authors present the results of a retrospective national enquiry which took place in 1999 and was mailed and faxed to the 3,800 cardiologists practising in the private sector in order to assess the different types of continuous, individual and collective postgraduate training which they had benefited from in the preceding 12 months. The data was analysed by comparison with that obtained from an individualized representative sample in a panel of private sector cardiologists. The results were then compared with the criteria of a yardstick proposed by the National Committee of Continuous Medical Education of 1997, according to the April 25th 1996 decree. The meeting of these criteria would require carrying out 114,000 to 76,000 hour-equivalents of continuous education whereas the present offer is about 100,000 hour-equivalents. The different forms of individual or collective training were compared in the 327 questionnaires which were exploitable following adhesion to the French Society of Cardiology, to the Cardiologists' Union, to local cardiological societies, by age, gender and type of practice. The average number of annual hours of collective education was 52.2 +/- 60.1 hours (25% quartile = 25 hours, 75% = 60 hours). The average value of hours of individual education was 89.7 +/- 89.3 hours (25% quartile = 25 hours; 75% = 120 hours). This evaluation indicates that about 15% of cardiologists practising in the private sector have inadequate continuous medical education and that 68% would satisfy the criteria laid down in 1997. Moreover, the present offer would seem to be adequate providing the criteria of accreditation have been met.

  10. Influence of Continuing Medical Education on Rheumatologists' Performance on National Quality Measures for Rheumatoid Arthritis.

    Science.gov (United States)

    Sapir, Tamar; Rusie, Erica; Greene, Laurence; Yazdany, Jinoos; Robbins, Mark L; Ruderman, Eric M; Carter, Jeffrey D; Patel, Barry; Moreo, Kathleen

    2015-12-01

    In recent years researchers have reported deficits in the quality of care provided to patients with rheumatoid arthritis (RA), including low rates of performance on quality measures. We sought to determine the influence of a quality improvement (QI) continuing education program on rheumatologists' performance on national quality measures for RA, along with other measures aligned with National Quality Strategy priorities. Performance was assessed through baseline and post-education chart audits. Twenty community-based rheumatologists across the United States were recruited to participate in the QI education program and chart audits. Charts were retrospectively audited before (n = 160 charts) and after (n = 160 charts) the rheumatologists participated in a series of accredited QI-focused educational activities that included private audit feedback, small-group webinars, and online- and mobile-accessible print and video activities. The charts were audited for patient demographics and the rheumatologists' documented performance on the 6 quality measures for RA included in the Physician Quality Reporting System (PQRS). In addition, charts were abstracted for documentation of patient counseling about medication benefits/risks and adherence, lifestyle modifications, and quality of life; assessment of RA medication side effects; and assessment of RA medication adherence. Mean rates of documented performance on 4 of the 6 PQRS measures for RA were significantly higher in the post-education versus baseline charts (absolute increases ranged from 9 to 24% of patient charts). In addition, after the intervention, significantly higher mean rates were observed for patient counseling about medications and quality of life, and for assessments of medication side effects and adherence (absolute increases ranged from 9 to 40% of patient charts). This pragmatic study provides preliminary evidence for the positive influence of QI-focused education in helping rheumatologists improve

  11. Competency-based medical education and continuing professional development: A conceptualization for change.

    Science.gov (United States)

    Lockyer, Jocelyn; Bursey, Ford; Richardson, Denyse; Frank, Jason R; Snell, Linda; Campbell, Craig

    2017-06-01

    Competency-based medical education (CBME) is as important in continuing professional development (CPD) as at any other stage of a physician's career. Principles of CBME have the potential to revolutionize CPD. Transitioning to CBME-based CPD will require a cultural change to gain commitment from physicians, their employers and institutions, CPD providers, professional organizations, and medical regulators. It will require learning to be aligned with professional and workplace standards. Practitioners will need to develop the expertise to systematically examine their own clinical performance data, identify performance improvement opportunities and possibilities, and develop a plan to address areas of concern. Health care facilities and systems will need to produce data on a regular basis and to develop and train CPD educators who can work with physician groups. Stakeholders, such as medical regulatory authorities who are responsible for licensing physicians and other standard-setting bodies that credential and develop maintenance-of-certification systems, will need to change their paradigm of competency enhancement through CPD.

  12. Medical Surveillance, Continuous Health Promotion and a Participatory Intervention in a Small Company

    Directory of Open Access Journals (Sweden)

    Nicola Magnavita

    2018-04-01

    Full Text Available The workplace is an ideal setting for health promotion. The regular medical examination of workers enables us to screen for numerous diseases, spread good practices and correct lifestyles, and obtain a favourable risk/benefit ratio. The continuous monitoring of the level of workers’ wellbeing using a holistic approach during medical surveillance enables us to promptly identify problems in work organisation and the company climate. Problems of this kind can be adequately managed by using a participatory approach. The aim of this paper is twofold: to signal this way of proceeding with medical surveillance, and to describe an organisational development intervention. Participatory groups were used to improve occupational life in a small company. After intervention we observed a reduction in levels of perceived occupational stress measured with the Effort/Reward Imbalance questionnaire, and an improvement in psychological wellbeing assessed by means of the Goldberg Anxiety/Depression scale. Although the limited size of the sample and the lack of a control group call for a cautious evaluation of this study, the participatory strategy proved to be a useful tool due to its cost-effectiveness.

  13. Application of international videoconferences for continuing medical education programs related to laparoscopic surgery.

    Science.gov (United States)

    Huang, Ke-Jian; Cen, Gang; Qiu, Zheng-Jun; Jiang, Tao; Cao, Jun; Fu, Chun-Yu

    2014-02-01

    Continuing medical education (CME) is an effective way for practicing physicians to acquire up-to-date clinical information. We conducted four CME seminars in 2007-2010 endorsed by the Chinese Medical Association Council on Medical Education. Overseas telelectures and live case demonstrations were introduced in each seminar via telemedicine based on a digital video transport system. Network stability and packet loss were recorded. An anonymous mini-questionnaire was conducted to evaluate the satisfaction of attendees regarding the image and sound quality, content selection, and overall evaluation. Four telelectures and five live case demonstrations were successfully conducted. Stability of the network was maintained during each videoconference. High-quality videos of 720 × 480 pixels at the rate of 30 frames per second were shown to the entire group of attendees. The time delay between Shanghai and Fukuoka, Japan, was only 0.3 s, and the packet loss was 0%. We obtained 129 valid responses to the mini-questionnaire from a total of 146 attendees. The majority of the attendees were satisfied with the quality of transmitted images and voices and with the selected contents. The overall evaluation was ranked as excellent or good. Videoconferences are excellent channels for CME programs associated with laparoscopic training.

  14. Medical Surveillance, Continuous Health Promotion and a Participatory Intervention in a Small Company.

    Science.gov (United States)

    Magnavita, Nicola

    2018-04-02

    The workplace is an ideal setting for health promotion. The regular medical examination of workers enables us to screen for numerous diseases, spread good practices and correct lifestyles, and obtain a favourable risk/benefit ratio. The continuous monitoring of the level of workers' wellbeing using a holistic approach during medical surveillance enables us to promptly identify problems in work organisation and the company climate. Problems of this kind can be adequately managed by using a participatory approach. The aim of this paper is twofold: to signal this way of proceeding with medical surveillance, and to describe an organisational development intervention. Participatory groups were used to improve occupational life in a small company. After intervention we observed a reduction in levels of perceived occupational stress measured with the Effort/Reward Imbalance questionnaire, and an improvement in psychological wellbeing assessed by means of the Goldberg Anxiety/Depression scale. Although the limited size of the sample and the lack of a control group call for a cautious evaluation of this study, the participatory strategy proved to be a useful tool due to its cost-effectiveness.

  15. Adapting continuing medical education for post-conflict areas: assessment in Nagorno Karabagh - a qualitative study.

    Science.gov (United States)

    Balalian, Arin A; Simonyan, Hambardzum; Hekimian, Kim; Crape, Byron

    2014-08-06

    One of the major challenges in the current century is the increasing number of post-conflict states where infrastructures are debilitated. The dysfunctional health care systems in post-conflict settings are putting the lives of the populations in these zones at increased risk. One of the approaches to improve such situations is to strengthen human resources by organizing training programmes to meet the special needs in post-conflict zones. Evaluations of these training programmes are essential to assure effectiveness and adaptation to the health service needs in these conditions. A specialized qualitative evaluation was conducted to assess and improve a post-conflict continuing medical education (CME) programme that was conducted in Nagorno Karabagh. Qualitative research guides were designed for this post-conflict zone that included focus group discussions with physician programme participants and semi-structured in-depth interviews with directors of hospitals and training supervisors. Saturation was achieved among the three participating groups in the themes of impact of participation in the CME and obstacles to application of obtained skills. All respondents indicated that the continuing medical education programme created important physician networks absent in this post-conflict zone, updated professional skills, and improved professional confidence among participants. However, all respondents indicated that some skills gained were inapplicable in Nagorno Karabagh hospitals and clinics due to lack of appropriate medical equipment, qualified supporting human resources and facilities. The qualitative research methods evaluation highlighted the fact that the health care human resources training should be closely linked to appropriate technologies, supplies, facilities and human resources available in post-conflict zones and identified the central importance of creating health professional networks and professional confidence among physicians in these zones. The

  16. Promoting networks between evidence-based medicine and values-based medicine in continuing medical education.

    Science.gov (United States)

    Altamirano-Bustamante, Myriam M; Altamirano-Bustamante, Nelly F; Lifshitz, Alberto; Mora-Magaña, Ignacio; de Hoyos, Adalberto; Avila-Osorio, María Teresa; Quintana-Vargas, Silvia; Aguirre, Jorge A; Méndez, Jorge; Murata, Chiharu; Nava-Diosdado, Rodrigo; Martínez-González, Oscar; Calleja, Elisa; Vargas, Raúl; Mejía-Arangure, Juan Manuel; Cortez-Domínguez, Araceli; Vedrenne-Gutiérrez, Fernand; Sueiras, Perla; Garduño, Juan; Islas-Andrade, Sergio; Salamanca, Fabio; Kumate-Rodríguez, Jesús; Reyes-Fuentes, Alejandro

    2013-02-15

    In recent years, medical practice has followed two different paradigms: evidence-based medicine (EBM) and values-based medicine (VBM). There is an urgent need to promote medical education that strengthens the relationship between these two paradigms. This work is designed to establish the foundations for a continuing medical education (CME) program aimed at encouraging the dialogue between EBM and VBM by determining the values relevant to everyday medical activities. A quasi-experimental, observational, comparative, prospective and qualitative study was conducted by analyzing through a concurrent triangulation strategy the correlation between healthcare personnel-patient relationship, healthcare personnel's life history, and ethical judgments regarding dilemmas that arise in daily clinical practice.In 2009, healthcare personnel working in Mexico were invited to participate in a free, online clinical ethics course. Each participant responded to a set of online survey instruments before and after the CME program. Face-to-face semi-structured interviews were conducted with healthcare personnel, focusing on their views and representations of clinical practice. The healthcare personnel's core values were honesty and respect. There were significant differences in the clinical practice axiology before and after the course (P ethical discernment, the CME program had an impact on autonomy (P ≤0.0001). Utilitarian autonomy was reinforced in the participants (P ≤0.0001). Regarding work values, significant differences due to the CME intervention were found in openness to change (OC) (P ethical discernment and healthcare personnel-patient relation were beneficence, respect and compassion, respectively. The healthcare personnel participating in a CME intervention in clinical ethics improved high-order values: Openness to change (OC) and Self Transcendence (ST), which are essential to fulfilling the healing ends of medicine. The CME intervention strengthened the role of

  17. Validation of a Teaching Effectiveness Assessment in Psychiatry Continuing Medical Education.

    Science.gov (United States)

    Palmer, Brian A; Frye, Mark A; Vickers Douglas, Kristin S; Staab, Jeffrey P; Bright, Robert P; Schleck, Cathy D; Mandrekar, Jayawant N; Mahapatra, Saswati; Beckman, Thomas J; Wittich, Christopher M

    2017-07-06

    Little is known about factors associated with effective continuing medical education (CME) in psychiatry. The authors aimed to validate a method to assess psychiatry CME teaching effectiveness and to determine associations between teaching effectiveness scores and characteristics of presentations, presenters, and participants. This cross-sectional study was conducted at the Mayo Clinic Psychiatry Clinical Reviews and Psychiatry in Medical Settings. Presentations were evaluated using an eight-item CME teaching effectiveness instrument, its content based on previously published instruments. Factor analysis, internal consistency and interrater reliabilities, and temporal stability reliability were calculated. Associations were determined between teaching effectiveness scores and characteristics of presentations, presenters, and participants. In total, 364 participants returned 246 completed surveys (response rate, 67.6%). Factor analysis revealed a unidimensional model of psychiatry CME teaching effectiveness. Cronbach α for the instrument was excellent at 0.94. Item mean score (SD) ranged from 4.33 (0.92) to 4.71 (0.59) on a 5-point scale. Overall interrater reliability was 0.84 (95% CI, 0.75-0.91), and temporal stability was 0.89 (95% CI, 0.77-0.97). No associations were found between teaching effectiveness scores and characteristics of presentations, presenters, and participants. This study provides a new, validated measure of CME teaching effectiveness that could be used to improve psychiatry CME. In contrast to prior research in other medical specialties, CME teaching effectiveness scores were not associated with use of case-based or interactive presentations. This outcome suggests the need for distinctive considerations regarding psychiatry CME; a singular approach to CME teaching may not apply to all medical specialties.

  18. Measuring patient-centered medical home access and continuity in clinics with part-time clinicians.

    Science.gov (United States)

    Rosland, Ann-Marie; Krein, Sarah L; Kim, Hyunglin Myra; Greenstone, Clinton L; Tremblay, Adam; Ratz, David; Saffar, Darcy; Kerr, Eve A

    2015-05-01

    Common patient-centered medical home (PCMH) performance measures value access to a single primary care provider (PCP), which may have unintended consequences for clinics that rely on part-time PCPs and team-based care. Retrospective analysis of 110,454 primary care visits from 2 Veterans Health Administration clinics from 2010 to 2012. Multi-level models examined associations between PCP availability in clinic, and performance on access and continuity measures. Patient experiences with access and continuity were compared using 2012 patient survey data (N = 2881). Patients of PCPs with fewer half-day clinic sessions per week were significantly less likely to get a requested same-day appointment with their usual PCP (predicted probability 17% for PCPs with 2 sessions/week, 20% for 5 sessions/week, and 26% for 10 sessions/week). Among requests that did not result in a same-day appointment with the usual PCP, there were no significant differences in same-day access to a different PCP, or access within 2 to 7 days with patients' usual PCP. Overall, patients had >92% continuity with their usual PCP at the hospital-based site regardless of PCP sessions/week. Patients of full-time PCPs reported timely appointments for urgent needs more often than patients of part-time PCPs (82% vs 71%; P Part-time PCP performance appeared worse when using measures focused on same-day access to patients' usual PCP. However, clinic-level same-day access, same-week access to the usual PCP, and overall continuity were similar for patients of part-time and full-time PCPs. Measures of in-person access to a usual PCP do not capture alternate access approaches encouraged by PCMH, and often used by part-time providers, such as team-based or non-face-to-face care.

  19. Assessing the impact of a medical librarian on identification of valid and actionable practice gaps for a continuing medical education committee.

    Science.gov (United States)

    Bartkowiak, Barbara A; Safford, Lindsey A; Stratman, Erik J

    2014-01-01

    Identifying educational needs related to professional practice gaps can be a complex process for continuing medical education (CME) committees and for physicians who submit activity applications. Medical librarians possess unique skills that may be useful for identifying practice gaps relevant to CME committees. We assessed this assumption by assessing a medical librarian's contributions to practice gap identification for the Marshfield Clinic's CME Committee. We reviewed all locally relevant, locally actionable practice gaps identified annually by various stakeholders and presented to our CME Committee from 2010 to 2013. Total numbers of practice gaps identified, total categorized as actionable, and numbers of subsequent activities resulting from these gaps were calculated for each year. Medical librarian totals were compared to those of other CME committee stakeholders to determine the relative contribution. The medical librarian identified unique, actionable published practice gaps that directly contributed to CME activity planning. For each study year, contributions by the medical librarian grew, from 0 of 27 actionable gaps validated by CME Committee in 2010 to 49 of 108 (45.4%) in 2013. With the librarian's assistance, the number of valid practice gaps submitted between 2010 and 2013 by stakeholders climbed from 23 for 155 activities (14.8%) to 133 for 157 activities (84.7%). Medical librarians can provide a valuable service to CME committees by identifying valid professional practice gaps that inform decisions about educational activities aimed at improving clinical practice. Medical librarians bring into deliberations unique information, including national health policy priorities, practice gaps found in the literature, and point-of-care search engine statistics. © 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for

  20. A tale of Congress, continuing medical education, and the history of medicine.

    Science.gov (United States)

    Partin, Clyde; Kushner, Howard I; Horton, Mary E Kollmer

    2014-04-01

    Well-intentioned attempts by the Senate Finance Committee to improve the content and quality of continuing medical education (CME) offerings had the unanticipated consequence of decimating academically oriented history of medicine conferences. New guidelines intended to keep CME courses free of commercial bias from the pharmaceutical industry were worded in a fashion that caused CME officials at academic institutions to be reluctant to offer CME credit for history of medicine gatherings. At the 2013 annual conference of the American Association for the History of Medicine, we offered a novel solution for determining CME credit in line with current guidelines. We asked attendees to provide narrative critiques for each presentation for which they desired CME credit. In this essay, we evaluate the efficacy of this approach.

  1. Effectiveness of e-learning in continuing medical education for occupational physicians.

    Science.gov (United States)

    Hugenholtz, Nathalie I R; de Croon, Einar M; Smits, Paul B; van Dijk, Frank J H; Nieuwenhuijsen, Karen

    2008-08-01

    Within a clinical context e-learning is comparable to traditional approaches of continuing medical education (CME). However, the occupational health context differs and until now the effect of postgraduate e-learning among occupational physicians (OPs) has not been evaluated. To evaluate the effect of e-learning on knowledge on mental health issues as compared to lecture-based learning in a CME programme for OPs. Within the context of a postgraduate meeting for 74 OPs, a randomized controlled trial was conducted. Test assessments of knowledge were made before and immediately after an educational session with either e-learning or lecture-based learning. In both groups, a significant gain in knowledge on mental health care was found (P effect of e-learning on OPs' mental health care knowledge is comparable to a lecture-based approach. Therefore, e-learning can be beneficial for the CME of OPs.

  2. Study of relation of continuing medical education to quality of family physicians' care.

    Science.gov (United States)

    Dunn, E V; Bass, M J; Williams, J I; Borgiel, A E; MacDonald, P; Spasoff, R A

    1988-10-01

    A random sample of 120 physicians in Ontario was studied to assess quality of care in primary care and test an hypothesis that quality of care was related to continuing medical education (CME) activities. The quality-of-care scores were obtained by an in-office audit of a random selection of charts. The scores were global scores for charting, prevention, the use of 13 classes of drugs, and care of a two-year period for 182 different diagnoses. There were no relationships between global quality-of-care scores based on these randomly chosen charts and either the type or quantity of the physicians' CME activities. These activities were reading journals, attending rounds, attending scientific conferences, having informal consultations, using audio and video cassettes, and engaging in self-assessment. The implications of these findings are significant for future research in CME and for planners of present CME programs.

  3. Evaluating online continuing medical education seminars: evidence for improving clinical practices.

    Science.gov (United States)

    Weston, Christine M; Sciamanna, Christopher N; Nash, David B

    2008-01-01

    The purpose of this study was to evaluate the potential for online continuing medical education (CME) seminars to improve quality of care. Primary care physicians (113) participated in a randomized controlled trial to evaluate an online CME series. Physicians were randomized to view either a seminar about type 2 diabetes or a seminar about systolic heart failure. Following the seminar, physicians were presented with 4 clinical vignettes and asked to describe what tests, treatments, counseling, or referrals they would recommend. Physicians who viewed the seminars were significantly more likely to recommend guideline-consistent care to patients in the vignettes. For example, physicians who viewed the diabetes seminar were significantly more likely to order an eye exam for diabetes patients (63%) compared with physicians in the control group (27%). For some guidelines there were no group differences. These results provide early evidence of the effectiveness of online CME programs to improve physician clinical practice.

  4. Online continuing medical education (CME) for GPs: does it work? A systematic review.

    Science.gov (United States)

    Thepwongsa, Isaraporn; Kirby, Catherine N; Schattner, Peter; Piterman, Leon

    2014-10-01

    Numerous studies have assessed the effectiveness of online continuing medical education (CME) designed to improve healthcare professionals' care of patients. The effects of online educational interventions targeted at general practitioners (GP), however, have not been systematically reviewed. A computer search was conducted through seven databases for studies assessing changes in GPs' knowledge and practice, or patient outcomes following an online educational intervention. Eleven studies met the eligibility criteria. Most studies (8/11, 72.7%) found a significant improvement in at least one of the following outcomes: satisfaction, knowledge or practice change. There was little evidence for the impact of online CME on patient outcomes. Variability in study design, characteristics of online and outcome measures limited conclusions on the effects of online CME. Online CME could improve GP satisfaction, knowledge and practices but there are very few well-designed studies that focus on this delivery method of GP education.

  5. Continuously Operating Biosensor and Its Integration into a Hermetically Sealed Medical Implant

    Directory of Open Access Journals (Sweden)

    Mario Birkholz

    2016-10-01

    Full Text Available An integration concept for an implantable biosensor for the continuous monitoring of blood sugar levels is presented. The system architecture is based on technical modules used in cardiovascular implants in order to minimize legal certification efforts for its perspective usage in medical applications. The sensor chip operates via the principle of affinity viscometry, which is realized by a fully embedded biomedical microelectromechanical systems (BioMEMS prepared in 0.25-µm complementary metal–oxide–semiconductor (CMOS/BiCMOS technology. Communication with a base station is established in the 402–405 MHz band used for medical implant communication services (MICS. The implant shall operate within the interstitial tissue, and the hermetical sealing of the electronic system against interaction with the body fluid is established using titanium housing. Only the sensor chip and the antenna are encapsulated in an epoxy header closely connected to the metallic housing. The study demonstrates that biosensor implants for the sensing of low-molecular-weight metabolites in the interstitial may successfully rely on components already established in cardiovascular implantology.

  6. Information technology and its role in anaesthesia training and continuing medical education.

    Science.gov (United States)

    Chu, Larry F; Erlendson, Matthew J; Sun, John S; Clemenson, Anna M; Martin, Paul; Eng, Reuben L

    2012-03-01

    Today's educators are faced with substantial challenges in the use of information technology for anaesthesia training and continuing medical education. Millennial learners have uniquely different learning styles than previous generations of students. These preferences distinctly incorporate the use of digital information technologies and social technologies to support learning. To be effective teachers, modern educators must be familiar with these new information technologies and understand how to use them for medical education. Examples of new information technologies include learning management systems, lecture capture, social media (YouTube, Flickr), social networking (Facebook), Web 2.0, multimedia (video learning triggers and point-of-view video) and mobile computing applications. The information technology challenges for educators in the twenty-first century include: (a) understanding how technology shapes the learning preferences of today's anaesthesia residents, (b) distinguishing between the function and properties of new learning technologies and (c) properly using these learning technologies to enhance the anaesthesia curriculum. Copyright © 2012 Elsevier Ltd. All rights reserved.

  7. eLearning: a review of Internet-based continuing medical education.

    Science.gov (United States)

    Wutoh, Rita; Boren, Suzanne Austin; Balas, E Andrew

    2004-01-01

    The objective was to review the effect of Internet-based continuing medical education (CME) interventions on physician performance and health care outcomes. Data sources included searches of MEDLINE (1966 to January 2004), CINAHL (1982 to December 2003), ACP Journal Club (1991 to July/August 2003), and the Cochrane Database of Systematic Reviews (third quarter, 2003). Studies were included in the analyses if they were randomized controlled trials of Internet-based education in which participants were practicing health care professionals or health professionals in training. CME interventions were categorized according to the nature of the intervention, sample size, and other information about educational content and format. Sixteen studies met the eligibility criteria. Six studies generated positive changes in participant knowledge over traditional formats; only three studies showed a positive change in practices. The remainder of the studies showed no difference in knowledge levels between Internet-based interventions and traditional formats for CME. The results demonstrate that Internet-based CME programs are just as effective in imparting knowledge as traditional formats of CME. Little is known as to whether these positive changes in knowledge are translated into changes in practice. Subjective reports of change in physician behavior should be confirmed through chart review or other objective measures. Additional studies need to be performed to assess how long these new learned behaviors could be sustained. eLearning will continue to evolve as new innovations and more interactive modes are incorporated into learning.

  8. Continuous professional competence (CPC) for emergency medical technicians in Ireland: educational needs assessment.

    Science.gov (United States)

    Knox, Shane; Cullen, Walter; Dunne, Colum

    2013-12-17

    As in other countries, the Irish Regulator for Pre-Hospital practitioners, the Pre-Hospital Emergency Care Council (PHECC), will introduce a Continuous Professional Competence (CPC) framework for all Emergency Medical Technicians (EMTs), Paramedics and Advanced Paramedics (APs). This framework involves EMTs participating in regular and structured training to maintain professional competence and enable continuous professional developments. To inform the development of this framework, this study aimed to identify what EMTs consider the optimum educational outcomes and activity and their attitude towards CPC. All EMTs registered in Ireland (n = 925) were invited via email to complete an anonymous online survey. Survey questions were designed based on Continuous Professional Development (CPD) questionnaires used by other healthcare professions. Quantitative and qualitative analyses were performed. Response rate was 43% (n = 399). 84% of participants had been registered in Ireland for less than 24 months, while 59% had been registered EMTs for more than one year. Outcomes were: evidence of CPC should be a condition for EMT registration in Ireland (95%), 78% believed that EMTs who do not maintain CPC should be denied the option to re-register. Although not required to do so at the time of survey, 69% maintained a professional portfolio and 24% had completed up to 20 hours of CPC activities in the prior 12 months. From a list of 22 proposed CPC activities, 97% stated that practical scenario-based exercises were most relevant to their role. E-learning curricula without practical components were considered irrelevant (32%), but the majority of participants (91%) welcomed access to e-learning when supplemented by related practical modules. EMTs are supportive of CPC as a key part of their professional development and registration. Blended learning, which involves clinical and practical skills and e-learning, is the optimum approach.

  9. Continuing medical education in Serbia with particular reference to the Faculty of Medicine, Belgrade.

    Science.gov (United States)

    Bjegović-Mikanović, Vesna; Lalić, Nebojia; Wenzelt, Helmut; Nikolid-Mandić, Ruzica; Laaser, Ulrich

    2015-02-01

    Continuing Medical Education (CME), conceptualised as lifelong learning (LLL) aims at improving human resources and continuing professional development. Various documents of European institutions underline its key importance. This paper therefore tries to analyse the current status of CME and the main deficits in the delivery of LLL courses at medical faculties in Serbia with special consideration of the Faculty of Medicine in Belgrade with detailed financial data available. Data of 2,265 medical courses submitted in 2011 and 2012 for accredita- tion were made available, thereof 403 courses submitted by 4 medical faculties in Serbia (Belgrade, Kragujevac, Nil, Novi Sad). A subset of more detailed information on 88 delivered courses with 5,600 participants has been provided by the Faculty of Medicine, Belgrade. All data were transferred into an Excel file and analysed with XLSTAT 2009. To reduce the complexity and possible redundancy we performed a principal component analysis (PCA). Correlated component regression (CCR) models were used to identify determinants of course participation. During the 2-year period 12.9% of all courses were submitted on pre-clinical and 62.4% on clinical topics, 12.2% on public health, while 61.5% of all took place in Belgrade. The subset of the Faculty of Medicine, Belgrade comprised 3,471 participants registered with 51 courses accredited and delivered in 2011 and 2,129 participants with 37 courses accredited and delivered in 2012. The median number of participants per course for the entire period was 45; the median fee rates for participants were 5,000 dinars in 2011 and 8,000 in 2012, resulting together with donations--in a total income for both years together of 16,126,495.00 dinar or almost 144,000.00 euro. This allowed for a median payment of approximately 90 eur per hour lectured in 2011 and 49 euro in 2012. The 2 factors, D1 (performance) and D2 (attractiveness), identified in the PCA for Medical Faculties in Serbia, explain 71

  10. Continuing medical education in Serbia with particular reference to the Faculty of Medicine, Belgrade

    Directory of Open Access Journals (Sweden)

    Bjegović-Mikanović Vesna

    2015-01-01

    Full Text Available Background/Aim. Continuing Medical Education (CME, conceptualised as lifelong learning (LLL aims at improving human resources and continuing professional development. Various documents of European institutions underline its key importance. This paper therefore tries to analyse the current status of CME and the main deficits in the delivery of LLL courses at medical faculties in Serbia with special consideration of the Faculty of Medicine in Belgrade with detailed financial data available. Methods. Data of 2,265 medical courses submitted in 2011 and 2012 for accreditation were made available, thereof 403 courses submitted by 4 medical faculties in Serbia (Belgrade, Kragujevac, Niš, Novi Sad. A subset of more detailed information on 88 delivered courses with 5,600 participants has been provided by the Faculty of Medicine, Belgrade. All data were transferred into an Excel file and analysed with XLSTAT 2009. To reduce the complexity and possible redundancy we performed a principal component analysis (PCA. Correlated component regression (CCR models were used to identify determinants of course participation. Results. During the 2-year period 12.9% of all courses were submitted on preclinical and 62.4% on clinical topics, 12.2% on public health, while 61.5% of all took place in Belgrade. The subset of the Faculty of Medicine, Belgrade comprised 3,471 participants registered with 51 courses accredited and delivered in 2011 and 2,129 participants with 37 courses accredited and delivered in 2012. The median number of participants per course for the entire period was 45; the median fee rates for participants were 5,000 dinars in 2011 and 8,000 in 2012, resulting together with donations in a total income for both years together of 16,126,495.00 dinar or almost 144,000.00 euro. This allowed for a median payment of approximately 90 eur per hour lectured in 2011 and 49 euro in 2012. The 2 factors, D1 (performance and D2 (attractiveness, identified in the PCA

  11. The effect of continuous pressure monitoring on strategic shifting of medical inpatients at risk for PUs.

    Science.gov (United States)

    Motamedi, S M; de Grood, J; Harman, S; Sargious, P; Baylis, B; Flemons, W; Ghali, W A

    2012-11-01

    To assess the impact of continuous pressure imaging technology on strategic turning of patients by health professionals. This pilot study of a newly-developed continuous pressure imaging technology (XSENSOR ForeSite PatientTurn System) involved two phases of videotaped observation of medical inpatients, with each patient serving as his/her own control: a control phase in which continuous pressure imaging was not available to health-care providers and an intervention phase where it was. The primary outcome was to determine whether access to the technology influenced the rate of patient turns/shifts by nursing staff. Secondary outcomes included a comparison of the rates of other care provider shifts, patient self-shifts, and family assisted shifts. Qualitative data regarding nurse and patient/family perspectives were also obtained. Complete control/intervention data were available for nine patients.The mean rate of two-person assisted turns was 0.274 +/- 0.087 turns per hour in the control phase versus 0.413 +/- 0.091 turns per hour in the intervention phase (p = 0.08). For the combined endpoint of two-person assisted turns or patient transfers off the bed into a wheelchair/chair, there was a statistically significant difference in the mean number of turns per hour: mean of 0.491 +/- 0.271 turns per hour for the intervention group versus 0.327 +/- 0.235 turns per hour for the control group (p = 0.04). Provider interviews confirmed that nurses used information from the technology to inform their patient shifting strategies and behaviours. This pilot study provides some initial data supporting the hypothesis that continuous pressure imaging technology could positively impact the frequency of patient turns by care providers, as well as provide impetus to inspect specific skin locations,thereby providing a potential targeted risk mitigation strategy for the development of pressure ulcers. Funding for the study was obtained from PreCarn Inc., an independent, nonprofit

  12. Associations between teaching effectiveness and participant self-reflection in continuing medical education.

    Science.gov (United States)

    Ratelle, John T; Bonnes, Sara L; Wang, Amy T; Mahapatra, Saswati; Schleck, Cathy D; Mandrekar, Jayawant N; Mauck, Karen F; Beckman, Thomas J; Wittich, Christopher M

    2017-07-01

    Effective medical educators can engage learners through self-reflection. However, little is known about the relationships between teaching effectiveness and self-reflection in continuing medical education (CME). We aimed to determine associations between presenter teaching effectiveness and participant self-reflection in conference-based CME. This cross-sectional study evaluated presenters and participants at a national CME course. Participants provided CME teaching effectiveness (CMETE) ratings and self-reflection scores for each presentation. Overall CMETE and CME self-reflection scores (five-point Likert scale with one as strongly disagree and five as strongly agree) were averaged for each presentation. Correlations were measured among self-reflection, CMETE, and presentation characteristics. In total, 624 participants returned 430 evaluations (response, 68.9%) for the 38 presentations. Correlation between CMETE and self-reflection was medium (Pearson correlation, 0.3-0.5) or large (0.5-1.0) for most presentations (n = 33, 86.9%). Higher mean (SD) CME reflection scores were associated with clinical cases (3.66 [0.12] vs. 3.48 [0.14]; p = 0.003) and audience response (3.66 [0.12] vs. 3.51 [0.14]; p = 0.005). To our knowledge, this is the first study to show a relationship between teaching effectiveness and participant self-reflection in conference-based CME. Presenters should consider using clinical cases and audience response systems to increase teaching effectiveness and promote self-reflection among CME learners.

  13. 3D medical image segmentation based on a continuous modelling of the volume

    International Nuclear Information System (INIS)

    Marque, I.

    1990-12-01

    Several medical imaging/techniques, including Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) provide 3D information of the human body by means of a stack of parallel cross-sectional images. But a more sophisticated edge detection step has to be performed when the object under study is not well defined by its characteristic density or when an analytical knowledge of the surface of the object is useful for later processings. A new method for medical image segmentation has been developed: it uses the stability and differentiability properties of a continuous modelling of the 3D data. The idea is to build a system of Ordinary Differential Equations which the stable manifold is the surface of the object we are looking for. This technique has been applied to classical edge detection operators: threshold following, laplacian, gradient maximum in its direction. It can be used in 2D as well as in 3D and has been extended to seek particular points of the surface, such as local extrema. The major advantages of this method are as follows: the segmentation and boundary following steps are performed simultaneously, an analytical representation of the surface is obtained straightforwardly and complex objects in which branching problems may occur can be described automatically. Simulations on noisy synthetic images have induced a quantization step to test the sensitiveness to noise of our method with respect to each operator, and to study the influence of all the parameters. Last, this method has been applied to numerous real clinical exams: skull or femur images provided by CT, MR images of a cerebral tumor and of the ventricular system. These results show the reliability and the efficiency of this new method of segmentation [fr

  14. Continuing Medical Education Needs Assessment of General Physicians Working at Tabriz Health Centers in 2014

    Directory of Open Access Journals (Sweden)

    Parisa Golanbar

    2014-12-01

    Full Text Available Introduction: The aim of this study was to identify the educational needs of General Physicians working in the health centers of Tabriz in 2014. Methods: The study method was descriptive. The statistical population was 2,024. Of the population of the study, 322 physicians were randomly selected. In order to gather the data, the Delphi method and a researcher-made questionnaire were used in 14 domains of medicine, including: Communicable and Infectious Diseases, Non-communicable Diseases, Health Education, Mental and Social Health, Dental and Oral Health, Medical Procedures, Population and Family, Nutritional Health, Occupational Health, Environmental Health, Complementary Procedures, Health Crisis and Disasters, Laboratory and Drugs, and Alternative Medicine. The validity of the study was confirmed with the viewpoint of the Delphi team and the reliability was confirmed with the Alpha Cronbach (r = 0.84. For data analysis, we used descriptive statistic methods like frequency, percentage and mean, and the Friedman ranking test (calculated using SPSS v. 21. Results: The results showed that the first-ranked educational needs of every domain were the following (in order of domain listed above: respiratory infection, hypertension, healthy lifestyle, stress management, dental growth and care in children, raising hope and pleasure, weight and nutritional control, occupational health and safety, water hygiene, cardiopulmonary resuscitation, therapeutic exercises, natural disasters’ primary cares, rational use of drugs and traditional medicine.Conclusion: The first domain receiving the first rank of educational needs was non-communicable diseases, and the conformity range of implemented plans in continuing medical education with need assessment results was 53.84%.

  15. State Variation in Medical Imaging: Despite Great Variation, the Medicare Spending Decline Continues.

    Science.gov (United States)

    Rosenkrantz, Andrew B; Hughes, Danny R; Duszak, Richard

    2015-10-01

    The purpose of this study was to assess state-level trends in per beneficiary Medicare spending on medical imaging. Medicare part B 5% research identifiable files from 2004 through 2012 were used to compute national and state-by-state annual average per beneficiary spending on imaging. State-to-state geographic variation and temporal trends were analyzed. National average per beneficiary Medicare part B spending on imaging increased 7.8% annually between 2004 ($350.54) and its peak in 2006 ($405.41) then decreased 4.4% annually between 2006 and 2012 ($298.63). In 2012, annual per beneficiary spending was highest in Florida ($367.25) and New York ($355.67) and lowest in Ohio ($67.08) and Vermont ($72.78). Maximum state-to-state geographic variation increased over time, with the ratio of highest-spending state to lowest-spending state increasing from 4.0 in 2004 to 5.5 in 2012. Spending in nearly all states decreased since peaks in 2005 (six states) or 2006 (43 states). The average annual decrease among states was 5.1% ± 1.8% (range, 1.2-12.2%) The largest decrease was in Ohio. In only two states did per beneficiary spending increase (Maryland, 12.5% average annual increase since 2005; Oregon, 4.8% average annual increase since 2008). Medicare part B average per beneficiary spending on medical imaging declined in nearly every state since 2005 and 2006 peaks, abruptly reversing previously reported trends. Spending continued to increase, however, in Maryland and Oregon. Identification of state-level variation may facilitate future investigation of the potential effect of specific and regional changes in spending on patient access and outcomes.

  16. Continuing professional development training needs of medical laboratory personnel in Botswana.

    Science.gov (United States)

    Kasvosve, Ishmael; Ledikwe, Jenny H; Phumaphi, Othilia; Mpofu, Mulamuli; Nyangah, Robert; Motswaledi, Modisa S; Martin, Robert; Semo, Bazghina-Werq

    2014-08-18

    Laboratory professionals are expected to maintain their knowledge on the most recent advances in laboratory testing and continuing professional development (CPD) programs can address this expectation. In developing countries, accessing CPD programs is a major challenge for laboratory personnel, partly due to their limited availability. An assessment was conducted among clinical laboratory workforce in Botswana to identify and prioritize CPD training needs as well as preferred modes of CPD delivery. A self-administered questionnaire was disseminated to medical laboratory scientists and technicians registered with the Botswana Health Professions Council. Questions were organized into domains of competency related to (i) quality management systems, (ii) technical competence, (iii) laboratory management, leadership, and coaching, and (iv) pathophysiology, data interpretation, and research. Participants were asked to rank their self-perceived training needs using a 3-point scale in order of importance (most, moderate, and least). Furthermore, participants were asked to select any three preferences for delivery formats for the CPD. Out of 350 questionnaires that were distributed, 275 were completed and returned giving an overall response rate of 79%. The most frequently selected topics for training in rank order according to key themes were (mean, range) (i) quality management systems, most important (79%, 74-84%); (ii) pathophysiology, data interpretation, and research (68%, 52-78%); (iii) technical competence (65%, 44-73%); and (iv) laboratory management, leadership, and coaching (60%, 37-77%). The top three topics selected by the participants were (i) quality systems essentials for medical laboratory, (ii) implementing a quality management system, and (iii) techniques to identify and control sources of error in laboratory procedures. The top three preferred CPD delivery modes, in rank order, were training workshops, hands-on workshops, and internet-based learning

  17. [Continuous medical education of general practitioners/family doctors in chronic wound care].

    Science.gov (United States)

    Sinozić, Tamara; Kovacević, Jadranka

    2014-10-01

    A number of healthcare professionals, specialists in different fields and with different levels of education, as well as non-healthcare professionals, are involved in the care of chronic wound patients, thus forming a multidisciplinary team that is not only responsible for the course and outcome of treatment, but also for the patient quality of life. Family doctor is also member of the team the task of which is to prevent, diagnose, monitor and anticipate complications and relapses, as well as complete recovery of chronic wound patients, with the overall care continuing even after the wound has healed, or is involved in palliative care. A family medicine practitioner with specialized education and their team of associates in the primary health care, along with material conditions and equipment improvement, can provide quality care for patients with peripheral cardiovascular diseases and chronic wounds, organized according to the holistic approach. It is essential that all professional associations of family medicine as well as professional associations of other specialties - fields that are involved in wound prevention and treatment - be included in developing the continuous medical education program. The benefits of modern information technology should be used to good advantage. The education should be adapted to the needs of family practitioners in terms of the form, place, time, volume, financial affordability and choice of topic. The interest shown in team education should be transformed into specialized programs in the creation of which it is essential to include both physicians and nurses and their respective professional associations. Special attention should be paid to education and training of young doctors/nurses, those with less work experience, those that have not yet been part of such education, those that lack experience in working with wound patients, those whose teams deal mostly with elderly patients, and also residents in family medicine and

  18. Specialist medication review does not benefit short-term outcomes and net costs in continuing-care patients.

    LENUS (Irish Health Repository)

    Pope, George

    2012-01-31

    OBJECTIVES: to evaluate specialist geriatric input and medication review in patients in high-dependency continuing care. DESIGN: prospective, randomised, controlled trial. SETTING: two residential continuing care hospitals. PARTICIPANTS: two hundred and twenty-five permanent patients. INTERVENTION: patients were randomised to either specialist geriatric input or regular input. The specialist group had a medical assessment by a geriatrician and medication review by a multidisciplinary expert panel. Regular input consisted of review as required by a medical officer attached to each ward. Reassessment occurred after 6 months. RESULTS: one hundred and ten patients were randomised to specialist input and 115 to regular input. These were comparable for age, gender, dependency levels and cognition. After 6 months, the total number of medications per patient per day fell from 11.64 to 11.09 in the specialist group (P = 0.0364) and increased from 11.07 to 11.5 in the regular group (P = 0.094). There was no significant difference in mortality or frequency of acute hospital transfers (11 versus 6 in the specialist versus regular group, P = 0.213). CONCLUSION: specialist geriatric assessment and medication review in hospital continuing care resulted in a reduction in medication use, but at a significant cost. No benefits in hard clinical outcomes were demonstrated. However, qualitative benefits and lower costs may become evident over longer periods.

  19. A cross-sectional study of learning styles among continuing medical education participants.

    Science.gov (United States)

    Collins, C Scott; Nanda, Sanjeev; Palmer, Brian A; Mohabbat, Arya B; Schleck, Cathy D; Mandrekar, Jayawant N; Mahapatra, Saswati; Beckman, Thomas J; Wittich, Christopher M

    2018-04-27

    Experiential learning has been suggested as a framework for planning continuing medical education (CME). We aimed to (1) determine participants' learning styles at traditional CME courses and (2) explore associations between learning styles and participant characteristics. Cross-sectional study of all participants (n = 393) at two Mayo Clinic CME courses who completed the Kolb Learning Style Inventory and provided demographic data. A total of 393 participants returned 241 surveys (response rate, 61.3%). Among the 143 participants (36.4%) who supplied complete demographic and Kolb data, Kolb learning styles included diverging (45; 31.5%), assimilating (56; 39.2%), converging (8; 5.6%), and accommodating (34; 23.8%). Associations existed between learning style and gender (p = 0.02). For most men, learning styles were diverging (23 of 63; 36.5%) and assimilating (30 of 63; 47.6%); for most women, diverging (22 of 80; 27.5%), assimilating (26 of 80; 32.5%), and accommodating (26 of 80; 32.5%). Internal medicine and psychiatry CME participants had diverse learning styles. Female participants had more variation in their learning styles than men. Teaching techniques must vary to appeal to all learners. The experiential learning theory sequentially moves a learner from Why? to What? to How? to If? to accommodate learning styles.

  20. Game-based versus traditional case-based learning: comparing effectiveness in stroke continuing medical education.

    Science.gov (United States)

    Telner, Deanna; Bujas-Bobanovic, Maja; Chan, David; Chester, Bob; Marlow, Bernard; Meuser, James; Rothman, Arthur; Harvey, Bart

    2010-09-01

    To evaluate family physicians' enjoyment of and knowledge gained from game-based learning, compared with traditional case-based learning, in a continuing medical education (CME) event on stroke prevention and management. An equivalence trial to determine if game-based learning was as effective as case-based learning in terms of attained knowledge levels. Game questions and small group cases were developed. Participants were randomized to either a game-based or a case-based group and took part in the event. Ontario provincial family medicine conference. Thirty-two family physicians and 3 senior family medicine residents attending the conference. Participation in either a game-based or a case-based CME learning group. Scores on 40-item immediate and 3-month posttests of knowledge and a satisfaction survey. Results from knowledge testing immediately after the event and 3 months later showed no significant difference in scoring between groups. Participants in the game-based group reported higher levels of satisfaction with the learning experience. Games provide a novel way of organizing CME events. They might provide more group interaction and discussion, as well as improve recruitment to CME events. They might also provide a forum for interdisciplinary CME. Using games in future CME events appears to be a promising approach to facilitate participant learning.

  1. Evaluation of the status of laboratory practices and the need for continuing education in medical mycology.

    Science.gov (United States)

    Rosner, Eunice R; Reiss, Errol; Warren, Nancy G; Shadomy, H Jean; Lipman, Harvey B

    2002-08-01

    A survey to determine the need for training in medical mycology was sent to 605 US laboratories. Training needs were determined by comparing actual laboratory mycology practices with recommended practices, documenting the extent of mycology training reported by employees, and asking respondents to specify the fungi they considered most difficult to identify. The response rate was 56.7% (with only 316 laboratories providing sufficient information). Results showed a large degree of interlaboratory variation in practices and suggested that more judicious practices could lower costs and improve clinical relevance. Only 55.6% of laboratories reported that at least 1 employee attended a formal mycology continuing education program in the 4 years before the survey. Species of dermatophytes, dematiaceous fungi, and non-Candida yeasts were the most difficult to identify. Training may be needed in basic isolation procedures and in advanced topics such as identification of problematic molds and yeasts and antifungal susceptibility testing. Educators should consider clinical relevance and cost-containment without sacrificing quality when designing courses. Support for additional mycology training may improve if hospital and laboratory administrators are alerted to potential dangers and costs involved in treating patients with invasive fungal infections.

  2. Does an outcome-based approach to continuing medical education improve physicians' competences in rational prescribing?

    Science.gov (United States)

    Esmaily, Hamideh M; Savage, Carl; Vahidi, Rezagoli; Amini, Abolghasem; Dastgiri, Saeed; Hult, Hakan; Dahlgren, Lars Owe; Wahlstrom, Rolf

    2009-11-01

    Continuing medical education (CME) is compulsory in Iran, and traditionally it is lecture-based, which is mostly not successful. Outcome-based education has been proposed for CME programs. To evaluate the effectiveness of an outcome-based educational intervention with a new approach based on outcomes and aligned teaching methods, on knowledge and skills of general physicians (GPs) working in primary care compared with a concurrent CME program in the field of "Rational prescribing". The method used was cluster randomized controlled design. All GPs working in six cities in one province in Iran were invited to participate. The cities were matched and randomly divided into an intervention arm for education on rational prescribing with an outcome-based approach, and a control arm for a traditional program on the same topic. Knowledge and skills were assessed using a pre- and post-test, including case scenarios. In total, 112 GPs participated. There were significant improvements in knowledge and prescribing skills after the training in the intervention arm as well as in comparison with the changes in the control arm. The overall intervention effect was 26 percentage units. The introduction of an outcome-based approach in CME appears to be effective when creating programs to improve GPs' knowledge and skills.

  3. Preventive intervention in diabetes: a new model for continuing medical education.

    Science.gov (United States)

    Beaser, Richard S; Brown, Julie A

    2013-04-01

    Competence and skills in overcoming clinical inertia for diabetes treatment, and actually supporting and assisting the patient through adherence and compliance (as opposed to just reiterating what they "should" be doing and then assigning them the blame if they fail) is a key component to success in addressing diabetes, and to date it is a component that has received little formal attention. To improve and systematize diabetes care, it is critical to move beyond the "traditional" continuing medical education (CME) model of imparting knowledge as the entirety of the educational effort, and move toward a focus on Performance Improvement CME. This new approach does not just teach new information but also provides support for improvements where needed most within practice systems based on targeted data-based on self-assessments for the entire system of care. Joslin data conclude that this new approach will benefit support, clinical, and office teams as well as the specialist. In short, the Performance Improvement CME structure reflects the needed components of the successful practice today, particularly for chronic conditions such as diabetes, including the focus on interdisciplinary team care and on quality improvement, which is becoming more and more aligned with reimbursement schemes, public and private, in the U.S. Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  4. Paramedic Learning Style Preferences and Continuing Medical Education Activities: A Cross-Sectional Survey Study.

    Science.gov (United States)

    Staple, Louis; Carter, Alix; Jensen, Jan L; Walker, Mark

    2018-01-01

    Paramedics participate in continuing medical education (CME) to maintain their skills and knowledge. An understanding of learning styles is important for education to be effective. This study examined the preferred learning styles of ground ambulance paramedics and describes how their preferred learning styles relate to the elective CME activities these paramedics attend. All paramedics (n=1,036) employed in a provincial ground ambulance service were invited to participate in a survey containing three parts: demographics, learning style assessed by the Kolb Learning Style Inventory (LSI), and elective CME activity. 260 paramedics (25%) participated in the survey. Preferred learning styles were: assimilator, 28%; diverger, 25%; converger, 24%; and accommodator, 23%. Advanced life support (ALS) providers had a higher proportion of assimilators (36%), and basic life support (BLS) providers had a higher proportion of divergers (30%). The learning style categories of CME activities attended by paramedics were: assimilators, 25%; divergers, 26%; convergers, 25%; and accommodators, 24%. These results suggest that paramedics are a diverse group of learners, and learning style differs within their demographics. Paramedics attend CME activities that complement all learning styles. Organizations providing education opportunities to paramedics should consider paramedics a diverse learning group when designing their CME programs.

  5. [E-Learning--an important contribution to general medical training and continuing education?].

    Science.gov (United States)

    Ruf, D; Berner, M M; Kriston, L; Härter, M

    2008-09-01

    There is increasing activity in the development of e-learning modules for general medical training and continuing education. One of the central advantages of e-learning is flexibility regarding time and place of its use. The quality of the available e-learning opportunities varies quite considerably. For users it is often not easy to assess the quality of e-learning modules or to find offers of high quality. This could be a reason for the fact that despite the huge number of e-learning modules still only few students and physicians are using them. This is although e-learning has proven to be as effective as and even more efficient than learning in the classroom or with paper-based materials. This article summarizes the different models of e-learning, how and where to find offers of high quality, advantages of using e-learning, and the effectiveness and efficiency of such offers. In addition problems of e-learning and possibilities to overcome these problems are shown.

  6. Practice Change From Intermittent Medication Boluses to Bolusing From a Continuous Infusion in Pediatric Critical Care: A Quality Improvement Project.

    Science.gov (United States)

    Hochstetler, Jessica L; Thompson, A Jill; Ball, Natalie M; Evans, Melissa C; Frame, Shaun C; Haney, A Lauren; Little, Amelia K; O'Donnell, Jaime L; Rickett, Bryna M; Mack, Elizabeth H

    2018-04-12

    To determine whether implementing a guideline to bolus medications from continuous infusions in PICUs affects nursing satisfaction, patient safety, central line entries, medication utilization, or cost. This is a pre- and postimplementation quality improvement study. An 11-bed ICU and 14-bed cardiac ICU in a university-affiliated children's hospital. Patients less than 18 years old admitted to the PICU or pediatric cardiac ICU receiving a continuous infusion of dexmedetomidine, midazolam, fentanyl, morphine, vecuronium, or cisatracurium from May 2015 to May 2016, excluding November 2015 (washout period), were eligible for inclusion. Change in practice from administering bolus doses from an automated dispensing machine to administering bolus medications from continuous infusion in PICUs. Timing studies were conducted pre- and post implementation in 29 and 26 occurrences, respectively. The median time from the decision to give a bolus until it began infusing decreased by 169 seconds (p 0.05). Annualized cost avoidance was $124,160. Implementation of bolus medications from continuous infusion in PICUs significantly decreased time to begin a bolus dose and increased nursing satisfaction. The practice change also improved medication utilization without negatively impacting patient safety.

  7. Continuing or Temporarily Stopping Prestroke Antihypertensive Medication in Acute Stroke:An Individual Patient Data Meta-Analysis

    OpenAIRE

    Woodhouse, Lisa J.; Manning, Lisa; Potter, John F.; Berge, Eivind; Sprigg, Nikola; Wardlaw, Joanna; Lees, Kennedy R.; Bath, Philip M.; Robinson, Thompson G.; , Blood Pressure in Acute Stroke Collaboration (BASC)

    2017-01-01

    Over 50% of patients are already taking blood pressure-lowering therapy on hospital admission for acute stroke. An individual patient data meta-analysis from randomized controlled trials was undertaken to determine the effect of continuation versus temporarily stopping pre-existing antihypertensive medication in acute stroke. Key databases were searched for trials against the following inclusion criteria: randomized design; stroke onset ≤48 hours; investigating the effect of continuation vers...

  8. 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

  9. Continuing Medical Education Improves Gastroenterologists' Compliance with Inflammatory Bowel Disease Quality Measures.

    Science.gov (United States)

    Sapir, Tamar; Moreo, Kathleen; Carter, Jeffrey D; Greene, Laurence; Patel, Barry; Higgins, Peter D R

    2016-07-01

    Low rates of compliance with quality measures for inflammatory bowel disease (IBD) have been reported for US gastroenterologists. We assessed the influence of quality improvement (QI) education on compliance with physician quality reporting system (PQRS) measures for IBD and measures related to National Quality Strategy (NQS) priorities. Forty community-based gastroenterologists participated in the QI study; 20 were assigned to educational intervention and control groups, respectively. At baseline, randomly selected charts of patients with moderate-to-severe ulcerative colitis were retrospectively reviewed for the gastroenterologists' performance of 8 PQRS IBD measures and 4 NQS-related measures. The intervention group participated in a series of accredited continuing medical education (CME) activities focusing on QI. Follow-up chart reviews were conducted 6 months after the CME activities. Independent t tests were conducted to compare between-group differences in baseline-to-follow-up rates of documented compliance with each measure. The analysis included 299 baseline charts and 300 follow-up charts. The intervention group had significantly greater magnitudes of improvement than the control group for the following measures: assessment of IBD type, location, and activity (+14 %, p = 0.009); influenza vaccination (+13 %, p = 0.025); pneumococcal vaccination (+20 %, p = 0.003); testing for latent tuberculosis before anti-TNF-α therapy (+10 %, p = 0.028); assessment of hepatitis B virus status before anti-TNF-α therapy (+9 %, p = 0.010); assessment of side effects (+17 %, p = 0.048), and counseling patients about cancer risks (+13 %, p = 0.013). QI-focused CME improves community-based gastroenterologists' compliance with IBD quality measures and measures aligned with NQS priorities.

  10. Continuing Medical Education Speakers with High Evaluation Scores Use more Image-based Slides

    Directory of Open Access Journals (Sweden)

    Ferguson, Ian

    2017-01-01

    Full Text Available Although continuing medical education (CME presentations are common across health professions, it is unknown whether slide design is independently associated with audience evaluations of the speaker. Based on the conceptual framework of Mayer’s theory of multimedia learning, this study aimed to determine whether image use and text density in presentation slides are associated with overall speaker evaluations. This retrospective analysis of six sequential CME conferences (two annual emergency medicine conferences over a three-year period used a mixed linear regression model to assess whether postconference speaker evaluations were associated with image fraction (percentage of image-based slides per presentation and text density (number of words per slide. A total of 105 unique lectures were given by 49 faculty members, and 1,222 evaluations (70.1% response rate were available for analysis. On average, 47.4% (SD=25.36 of slides had at least one educationally-relevant image (image fraction. Image fraction significantly predicted overall higher evaluation scores [F(1, 100.676=6.158, p=0.015] in the mixed linear regression model. The mean (SD text density was 25.61 (8.14 words/slide but was not a significant predictor [F(1, 86.293=0.55, p=0.815]. Of note, the individual speaker [χ2 (1=2.952, p=0.003] and speaker seniority [F(3, 59.713=4.083, p=0.011] significantly predicted higher scores. This is the first published study to date assessing the linkage between slide design and CME speaker evaluations by an audience of practicing clinicians. The incorporation of images was associated with higher evaluation scores, in alignment with Mayer’s theory of multimedia learning. Contrary to this theory, however, text density showed no significant association, suggesting that these scores may be multifactorial. Professional development efforts should focus on teaching best practices in both slide design and presentation skills.

  11. An online spaced-education game for global continuing medical education: a randomized trial.

    Science.gov (United States)

    Kerfoot, B Price; Baker, Harley

    2012-07-01

    To assess the efficacy of a "spaced-education" game as a method of continuing medical education (CME) among physicians across the globe. The efficacy of educational games for the CME has yet to be established. We created a novel online educational game by incorporating game mechanics into "spaced education" (SE), an evidence-based method of online CME. This 34-week randomized trial enrolled practicing urologists across the globe. The SE game consisted of 40 validated multiple-choice questions and explanations on urology clinical guidelines. Enrollees were randomized to 2 cohorts: cohort A physicians were sent 2 questions via an automated e-mail system every 2 days, and cohort B physicians were sent 4 questions every 4 days. Adaptive game mechanics re-sent the questions in 12 or 24 days if answered incorrectly and correctly, respectively. Questions expired if not answered on time (appointment dynamic). Physicians retired questions by answering each correctly twice-in-a-row (progression dynamic). Competition was fostered by posting relative performance among physicians. Main outcome measures were baseline scores (percentage of questions answered correctly upon initial presentation) and completion scores (percentage of questions retired). A total of 1470 physicians from 63 countries enrolled. Median baseline score was 48% (interquartile range [IQR] 17) and, in multivariate analyses, was found to vary significantly by region (Cohen dmax = 0.31, P = 0.001) and age (dmax = 0.41, P games. An online SE game can substantially improve guidelines knowledge and is a well-accepted method of global CME delivery.

  12. Leveraging Social Media to Promote Evidence-Based Continuing Medical Education.

    Science.gov (United States)

    Flynn, Simone; Hebert, Paul; Korenstein, Deborah; Ryan, Mark; Jordan, William B; Keyhani, Salomeh

    2017-01-01

    New dissemination methods are needed to engage physicians in evidence-based continuing medical education (CME). To examine the effectiveness of social media in engaging physicians in non-industry-sponsored CME. We tested the effect of different media platforms (e-mail, Facebook, paid Facebook and Twitter), CME topics, and different "hooks" (e.g., Q&A, clinical pearl and best evidence) on driving clicks to a landing site featuring non-industry sponsored CME. We modelled the effects of social media platform, CME topic, and hook using negative binomial regression on clicks to a single landing site. We used clicks to landing site adjusted for exposure and message number to calculate rate ratios. To understand how physicians interact with CME content on social media, we also conducted interviews with 10 physicians. The National Physicians Alliance (NPA) membership. NPA e-mail recipients, Facebook followers and friends, and Twitter followers. Clicks to the NPA's CME landing site. On average, 4,544 recipients received each message. Messages generated a total of 592 clicks to the landing site, for a rate of 5.4 clicks per 1000 recipients exposed. There were 5.4 clicks from e-mail, 11.9 clicks from Facebook, 5.5 clicks from paid Facebook, and 6.9 clicks from Twitter to the landing site for 1000 physicians exposed to each of 4 selected CME modules. A Facebook post generated 2.3x as many clicks to the landing site as did an e-mail after controlling for participant exposure, hook type and CME topic (pmedia might not be a preferred vehicle for disseminating CME. Social media has a modest impact on driving traffic to evidence-based CME options. Facebook had a superior effect on driving physician web traffic to evidence-based CME compared to other social media platforms and email.

  13. Continuing Medical Education Speakers with High Evaluation Scores Use more Image-based Slides.

    Science.gov (United States)

    Ferguson, Ian; Phillips, Andrew W; Lin, Michelle

    2017-01-01

    Although continuing medical education (CME) presentations are common across health professions, it is unknown whether slide design is independently associated with audience evaluations of the speaker. Based on the conceptual framework of Mayer's theory of multimedia learning, this study aimed to determine whether image use and text density in presentation slides are associated with overall speaker evaluations. This retrospective analysis of six sequential CME conferences (two annual emergency medicine conferences over a three-year period) used a mixed linear regression model to assess whether post-conference speaker evaluations were associated with image fraction (percentage of image-based slides per presentation) and text density (number of words per slide). A total of 105 unique lectures were given by 49 faculty members, and 1,222 evaluations (70.1% response rate) were available for analysis. On average, 47.4% (SD=25.36) of slides had at least one educationally-relevant image (image fraction). Image fraction significantly predicted overall higher evaluation scores [F(1, 100.676)=6.158, p=0.015] in the mixed linear regression model. The mean (SD) text density was 25.61 (8.14) words/slide but was not a significant predictor [F(1, 86.293)=0.55, p=0.815]. Of note, the individual speaker [χ 2 (1)=2.952, p=0.003] and speaker seniority [F(3, 59.713)=4.083, p=0.011] significantly predicted higher scores. This is the first published study to date assessing the linkage between slide design and CME speaker evaluations by an audience of practicing clinicians. The incorporation of images was associated with higher evaluation scores, in alignment with Mayer's theory of multimedia learning. Contrary to this theory, however, text density showed no significant association, suggesting that these scores may be multifactorial. Professional development efforts should focus on teaching best practices in both slide design and presentation skills.

  14. Content of web-based continuing medical education about HPV vaccination.

    Science.gov (United States)

    Kornides, Melanie L; Garrell, Jacob M; Gilkey, Melissa B

    2017-08-16

    Addressing low HPV vaccination coverage will require U.S. health care providers to improve their recommendation practices and vaccine delivery systems. Because readily available continuing medical education (CME) could be an important tool for supporting providers in this process, we sought to assess the content of web-based CME activities related to HPV vaccination. We conducted a content analysis of web-based CME activities about HPV vaccination available to U.S. primary care providers in May-September 2016. Using search engines, educational clearinghouses, and our professional networks, we identified 15 activities eligible for study inclusion. Through a process of open coding, we identified 45 commonly occurring messages in the CME activities, which we organized into five topic areas: delivering recommendations for HPV vaccination, addressing common parent concerns, implementing office-based strategies to increase HPV vaccination coverage, HPV epidemiology, and guidelines for HPV vaccine administration and safety. Using a standardized abstraction form, two coders then independently assessed which of the 45 messages each CME activity included. CME activities varied in the amount of content they delivered, with inclusion of the 45 messages ranging from 17% to 86%. Across activities, the most commonly included messages were related to guidelines for HPV vaccine administration and safety. For example, all activities (100%) specified that routine administration is recommended for ages 11 and 12. Most activities (73%) also noted that provider recommendations are highly influential. Fewer activities modeled examples of effective recommendations (47%), gave specific approaches to addressing common parent concerns (47%), or included guidance on office-based strategies to increase coverage (40%). Given that many existing CME activities lack substantive content on how to change provider practice, future activities should focus on the practical application of interpersonal

  15. The Haiti Medical Education Project: development and analysis of a competency based continuing medical education course in Haiti through distance learning.

    Science.gov (United States)

    Battat, Robert; Jhonson, Marc; Wiseblatt, Lorne; Renard, Cruff; Habib, Laura; Normil, Manouchka; Remillard, Brian; Brewer, Timothy F; Sacajiu, Galit

    2016-10-19

    Recent calls for reform in healthcare training emphasize using competency-based curricula and information technology-empowered learning. Continuing Medical Education programs are essential in maintaining physician accreditation. Haitian physicians have expressed a lack access to these activities. The Haiti Medical Education Project works in alliance with Haitian medical leadership, faculty and students to support the Country's medical education system. We present the creation, delivery and evaluation of a competency-based continuing medical education curriculum for physicians in rural Haiti. Real time lectures from local and international institutions were teleconferenced to physicians in remote Haitian sites using VidyoConferencing™ technology. With American Academy of Family Physicians (AAFP) and College of Family Physicians Canada (CFPC) guidelines as references, a competency-derived syllabus was created for a Haitian continuing medical education program. The resulting educational goals were reviewed by a committee of Haitian and North American physician/medical education practitioners to reflect local needs. All authors reviewed lectures and then conferred to establish agreement on competencies presented for each lecture. Sixty-seven lectures were delivered. Human immunodeficiency virus/Acquired Immunodeficiency Syndrome, ophthalmologic, infectious diseases, renal and endocrine competencies were well-represented, with more than 50 % of the joint AAFP and CFPC recommended competencies outlined. Areas under-represented included allergy and immunology, cardiology, surgery, pain management, gastroenterology, neurology, pulmonology, men's health and rheumatology; these topics accounted for less than 25 % of AAFP/CFPC recommended competencies. Areas not covered included geriatrics, nutrition, occupational health and women's health. Within practice-based lectures, only disaster medicine, health promotion and information management were included, but only partially

  16. A continuous quality improvement project to reduce medication error in the emergency department.

    Science.gov (United States)

    Lee, Sara Bc; Lee, Larry Ly; Yeung, Richard Sd; Chan, Jimmy Ts

    2013-01-01

    Medication errors are a common source of adverse healthcare incidents particularly in the emergency department (ED) that has a number of factors that make it prone to medication errors. This project aims to reduce medication errors and improve the health and economic outcomes of clinical care in Hong Kong ED. In 2009, a task group was formed to identify problems that potentially endanger medication safety and developed strategies to eliminate these problems. Responsible officers were assigned to look after seven error-prone areas. Strategies were proposed, discussed, endorsed and promulgated to eliminate the problems identified. A reduction of medication incidents (MI) from 16 to 6 was achieved before and after the improvement work. This project successfully established a concrete organizational structure to safeguard error-prone areas of medication safety in a sustainable manner.

  17. A Comparison of Internet-Based Learning and Traditional Classroom Lecture to Learn CPR for Continuing Medical Education

    Science.gov (United States)

    Hemmati, Nima; Omrani, Soghra; Hemmati, Naser

    2013-01-01

    The purpose of this study was to compare the satisfaction and effectiveness of Internet-based learning (IBL) and traditional classroom lecture (TCL) for continuing medical education (CME) programs by comparing final resuscitation exam results of physicians who received the newest cardiopulmonary resuscitation (CPR) curriculum guidelines training…

  18. A Correlational Study of Self-Directed Learning Readiness and Learning Activity Preference for Continuing Medical Education among Family Physicians

    Science.gov (United States)

    Barrett, Theresa J.

    2014-01-01

    This quantitative, nonexperimental, correlational study sought to determine whether a relationship exists between family physicians' levels of self-directed learning readiness (SDLR) and their preferences for continuing medical education (CME) activities. The study also sought to determine whether years in clinical practice or size of clinical…

  19. Education, training and continuing professional development for the medical physicist - The EFOMP view in relation to EC Council directives

    International Nuclear Information System (INIS)

    Lamm, I.L.

    2001-01-01

    The European Federation of Organisations for Medical Physics, EFOMP, is an umbrella organisation for National Medical Physics Organisations. One of the main objectives of EFOMP is to harmonise and promote the best practice of Medical Physics within Europe. To accomplish this goal, EFOMP has presented various recommendations and guidelines in a number of Policy Statements, unanimously adopted by EFOMP Member Organisations. Policy Statement No 9, 'Radiation Protection of the Patient in Europe: The Training of the Medical Physics Expert in Radiation Physics or Radiation Technology', is the EFOMP response to the Medical Exposure Directive, 97/43/Euratom. Here EFOMP presents its recommendations on the role and the competence requirements of the Medical Physics Expert, defined in this Directive, together with recommendations on education, training and Continuing Professional Development. The previous Directive 96/29/Euratom, the Basic Safety Standards Directive, defines a 'Qualified Expert' in the radiation protection of workers and the general public. EFOMP has an ongoing discussion on the interpretation of the competence requirements of the Qualified Expert in medical practice. The EFOMP approach to achieve harmonisation in the qualification of the Medical Physicist is to encourage the establishment of education and training schemes according to EFOMP recommendations. (author)

  20. Evaluation of Speakers at a National Continuing Medical Education (CME Course

    Directory of Open Access Journals (Sweden)

    Jannette Collins, MD, MEd, FCCP

    2002-12-01

    Full Text Available Purpose: Evaluations of a national radiology continuing medical education (CME course in thoracic imaging were analyzed to determine what constitutes effective and ineffective lecturing. Methods and Materials: Evaluations of sessions and individual speakers participating in a five-day course jointly sponsored by the Society of Thoracic Radiology (STR and the Radiological Society of North America (RSNA were tallied by the RSNA Department of Data Management and three members of the STR Training Committee. Comments were collated and analyzed to determine the number of positive and negative comments and common themes related to ineffective lecturing. Results: Twenty-two sessions were evaluated by 234 (75.7% of 309 professional registrants. Eighty-one speakers were evaluated by an average of 153 registrants (range, 2 – 313. Mean ratings for 10 items evaluating sessions ranged from 1.28 – 2.05 (1=most positive, 4=least positive; SD .451 - .902. The average speaker rating was 5.7 (1=very poor, 7=outstanding; SD 0.94; range 4.3 – 6.4. Total number of comments analyzed was 862, with 505 (58.6% considered positive and 404 (46.9% considered negative (the total number exceeds 862 as a “comment” could consist of both positive and negative statements. Poor content was mentioned most frequently, making up 107 (26.5% of 404 negative comments, and applied to 51 (63% of 81 speakers. Other negative comments, in order of decreasing frequency, were related to delivery, image slides, command of the English language, text slides, and handouts. Conclusions: Individual evaluations of speakers at a national CME course provided information regarding the quality of lectures that was not provided by evaluations of grouped presentations. Systematic review of speaker evaluations provided specific information related to the types and frequency of features related to ineffective lecturing. This information can be used to design CME course evaluations, design future CME

  1. Commentary: "I hope i'll continue to grow": rubrics and reflective writing in medical education.

    Science.gov (United States)

    Coulehan, Jack; Granek, Iris A

    2012-01-01

    One respected tradition in medical education holds that physicians should struggle to maintain sensibility, openness, and compassion in the face of strong contravening tendencies. However, today's medical education is structured around a more recent tradition, which maintains that physicians should struggle to develop emotional detachment as a prerequisite for objectivity. In this model, sensibility and reflective capacity are potentially subversive. Reflective writing is one component of a revisionist approach to medical education that explicitly addresses reflective "habits of the mind" as core competencies and builds on existential concerns voiced by medical students. In response to Wald and colleagues' study, the authors reflect on the role of repeated formative feedback in developing reflective capacity. Formative feedback is as critical in this process as it is in traditional clinical learning. The authors emphasize that well-designed rubrics can assist learners in delineating desired outcomes and teachers in providing appropriate guidance.

  2. Health Information Technology Continues to Show Positive Effect on Medical Outcomes: Systematic Review.

    Science.gov (United States)

    Kruse, Clemens Scott; Beane, Amanda

    2018-02-05

    Health information technology (HIT) has been introduced into the health care industry since the 1960s when mainframes assisted with financial transactions, but questions remained about HIT's contribution to medical outcomes. Several systematic reviews since the 1990s have focused on this relationship. This review updates the literature. The purpose of this review was to analyze the current literature for the impact of HIT on medical outcomes. We hypothesized that there is a positive association between the adoption of HIT and medical outcomes. We queried the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Medical Literature Analysis and Retrieval System Online (MEDLINE) by PubMed databases for peer-reviewed publications in the last 5 years that defined an HIT intervention and an effect on medical outcomes in terms of efficiency or effectiveness. We structured the review from the Primary Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and we conducted the review in accordance with the Assessment for Multiple Systematic Reviews (AMSTAR). We narrowed our search from 3636 papers to 37 for final analysis. At least one improved medical outcome as a result of HIT adoption was identified in 81% (25/37) of research studies that met inclusion criteria, thus strongly supporting our hypothesis. No statistical difference in outcomes was identified as a result of HIT in 19% of included studies. Twelve categories of HIT and three categories of outcomes occurred 38 and 65 times, respectively. A strong majority of the literature shows positive effects of HIT on the effectiveness of medical outcomes, which positively supports efforts that prepare for stage 3 of meaningful use. This aligns with previous reviews in other time frames. ©Clemens Scott Kruse, Amanda Beane. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 05.02.2018.

  3. Health Information Technology Continues to Show Positive Effect on Medical Outcomes: Systematic Review

    OpenAIRE

    Kruse, Clemens Scott; Beane, Amanda

    2018-01-01

    Background Health information technology (HIT) has been introduced into the health care industry since the 1960s when mainframes assisted with financial transactions, but questions remained about HIT’s contribution to medical outcomes. Several systematic reviews since the 1990s have focused on this relationship. This review updates the literature. Objective The purpose of this review was to analyze the current literature for the impact of HIT on medical outcomes. We hypothesized that there is...

  4. Nursing assessment of continuous vital sign surveillance to improve patient safety on the medical/surgical unit.

    Science.gov (United States)

    Watkins, Terri; Whisman, Lynn; Booker, Pamela

    2016-01-01

    Evaluate continuous vital sign surveillance as a tool to improve patient safety in the medical/surgical unit. Failure-to-rescue is an important measure of hospital quality. Patient deterioration is often preceded by changes in vital signs. However, continuous multi-parameter vital sign monitoring may decrease patient safety with an abundance of unnecessary alarms. Prospective observational study at two geographically disperse hospitals in a single hospital system. A multi-parameter vital sign monitoring system was installed in a medical/surgical unit in Utah and one in Alabama providing continuous display of SpO2, heart rate, blood pressure and respiration rate on a central station. Alarm thresholds and time to alert annunciations were set based on prior analysis of the distribution of each vital sign. At the end of 4 weeks, nurses completed a survey on their experience. An average alert per patient, per day was determined retrospectively from the saved vital signs data and knowledge of the alarm settings. Ninety-two per cent of the nurses agreed that the number of alarms and alerts were appropriate; 54% strongly agreed. On average, both units experienced 10·8 alarms per patient, per day. One hundred per cent agreed the monitor provided valuable patient data that increased patient safety; 79% strongly agreed. Continuous, multi-parameter patient monitoring could be performed on medical/surgical units with a small and appropriate level of alarms. Continuous vital sign assessment may have initiated nursing interventions that prevented failure-to-rescue events. Nurses surveyed unanimously agreed that continuous vital sign surveillance will help enhance patient safety. Nursing response to abnormal vital signs is one of the most important levers in patient safety, by providing timely recognition of early clinical deterioration. This occurs through diligent nursing surveillance, involving assessment, interpretation of data, recognition of a problem and meaningful

  5. Editorial Continuing Medical Education (CME) Continuing Medical ...

    African Journals Online (AJOL)

    System Administrator

    developments in the field of medicine. CME has evolved in the last ten years necessitated by the realization that the practice of medicine is constantly changing. New diseases are emerging; diagnostic techniques are being updated and new drugs and therapeutic methods being introduced into the market. Added to this is ...

  6. A Comparison Of Internet-Based Learning And Traditional Classroom Lecture To Learn Cpr For Continuing Medical Education

    OpenAIRE

    HEMMATI, Nima; OMRANI, Soghra; HEMMATI, Naser

    2013-01-01

    The purpose of this study was to compare the satisfaction and effectiveness of Internet-based learning (IBL) and traditional classroom lecture (TCL) for continuing medical education (CME) programs by comparing final resuscitation exam results of physicians who received the newest cardiopulmonary resuscitation (CPR) curriculum guidelines training either by traditional or by an Internet-based CME. A randomized two-group pretest-posttest quasi-experimental design was used. Postgraduate general ...

  7. Theoretical Biology and Medical Modelling: ensuring continued growth and future leadership.

    Science.gov (United States)

    Nishiura, Hiroshi; Rietman, Edward A; Wu, Rongling

    2013-07-11

    Theoretical biology encompasses a broad range of biological disciplines ranging from mathematical biology and biomathematics to philosophy of biology. Adopting a broad definition of "biology", Theoretical Biology and Medical Modelling, an open access journal, considers original research studies that focus on theoretical ideas and models associated with developments in biology and medicine.

  8. Auditing GPs' prescribing habits : Cardiovascular prescribing frequently continues medication initiated by specialists

    NARCIS (Netherlands)

    de Vries, C.S; van Diepen, N.M; de Jong-van den Berg, L T W

    Objective: To determine to what extent general practitioners' (GPs) prescribing behaviour is a result of repeat prescribing of medication which has been initiated by specialists. Method: During a 4-week period, pharmacists identified GPs' prescriptions for a large group of cardiovascular drugs.

  9. Effect of continued cannabis use on medication adherence in the first two years following onset of psychosis.

    Science.gov (United States)

    Schoeler, Tabea; Petros, Natalia; Di Forti, Marta; Klamerus, Ewa; Foglia, Enrico; Murray, Robin; Bhattacharyya, Sagnik

    2017-09-01

    Uncertainty exists whether the use of non-prescription psychoactive substances following onset of a first episode of psychosis (FEP), in particular cannabis use, affects medication adherence. Data from FEP patients (N=233) obtained through prospective assessments measured medication adherence and pattern of cannabis and other substance use in the first two years following onset of psychosis. Multiple logistic regression analyses were employed to compare the different substance use groups with regard to risk of medication non-adherence, while controlling for confounders. The proportion of non-adherent patients was higher in those who continued using high-potency forms of cannabis (skunk-like) following the onset (83%) when compared to never regular users (51%), corresponding to an Odds Ratio (OR) of 5.26[95% Confidence Interval (CI) 1.91-15.68]. No significant increases in risk were present in those who used cannabis more sporadically or used milder forms of cannabis (hash-like). Other substances did not make an independent contribution in this model, including cigarette use ([OR 0.88, 95% CI 0.41-1.89]), alcohol use ([OR 0.66, 95% CI 0.27-1.64]) or regular use of other illicit drugs ([OR 1.03, 95% CI 0.34-3.15]) following the onset. These results suggest that continued use of high-potency cannabis following the onset of psychosis may adversely affect medication adherence. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  10. Managing perceived conflicts of interest while ensuring the continued innovation of medical technology.

    Science.gov (United States)

    Van Haute, Andrew

    2011-09-01

    If it were not for the ongoing collaboration between vascular surgeons and the medical technology industry, many of these advanced treatments used every day in vascular interventional surgery would not exist. The flip side of this coin is that these vital relationships create multiple roles for surgeons and must be appropriately managed. The dynamic process of innovation, along with factors such as product delivery technique refinement, education, testing and clinical trials, and product support, all make it necessary for ongoing and close collaboration between surgeons and the device industry. This unique relationship sometimes leads to the perception of conflicts of interest for physicians, in part because the competing pressures from the multiple, overlapping roles as clinician/caregiver/investigator/innovator/customer are significant. To address this issue, the Advanced Medical Technology Association (AdvaMed), the nation's largest medical technology association representing medical device and diagnostics companies, developed a Code of Ethics to guide medical technology companies in their interactions with health care professionals. First introduced in 1993, the AdvaMed Code strongly encourages both industry and physicians to commit to openness and high ethical standards in the conduct of their business interactions. The AdvaMed Code addresses many of the types of interactions that can occur between companies and health care professionals, including training, consulting agreements, the provision of demonstration and evaluation units, and charitable donations. By following the Code, companies send a strong message that treatment decisions must always be based on the best interest of the patient. Copyright © 2011. Published by Mosby, Inc.

  11. Continuous 24-hour ocular dimensional profile recording in medically treated normal-tension glaucoma

    Directory of Open Access Journals (Sweden)

    Lee JWY

    2015-01-01

    Full Text Available Jacky WY Lee,1,2 Lin Fu,1 Jennifer WH Shum,1 Jonathan CH Chan,3 Jimmy SM Lai1 1Department of Ophthalmology, The University of Hong Kong, Hong Kong; 2Department of Ophthalmology, Caritas Medical Centre, Hong Kong; 3Department of Ophthalmology, Queen Mary Hospital, Hong Kong Purpose: To analyze the 24-hour ocular dimensional profile in normal-tension glaucoma (NTG patients on medical treatment.Methods: Consecutive, medically treated NTG subjects were recruited from a university eye center. Subjects were on a mean of 1.7±0.7 types of antiglaucoma medications and 56.6% were on a prostaglandin analog. A contact lens-based sensor device was worn in one eye of NTG patients to record the intraocular pressure (IOP-related profile for 24 hours, recording the following: variability from mean over 24 hours, nocturnally and diurnally, as well as the number of peaks and troughs diurnally and nocturnally.Results: In 18 NTG subjects, the nocturnal variability around the mean contact lens-based sensor device signal was 48.9% less than the diurnal variability around the mean. The number of peaks was 54.7% less during the nocturnal period than during the diurnal period. The rate of increase in the ocular dimensional profile when going to sleep was significantly greater than the rate of decrease upon waking (P<0.001.Conclusion: In medically treated NTG subjects, there was more variability in the IOP-related pattern during the daytime and there were fewer peaks during sleep. Keywords: intraocular pressure, 24-hour, normal tension glaucoma

  12. Continuous subcutaneous delivery of medications for home care palliative patients-using an infusion set or a pump?

    Science.gov (United States)

    Menahem, Sasson; Shvartzman, Pesach

    2010-09-01

    The purpose of this study was to evaluate safety, feasibility, and efficacy of continuous drug delivery by the subcutaneous route through a solution bag connected to an infusion set compared with an infusion pump in a home palliative care setting. Patients in need of continuous subcutaneous medication delivery for pain control, nausea, and/or vomiting were recruited. The study was designed as a double-blind, crossover study. The patient was connected to two parallel subcutaneous lines running simultaneously, connected together to a line entering the subcutaneous tissue. One line is connected to an infusion set and the other to a pump. The infusion set included a 500-cc solution bag connected to a 1.5-m plastic tube containing a drip chamber controlled by a roller clamp that is gravity driven without hyaluronidase. Active medications were randomly assigned to start in either administration method and switched after 24 h. An independent research assistant evaluated symptom control and side effects at baseline and every 24 h for 2 days using a structured questionnaire. Another independent research assistant connected the lines after adding medications and evaluated technical and clinical failures. Twenty-seven patients were recruited, and of them, 18 completed the study. Incidents in fluid administration were more common through the infusion set (18 times) compared to the pump (only twice). On the other hand, no clinical significant change was noted in the average symptom levels and side effects when medications were given through the infusion set versus the pump. No local edema or irritation was observed in either way of administration. In a home palliative care setting with a medical staff on call for 24 h, using medications for symptom control can be considered to be infused to a fluid solution bag through an infusion set instead of using a syringe driver or a pump when there is a responsible caregiver to follow up on the fluid. Subcutaneous constant drug delivery

  13. Clinician Acceptance of Electronic Medical Records (EMRs): Relating Personality Factors to Continuance Intention

    Science.gov (United States)

    McClellan, Molly Ann

    2011-01-01

    Many models currently exist for evaluating acceptance and continued use of technology. However, none of these models are healthcare specific, nor do they involve aspects of users' personality. Although the five-factor model (FFM) of personality has been effectively used in psychology and human resources and management research to predict…

  14. Relations between professional medical associations and healthcare industry, concerning scientific communication and continuing medical education: a policy statement from the European Society of Cardiology.

    Science.gov (United States)

    2012-01-01

    Physicians have an ethical duty to keep up-to-date with current knowledge. Professional medical associations such as the European Society of Cardiology (ESC) support these obligations. In Europe, the costs of continuing medical education (CME) are insufficiently supported from governments and employers; however, medical associations have been criticized for accepting alternative financial support from industry. Medical education and training in research include learning how to assess the quality and reliability of any information. There is some risk of bias in any form of scientific communication including intellectual, professional, and financial and it is essential that in particular, the latter must be acknowledged by full disclosure. It is essential that there is strong collaboration between basic and clinical researchers from academic institutions on the one hand, with engineers and scientists from the research divisions of device and pharmaceutical companies on the other. This is vital so that new diagnostic methods and treatments are developed. Promotion of advances by industry may accelerate their implementation into clinical practice. Universities now frequently exhort their academic staff to protect their intellectual property or commercialize their research. Thus, it is not commercial activity or links per se that have become the target for criticism but the perceived influence of commercial enterprises on clinical decision-making or on messages conveyed by professional medical organizations. This document offers the perspective of the ESC on the current debate, and it recommends how to minimize bias in scientific communications and CME and how to ensure proper ethical standards and transparency in relations between the medical profession and industry. Copyright © 2012. Published by Elsevier España.

  15. Relations between professional medical associations and the health-care industry, concerning scientific communication and continuing medical education: a policy statement from the European Society of Cardiology.

    Science.gov (United States)

    2012-06-01

    Physicians have an ethical duty to keep up-to-date with current knowledge. Professional medical associations such as the European Society of Cardiology (ESC) support these obligations. In Europe, the costs of continuing medical education (CME) are insufficiently supported from governments and employers; however, medical associations have been criticized for accepting alternative financial support from industry. Medical education and training in research include learning how to assess the quality and reliability of any information. There is some risk of bias in any form of scientific communication including intellectual, professional, and financial and it is essential that in particular, the latter must be acknowledged by full disclosure. It is essential that there is strong collaboration between basic and clinical researchers from academic institutions on the one hand, with engineers and scientists from the research divisions of device and pharmaceutical companies on the other. This is vital so that new diagnostic methods and treatments are developed. Promotion of advances by industry may accelerate their implementation into clinical practice. Universities now frequently exhort their academic staff to protect their intellectual property or commercialize their research. Thus, it is not commercial activity or links per se that have become the target for criticism but the perceived influence of commercial enterprises on clinical decision-making or on messages conveyed by professional medical organizations. This document offers the perspective of the ESC on the current debate, and it recommends how to minimize bias in scientific communications and CME and how to ensure proper ethical standards and transparency in relations between the medical profession and industry.

  16. Historical continuity in the methodology of modern medical science: Leonardo leads the way.

    Science.gov (United States)

    Pasipoularides, Ares

    2014-02-01

    Early modern medical science did not arise ex nihilo, but was the culmination of a long history stretching back through the Renaissance, the Middle Ages, Byzantium and Roman times, into Greek Antiquity. The long interval between Aristotle and Galen and Harvey and Descartes was punctuated by outstanding visionaries, including Leonardo, the ultimate Renaissance man. His attitude and mindset were based on Aristotelian pursuit of empirical fact and rational thought. He declared himself to be a "man without letters" to underscore his disdain for those whose culture was only mnemonics and philosophical inferences from authoritative books. Leonardo read the Book of Nature with the immense curiosity of the pioneering scientist, ushering in the methodology of modern medical science with help from forerunners. He left no publications, but extensive personal Notebooks: on his scientific research, hydrodynamics, physiological anatomy, etc. Apparently, numerous successors availed themselves of his methodologies and insights, albeit without attribution. In his Notebooks, disordered and fragmentary, Leonardo manifests the exactitude of the engineer and scientist, the spontaneous freshness of one speaking of what he has at heart and that he knows well. His style is unrefined, but intensely personal, rich with emotion and, sometimes, poetic. Leonardo, the visionary anatomist, strived consistently not merely to imitate nature by depicting body structures, but to perceive through analysis and simulations the intimate physiologic processes; i.e., the biomechanics underlying the workings of all bodily organs and components, even the mysterious beating heart. It is fitting to regard him as the first modern medical scientist. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  17. Influence of Continuing Medical Education on Rheumatologists? Performance on National Quality Measures for Rheumatoid Arthritis

    OpenAIRE

    Sapir, Tamar; Rusie, Erica; Greene, Laurence; Yazdany, Jinoos; Robbins, Mark L.; Ruderman, Eric M.; Carter, Jeffrey D.; Patel, Barry; Moreo, Kathleen

    2015-01-01

    Introduction: In recent years researchers have reported deficits in the quality of care provided to patients with rheumatoid arthritis (RA), including low rates of performance on quality measures. We sought to determine the influence of a quality improvement (QI) continuing education program on rheumatologists’ performance on national quality measures for RA, along with other measures aligned with National Quality Strategy priorities. Performance was assessed through baseline and post-educati...

  18. DOD and VA Health Care: Actions Needed to Help Ensure Appropriate Medication Continuation and Prescribing Practices

    Science.gov (United States)

    2016-01-01

    Hydrocodone ibuprofen 0.1 Oxymorphone 0.1 Meperidinee 0.1 Methadone √ 0.1 Codeine √ 0.1 Tapentadol < 0.1 Oxaprozin < 0.1 Diclofenac misoprostopolf...formulation (e.g., extended or immediate release), salt form (e.g., hydrochloride or sulfate), or strength of the medication. bThis represents the most...form (e.g., liquid or tablet), modified release formulation (e.g., extended or immediate release), salt form (e.g., hydrochloride or sulfate

  19. Peer-to-Peer JXTA Architecture for Continuing Mobile Medical Education Incorporated in Rural Public Health Centers.

    Science.gov (United States)

    Rajasekaran, Rajkumar; Iyengar, Nallani Chackravatula Sriman Narayana

    2013-04-01

    Mobile technology helps to improve continuing medical education; this includes all aspects of public health care as well as keeping one's knowledge up-to-date. The program of continuing medical and health education is intertwined with mobile health technology, which forms an imperative component of national strategies in health. Continuing mobile medical education (CMME) programs are designed to ensure that all medical and health-care professionals stay up-to-date with the knowledge required through mobile JXTA to appraise modernized strategies so as to achieve national goals of health-care information distribution. In this study, a 20-item questionnaire was distributed to 280 health professionals practicing traditional training learning methodologies (180 nurses, 60 doctors, and 40 health inspectors) in 25 rural hospitals. Among the 83% respondents, 56% are eager to take new learning methodologies as part of their evaluation, which is considered for promotion to higher grades, increments, or as part of their work-related activities. The proposed model was executed in five public health centers in which nurses and health inspectors registered in the JXTA network were referred to the record peer group by administrators. A mobile training program on immunization was conducted through the ADVT, with the lectures delivered on their mobiles. Credits are given after taking the course and completing an evaluation test. The system is faster compared with traditional learning. Medical knowledge management and mobile-streaming application support the CMME system through JXTA. The mobile system includes online lectures and practice quizzes, as well as assignments and interactions with health professionals. Evaluation and assessments are done online and credits certificates are provided based on the score the student obtains. The acceptance of mobile JXTA peer-to-peer learning has created a drastic change in learning methods among rural health professionals. The professionals

  20. A Systematic Review of Statistical Methods Used to Test for Reliability of Medical Instruments Measuring Continuous Variables

    Directory of Open Access Journals (Sweden)

    Rafdzah Zaki

    2013-06-01

    Full Text Available   Objective(s: Reliability measures precision or the extent to which test results can be replicated. This is the first ever systematic review to identify statistical methods used to measure reliability of equipment measuring continuous variables. This studyalso aims to highlight the inappropriate statistical method used in the reliability analysis and its implication in the medical practice.   Materials and Methods: In 2010, five electronic databases were searched between 2007 and 2009 to look for reliability studies. A total of 5,795 titles were initially identified. Only 282 titles were potentially related, and finally 42 fitted the inclusion criteria. Results: The Intra-class Correlation Coefficient (ICC is the most popular method with 25 (60% studies having used this method followed by the comparing means (8 or 19%. Out of 25 studies using the ICC, only 7 (28% reported the confidence intervals and types of ICC used. Most studies (71% also tested the agreement of instruments. Conclusion: This study finds that the Intra-class Correlation Coefficient is the most popular method used to assess the reliability of medical instruments measuring continuous outcomes. There are also inappropriate applications and interpretations of statistical methods in some studies. It is important for medical researchers to be aware of this issue, and be able to correctly perform analysis in reliability studies.

  1. Continuous improvement of the regulatory framework for the control of medical exposure

    International Nuclear Information System (INIS)

    Larcher, Ana M.; Ortiz Lopez, Pedro; Arias, Cesar; Marechal, Maria H.; Hernandez Alvarez, Ramon; Ferrer Garcia, Natividad; Castaneda Mucino, Antonia; Faller, Blanca

    2008-01-01

    One of the key elements to guide the improvement of the regulatory control is the availability of a self-assessment tool for regulatory performance. Although there is general guidance on self-assessment for regulators and users (IAEA), there is a need for more specific advice on how to address challenges and difficulties faced by regulatory bodies, when regulating radiation protection of patients. Examples of these challenges are the need for regulatory initiatives, in cooperation with health and education authorities, professional bodies and equipment suppliers, and to put in place necessary elements that are beyond responsibility of individual user of radiation, to enable them compliance with safety standards. Purpose: Within the programme of the Ibero American Forum of Nuclear and Radiation Safety Regulatory Organizations, a project to develop such a self-assessment tool for the regulatory control of medical exposure has been designed. Method: National experiences in transposing and enforcing the international radiation safety standards, as to how the requirements are included in national regulations are reviewed. Further, difficulties to the implementation of safety requirements are analyzed and a self-assessment approach and possible regulatory solutions a are presented. Results and discussion: In this study the following documents are being produced: 1) transposition of international requirements into national regulations in the six countries of the Forum, 2) difficulties to implement and enforce the requirements, 3) guidance on self-assessment of regulatory framework for medical exposure, 4) suggested contribution to the revision of international radiation safety standards. (author)

  2. Continuous Improvement of the Regulatory Framework for the Control of Medical Exposure

    International Nuclear Information System (INIS)

    Larcher, A.M.; Ortiz lopez, Pedro; Arias, Cesar; Marechal, Maria H.; Hernandez Alvarez, Ramon; Ferrer Garcia, Natividad; Castaneda Mucino, Antonia; Faller, Blanca

    2011-01-01

    Background: One of the key elements to guide the improvement of the regulatory control is the availability of a self-assessment tool for regulatory performance. Although there is general guidance on self-assessment for regulators and users (IAEA), there is a need for specific advice on how to address challenges and difficulties faced by regulatory bodies, when regulating radiation protection of patients. Examples of these challenges are the need of regulatory initiatives, in cooperation with health and education authorities, professional bodies and equipment suppliers, and to put in place necessary elements that are beyond responsibility of individual users of radiation, to enable them compliance with safety standards. Purpose: within the programme of the Ibero American Forum of Nuclear and Radiation Safety Regulatory Organizations, a project to develop such a self assessment tool for the regulatory control of medical exposure has been designed. Method: national experiences in transposing and enforcing the international radiation safety standards, as to how the requirements are included in national regulations are reviewed. Further, difficulties to the implementation of safety requirements are included in national regulations are analyzed and a self assessment approach and possible regulatory solutions are presented. Results and discussion: in tis study the following documents are being produced: 1) Transposition of international requirements into national regulations in the six countries of the Forum, 2) difficulties to implement and enforce the requirements, 3) guidance on self assessment of regulatory framework for medical exposure, 4) suggested contribution to the revision of international radiation safety standards. (authors)

  3. How do medical doctors in the European Union demonstrate that they continue to meet criteria for registration and licencing?

    Science.gov (United States)

    Solé, Meritxell; Panteli, Dimitra; Risso-Gill, Isabelle; Döring, Nora; Busse, Reinhard; McKee, Martin; Legido-Quigley, Helena

    2014-12-01

    This paper reviews procedures for ensuring that physicians in the European Union (EU) continue to meet criteria for registration and the implications of these procedures for cross-border movement of health professionals following implementation of the 2005/36/EC Directive on professional qualifications. A questionnaire was completed by key informants in 10 EU member states, supplemented by a review of peer-reviewed and grey literature and a review conducted by key experts in each country. The questionnaire covered three aspects: actors involved in processes for ensuring continued adherence to standards for registration and/or licencing (such as revalidation), including their roles and functions; the processes involved, including continuing professional development (CPD) and/or continuing medical education (CME); and contextual factors, particularly those impacting professional mobility. All countries included in the study view CPD/CME as one mechanism to demonstrate that doctors continue to meet key standards. Although regulatory bodies in a few countries have established explicit systems of ensuring continued competence, at least for some doctors (in Belgium, Germany, Hungary, the Netherlands, Slovenia and the UK), self-regulation is considered sufficient to ensure that physicians are up to date and fit to practice in others (Austria, Finland, Estonia and Spain). Formal systems vary greatly in their rationale, structure, and coverage. Whereas in Germany, Hungary and Slovenia, systems are exclusively focused on CPD/CME, the Netherlands also includes peer review and minimum activity thresholds. Belgium and the UK have developed more complex mechanisms, comprising a review of complaints or compliments on performance and (in the UK) colleague and patient questionnaires. Systems for ensuring that doctors continue to meet criteria for registration and licencing across the EU are complex and inconsistent. Participation in CPD/CME is only one aspect of maintaining

  4. Securing the Continuity of Medical Competence in Times of Demographic Change: A Proposal.

    Science.gov (United States)

    Hasebrook, Joachim Paul; Hinkelmann, Jürgen; Volkert, Thomas; Rodde, Sibyll; Hahnenkamp, Klaus

    2016-12-21

    University hospitals make up the backbone of medical and economic services of hospitals in Germany: they qualify specialist physicians, ensure medical research, and provide highly specialized maximum medical care, which other hospitals cannot undertake. In addition to this assignment, medical research and academic teaching must be managed despite a growing shortage of specialist physicians. By the year 2020, the need for the replacement of retired physicians and increased demand will total 30,000 positions. The situation will become more difficult because, on the whole, patients are becoming older and sicker and because specialist physicians are able to find more attractive working conditions in smaller hospitals, abroad, or outside of curative medicine. In order to retain sufficient qualified employees, major improvements in quality are required in terms of working and training conditions. For this purpose, a sustainable innovation process is necessary, which incorporates solutions from outside of the health care sector in order to be able to learn from experiences and mistakes from other industries. The FacharztPlus project aims to find suitable measures in order to retain specialist physicians for more years after the completion of 5 years of professional training. This should determine the suitability of additional qualifications alongside the professional career and an expertise-related work organization oriented to different stages of life. Structured interviews, surveys, and repertory grids are used as preparation for cross-industry expert panels to create future work scenarios for university hospitals. Industries involved are harbor logistics (container terminal), airports, and digitized industrial production ("industry 4.0") because these industries are also facing a shortage of qualified staff and have to respond to rapidly changing demands. Based on the experts' scenarios, consensus groups will be established in each university hospital trying to reach

  5. Continuous engineering of nano-cocrystals for medical and energetic applications

    Science.gov (United States)

    Spitzer, D.; Risse, B.; Schnell, F.; Pichot, V.; Klaumünzer, M.; Schaefer, M. R.

    2014-10-01

    Cocrystals, solid mixtures of different molecules on molecular scale, are supposed to be tailor made materials with improved employability compared to their pristine individual components in domains such as medicine and explosives. In medicine, cocrystals are obtained by crystallization of active pharmaceutical ingredients with precisely chosen coformers to design medicaments that demonstrate enhanced stability, high solubility, and therefore high bioavailability and optimized drug up-take. Nanoscaling may further advance these characteristica compared to their micronsized counterparts - because of a larger surface to volume ratio of nanoparticles. In the field of energetic materials, cocrystals offer the opportunity to design smart explosives, combining high reactivity with significantly reduced sensitivity, nowadays essential for a safe manipulation and handling. Furthermore, cocrystals are used in ferroelectrics, non-linear material response and electronic organics. However, state of the art batch processes produce low volume of cocrystals of variable quality and only have produced micronsized cocrystals so far, no nano-cocrystals. Here we demonstrate the continuous preparation of pharmaceutical and energetic micro- and nano-cocrystals using the Spray Flash Evaporation process. Our laboratory scale pilot plant continuously prepared up to 8 grams per hour of Caffeine/Oxalic acid 2:1, Caffeine/Glutaric acid 1:1, TNT/CL-20 1:1 and HMX/Cl-20 1:2 nano- and submicronsized cocrystals.

  6. Use of flawed multiple-choice items by the New England Journal of Medicine for continuing medical education.

    Science.gov (United States)

    Stagnaro-Green, Alex S; Downing, Steven M

    2006-09-01

    Physicians in the United States are required to complete a minimum number of continuing medical education (CME) credits annually. The goal of CME is to ensure that physicians maintain their knowledge and skills throughout their medical career. The New England Journal of Medicine (NEJM) provides its readers with the opportunity to obtain weekly CME credits. Deviation from established item-writing principles may result in a decrease in validity evidence for tests. This study evaluated the quality of 40 NEJM MCQs using the standard evidence-based principles of effective item writing. Each multiple-choice item reviewed had at least three item flaws, with a mean of 5.1 and a range of 3 to 7. The results of this study demonstrate that the NEJM uses flawed MCQs in its weekly CME program.

  7. Don't forget the learner: an essential aspect for developing effective hypermedia online learning in continuing medical education.

    Science.gov (United States)

    Sandars, John; Homer, Matthew; Walsh, Kieran; Rutherford, Alaster

    2012-03-01

    There is increasing use of hypermedia online learning in continuing medical education (CME) that presents the learner with a wide range of different learning resources, requiring the learner to use self-regulated learning (SRL) skills. This study is the first to apply an SRL perspective to understand how learners engage with hypermedia online learning in CME. We found that the main SRL skills used by learners were use of strategies and monitoring. The increasing use of strategies was associated with increasing interest in the topic and with increasing satisfaction with the learning experience. Further research is recommended to understand SRL processes and its impact on learning in other aspects of hypermedia online learning across the different phases of medical education. Research is also recommended to implement and evaluate the learning impact of a variety of approaches to develop the SRL skills of hypermedia online learners in CME.

  8. Change in the intrathyroidal kinetics of radioiodine under continued and discontinued antithyroid medication in Graves' disease

    Energy Technology Data Exchange (ETDEWEB)

    Dunkelmann, Simone; Kuenstner, Hubertus; Nabavi, Elham; Rohde, Bettina; Groth, Peter; Schuemichen, Carl [University of Rostock, Clinic of Nuclear Medicine, Rostock (Germany)

    2007-02-15

    This study evaluated the thyroidal kinetics of radioiodine in Graves' disease under continued thiamazole medication and after discontinuation of thiamazole for 1-2 days, with a view to keeping the period of discontinuation as short as possible and to exploring the underlying mechanism of a postulated radioprotective effect of antithyroid drugs. In 316 patients, diagnostic and therapeutic radioiodine kinetics were followed up for 2 days by ten uptake measurements each and were defined mathematically by a two-compartment model. Without thiamazole or when thiamazole was discontinued for at least 2 days, all uptake curves could be fitted perfectly by a simple in- and output function; the mean square error (mse) was 0.38 (test) and 0.28 (therapy). Under continued thiamazole medication (11.0{+-}7.0 mg/day), the energy dose delivered to the thyroid was lowered by factor of 2.5. Uptake curves were deformed (mse: 1.06, test and 0.86, therapy) and appeared two peaked, suggesting coexistence of follicles with blocked and follicles with intact hormone synthesis and hence heterogeneous radioiodine uptake in the thyroid. In patients with maximally altered uptake curves, the success rate was as low as 31%. One day after discontinuation of thiamazole, mse was still increased (0.78, test), while 2 days afterwards it had normalised (0.36, test) and 3 days afterwards (mse: 0.24, therapy) the success rate was 87%. Efficacy of radioiodine therapy under continued thiamazole medication is reduced not only by a lower uptake and shorter half-life of radioiodine, but also by a heterogeneous energy dose distribution in the thyroid. Discontinuation of thiamazole (but probably not of propylthiouracil) for at least 2 days is required to restore the efficacy of radioiodine. (orig.)

  9. The Gap in Medical Informatics and Continuing Education Between the United States and China: A Comparison of Conferences in 2016.

    Science.gov (United States)

    Liang, Jun; Wei, Kunyan; Meng, Qun; Chen, Zhenying; Zhang, Jiajie; Lei, Jianbo

    2017-06-21

    China launched its second health reform in 2010 with considerable investments in medical informatics (MI). However, to the best of our knowledge, research on the outcomes of this ambitious undertaking has been limited. Our aim was to understand the development of MI and the state of continuing education in China and the United States from the perspective of conferences. We conducted a quantitative and qualitative analysis of four MI conferences in China and two in the United States: China Medical Information Association Annual Symposium (CMIAAS), China Hospital Information Network Annual Conference (CHINC), China Health Information Technology Exchange Annual Conference (CHITEC), China Annual Proceeding of Medical Informatics (CPMI) versus the American Medical Informatics Association (AMIA) and Healthcare Information and Management Systems Society (HIMSS). The scale, composition, and regional distribution of attendees, topics, and research fields for each conference were summarized and compared. CMIAAS and CPMI are mainstream academic conferences, while CHINC and CHITEC are industry conferences in China. Compared to HIMSS 2016, the meeting duration of CHITEC was 3 versus 5 days, the number of conference sessions was 132 versus 950+, the number of attendees was 5000 versus 40,000+, the number of vendors was 152 versus 1400+, the number of subforums was 12 versus 230, the number of preconference education symposiums and workshops was 0 versus 12, and the duration of preconference educational symposiums and workshops was 0 versus 1 day. Compared to AMIA, the meeting duration of Chinese CMIAAS was 2 versus 5 days, the number of conference sessions was 42 versus 110, the number of attendees was 200 versus 2500+, the number of vendors was 5 versus 75+, and the number of subforums was 4 versus 10. The number of preconference tutorials and working groups was 0 versus 29, and the duration of tutorials and working group was 0 versus 1.5 days. Given the size of the Chinese

  10. Impact of continuous glucose monitoring on quality of life, treatment satisfaction, and use of medical care resources

    DEFF Research Database (Denmark)

    Hommel, E; Olsen, B; Battelino, T

    2014-01-01

    To investigate the impact of continuous glucose monitoring (CGM) on health-related quality of life (HRQOL), treatment satisfaction (TS) medical resource use, and indirect costs in the SWITCH study. SWITCH was a multicentre, randomized, crossover study. Patients with type 1 diabetes (n = 153) using...... longer during the sensor-On arm. Regarding indirect costs, children with >70 % sensor usage missed fewer school days, compared with the sensor-Off arm (P = 0.0046) but there was no significant difference in the adults days of work off. The addition of CGM to CSII resulted in better metabolic control...

  11. Continuing medical and dental education on the global stage: the nexus of supporting international Christian healthcare workers and developing educators

    Directory of Open Access Journals (Sweden)

    Lyubov D Slashcheva

    2016-01-01

    Full Text Available One of the challenges facing international healthcare missionaries is that of maintaining up-to-date knowledge and staying current with professional certification. Since 1978, annual programs by the Christian Medical and Dental Associations have offered professional continuing education to thousands of US healthcare professionals serving as missionaries in the regions of Africa, Asia, and, in more recent years, globally. In addition, conference programming is designed to prepare, train, and support healthcare missionaries to, in turn, serve as educators in their places of ministry. The program is designed for both professional education and personal encouragement. Utilizing historical documents from program facilitation and interviews from those involved with its implementation, this paper describes the history, vision, and favorable quantitative growth and qualitative impact on participants. The program continues to grow as healthcare missionaries are educated near their places of service, while reinforcing their own roles as educators.

  12. The European Federation of Organisations for Medical Physics Policy Statement No. 10.1: Recommended Guidelines on National Schemes for Continuing Professional Development of Medical Physicists.

    Science.gov (United States)

    Christofides, Stelios; Isidoro, Jorge; Pesznyak, Csilla; Cremers, Florian; Figueira, Rita; van Swol, Christiaan; Evans, Stephen; Torresin, Alberto

    2016-01-01

    Continuing Professional Development (CPD) is vital to the medical physics profession if it is to embrace the pace of change occurring in medical practice. As CPD is the planned acquisition of knowledge, experience and skills required for professional practice throughout one's working life it promotes excellence and protects the profession and public against incompetence. Furthermore, CPD is a recommended prerequisite of registration schemes (Caruana et al. 2014) and is implied in the Council Directive 2013/59/EURATOM (EU BSS) and the International Basic Safety Standards (BSS). It is to be noted that currently not all national registration schemes require CPD to maintain the registration status necessary to practise medical physics. Such schemes should consider adopting CPD as a prerequisite for renewing registration after a set period of time. This EFOMP Policy Statement, which is an amalgamation and an update of the EFOMP Policy Statements No. 8 and No. 10, presents guidelines for the establishment of national schemes for CPD and activities that should be considered for CPD. Copyright © 2016. Published by Elsevier Ltd.

  13. A continuous usability evaluation of an electronic medication administration record application.

    Science.gov (United States)

    Vicente Oliveros, Noelia; Gramage Caro, Teresa; Pérez Menéndez-Conde, Covadonga; Álvarez-Diaz, Ana María; Martín-Aragón Álvarez, Sagrario; Bermejo Vicedo, Teresa; Delgado Silveira, Eva

    2017-12-01

    The complexity of an electronic medication administration record (eMAR) has been underestimated by most designers in the past. Usability issues, such as poorly designed user application flow in eMAR, are therefore of vital importance, since they can have a negative impact on nursing activities and result in poor outcomes. The purpose of this study was to evaluate the usability of an eMAR application during its development. A usability evaluation was conducted during the development of the eMAR application. Two usability methods were used: a heuristic evaluation complemented by usability testing. Each eMAR application version provided by the vendor was evaluated by 2 hospital pharmacists, who applied the heuristic method. They reviewed the eMAR tasks, detected usability problems and their heuristic violations, and rated the severity of the usability problems. Usability testing was used to assess the final application version by observing how 3 nurses interacted with the application. Thirty-four versions were assessed before the eMAR application was considered usable. During the heuristic evaluation, the usability problems decreased from 46 unique usability problems in version 1 (V1) to 9 in version 34 (V34). In V1, usability problems were categorized into 154 heuristic violations, which decreased to 27 in V34. The average severity rating also decreased from major usability problem (2.96) to no problem (0.23). During usability testing, the 3 nurses did not encounter new usability problems. A thorough heuristic evaluation is a good method for obtaining a usable eMAR application. This evaluation points key areas for improvement and decreases usability problems and their severity. © 2017 John Wiley & Sons, Ltd.

  14. Teaching a Systematic Approach for Transitioning Patients to College: An Interactive Continuing Medical Education Program.

    Science.gov (United States)

    Martel, Adele; Derenne, Jennifer; Chan, Vivien

    2015-10-01

    The purpose of this article is to determine the effectiveness of a hands-on continuing education program for practicing child and adolescent psychiatrists (CAPs) with a focus on best practices in transitioning psychiatric patients to college. The plan was to build on the unique knowledge and skill set of CAPs, use audience and facilitator feedback from prior programs to inform program content, structure, and format, and incorporate findings from the evolving literature. A 3-h interactive workshop was designed with an emphasis on audience participation. The workshop was divided into three main segments: didactics, whole group discussion/brainstorming, and small group discussion of illustrative case vignettes. Improvements and changes in knowledge, skills, and attitudes related to transition planning were identified by program participants. Quantitative feedback in the form of course evaluations, pre- and posttests, and a 6-month follow-up questionnaire indicate that the use of interactive teaching techniques is a productive learning experience for practicing CAPs. Qualitative feedback was that the discussion of the case vignettes was the most helpful. The use of a workshop format is an effective strategy to engage practicing CAPs in learning about and implementing best practices to support the transition of their patients to college and into young adulthood. Comprehensive and proactive transition planning, facilitated by clinicians, should promote the wellness of college-bound patients and help to reduce the potential risks in the setting of an upcoming transition.

  15. Lifelong Learning for Clinical Practice: How to Leverage Technology for Telebehavioral Health Care and Digital Continuing Medical Education.

    Science.gov (United States)

    Hilty, Donald M; Turvey, Carolyn; Hwang, Tiffany

    2018-03-12

    Psychiatric practice continues to evolve and play an important role in patients' lives, the field of medicine, and health care delivery. Clinicians must learn a variety of clinical care systems and lifelong learning (LLL) is crucial to apply knowledge, develop skills, and adjust attitudes. Technology is rapidly becoming a key player-in delivery, lifelong learning, and education/training. The evidence base for telepsychiatry/telemental health via videoconferencing has been growing for three decades, but a greater array of technologies have emerged in the last decade (e.g., social media/networking, text, apps). Clinicians are combining telepsychiatry and these technologies frequently and they need to reflect on, learn more about, and develop skills for these technologies. The digital age has solidified the role of technology in continuing medical education and day-to-day practice. Other fields of medicine are also adapting to the digital age, as are graduate and undergraduate medical education and many allied mental health organizations. In the future, there will be more online training, simulation, and/or interactive electronic examinations, perhaps on a monthly cycle rather than a quasi-annual or 10-year cycle of recertification.

  16. [Continuing medical education and accreditation in occupational health: the new context].

    Science.gov (United States)

    Franco, G; Costa, G

    2008-01-01

    In the future many changes will extensively affect workforce, workplace and work organization. The changes expected in the workforce will be a larger share of workers over 55 years and of women and a larger share of migrants. Two main changes will affect the workplace: the increasing percentage of jobs in the service sector and the decreasing permanent relationship of the worker with the workplace with an increase in temporary work, on-call work and work at home. The evolution of global trade is accelerating the transformation of work organization, with important changes in management systems, production and services processes and their influence on the way work is performed. Although working conditions will continue to improve overall, many matters remain to be resolved due to the increase in workers' health demands and awareness. Old diseases, such as tuberculosis, and new aspects of the more common health disorders, such as stress related-disorders, will represent a challenge for the specialist. In addition, new hazards, such as the exposure to nanoparticles or to static magnetic fields, will be conditions worthy to be considered for the possible implication to health. The workplace will represent a privileged place to promote health and well being of workers aiming at ensuring an effective healthy lifestyle, career and employment security. In this rapidly changing and demanding context, a new challenge for the occupational physicians will start with having a good understanding of the implications for adhering to the ethical principles and to values of quality, equity, relevance and cost-effectiveness and maintaining a balance among them.

  17. The role of audience characteristics and external factors in continuing medical education and physician change: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.

    Science.gov (United States)

    Lowe, Mary Martin; Bennett, Nancy; Aparicio, Alejandro

    2009-03-01

    The Agency for Healthcare Research and Quality (AHRQ) Evidence Report identified and assessed audience characteristics (internal factors) and external factors that influence the effectiveness of continuing medical education (CME) in changing physician behavior. Thirteen studies examined a series of CME audience characteristics (internal factors), and six studies looked at external factors to reinforce the effects of CME in changing behavior. With regard to CME audience characteristics, the 13 studies examined age, gender, practice setting, years in practice, specialty, foreign vs US medical graduate, country of practice, personal motivation, nonmonetary rewards and motivations, learning satisfaction, and knowledge enhancement. With regard to the external characteristics, the six studies looked at the role of regulation, state licensing boards, professional boards, hospital credentialing, external audits, monetary and financial rewards, academic advancement, provision of tools, public demand and expectations, and CME credit. No consistent findings were identified. The AHRQ Evidence Report provides no conclusions about the ways that internal or external factors influence CME effectiveness in changing physician behavior. However, given what is known about how individuals approach learning, it is likely that internal factors play an important role in the design of effective CME. Regulatory and professional organizations are providing new structures, mandates, and recommendations for CME activities that influence the way CME providers design and present activities, supporting a role that is not yet clear for external factors. More research is needed to understand the impact of these factors in enhancing the effectiveness of CME.

  18. Integrating Quality Improvement and Continuing Professional Development at an Academic Medical Center: A Partnership Between Practice Plan, Hospital, and Medical School.

    Science.gov (United States)

    Gold, Barbara; England, Dawn; Riley, William; Jacobs-Halsey, Ginny; Webb, Corinne; Daniels, Bobbi

    2016-01-01

    While quality improvement (QI) initiatives can be a highly effective means for improving health care delivery in academic medical centers (AMCs), many health care professionals are not formally trained in basic QI methodology, engaging clinicians in QI activities can be challenging, and there is often a lack of integration and coordination among QI functions (eg, Departments of Quality and Safety, Continuing Professional Development). In our AMC, we undertook a collaborative approach to achieve better vertical and horizontal integration of our QI education efforts. This article provides a case example describing our organizational context, what was done, and with what effect and makes our example and lessons learned available to others. We developed a new educational QI program that was jointly planned and implemented by a group comprising major QI stakeholders. This project was intended to create horizontal organizational linkages between continuing professional development, clinicians, the hospital, and QI department and produce QI activities that aligned with the strategic objectives of senior management. The group developed and implemented a curriculum based on Lean methodology and concepts from the Institute for Health Care Improvement Model for Improvement. Two cohorts (27 teams) completed the training and planned and implemented QI projects. All projects were aligned with organizational quality, safety, and patient experience goals. The majority of projects met their aim statements. This case description provides an example of successful horizontal integration of an AMCs' QI functions to disseminate knowledge and implement meaningful QI aligned with strategic objectives (vertical integration).

  19. An Analysis of 2.3 Million Participations in the Continuing Medical Education Program of a General Medical Journal: Suitability, User Characteristics, and Evaluation by Readers.

    Science.gov (United States)

    Christ, Hildegard; Franklin, Jeremy; Griebenow, Reinhard; Baethge, Christopher

    2017-04-03

    Physicians frequently use continuing medical education (CME) in journals. However, little is known of the evaluation of journal CME by readers and also user and participation characteristics. Deutsches Ärzteblatt, the journal of the German Medical Association, is distributed to every physician in Germany and regularly offers its readers CME articles. Therefore, it provides a unique opportunity to analyze a journal CME program directed at an entire population of physicians. The aim is to show key sociodemographic characteristics of participants, frequency and temporal distributions of participations, and to analyze whether the articles are suitable for a general medical audience, how physicians rate the CME articles, how successful they were in answering simple multiple-choice questions, and to detect distinct clusters of participants. Using obligatory online evaluation forms and multiple-choice questions, we analyzed all participations of the entire 142 CME articles published between September 2004 and February 2014. We compared demographic characteristics of participants with official figures on those characteristics as provided by the German Medical Association. A total of 128,398 physicians and therapists (male: 54.64%, 70,155/128,393; median age class 40 to 49 years) participated 2,339,802 times (mean 16,478, SD 6436 participations/article). Depending on the year, between 12.33% (44,064/357,252) and 16.15% (50,259/311,230) of all physicians in the country participated at least once. The CME program was disproportionally popular with physicians in private practice, and many participations took place in the early mornings and evenings (4544.53%, 1,041,931/2,339,802) as well as over the weekend (28.70%, 671,563/2,339,802). Participation by specialty (ranked in descending order) was internal medicine (18.25%, 23,434/128,392), general medicine (16.38%, 21,033/128,392), anesthesiology (10.00%, 12,840/128,392), and surgery (7.06%, 9059/128,392). Participants rated

  20. The mCME Project: A Randomized Controlled Trial of an SMS-Based Continuing Medical Education Intervention for Improving Medical Knowledge among Vietnamese Community Based Physicians' Assistants.

    Directory of Open Access Journals (Sweden)

    Christopher J Gill

    Full Text Available Community health workers (CHWs provide critical services to underserved populations in low and middle-income countries, but maintaining CHW's clinical knowledge through formal continuing medical education (CME activities is challenging and rarely occurs. We tested whether a Short Message Service (SMS-based mobile CME (mCME intervention could improve medical knowledge among a cadre of Vietnamese CHWs (Community Based Physician's Assistants-CBPAs who are the leading providers of primary medical care for rural underserved populations.The mCME Project was a three arm randomized controlled trial. Group 1 served as controls while Groups 2 and 3 experienced two models of the mCME intervention. Group 2 (passive model participants received a daily SMS bullet point, and were required to reply to the text to acknowledge receipt; Group 3 (interactive model participants received an SMS in multiple choice question format addressing the same thematic area as Group 2, entering an answer (A, B, C or D in their response. The server provided feedback immediately informing the participant whether the answer was correct. Effectiveness was based on standardized examination scores measured at baseline and endline (six months later. Secondary outcomes included job satisfaction and self-efficacy.638 CBPAs were enrolled, randomized, and tested at baseline, with 592 returning at endline (93.7%. Baseline scores were similar across all three groups. Over the next six months, participation of Groups 2 and 3 remained high; they responded to >75% of messages. Group 3 participants answered 43% of the daily SMS questions correctly, but their performance did not improve over time. At endline, the CBPAs reported high satisfaction with the mCME intervention, and deemed the SMS messages highly relevant. However, endline exam scores did not increase over baseline, and did not differ between the three groups. Job satisfaction and self-efficacy scores also did not improve. Average

  1. "It is the medicines that keep us alive" : Lived experiences of diabetes medication use and continuity among adults in Southeastern Tanzania

    NARCIS (Netherlands)

    E. Metta (Emmy); H. Haisma (Hinke); F. Kessy (Flora); E. Geubbels (Eveline); I. Hutter (Inge); A. Bailey (Ajay)

    2015-01-01

    markdownabstractBackground: Diabetes is a chronic condition which requires many patients to use medications for the remainder of their lives. While this regimen is demanding, little research has been done on the experiences individuals have with diabetes medication use and the continuity of use,

  2. "It is the medicines that keep us alive" : lived experiences of diabetes medication use and continuity among adults in Southeastern Tanzania

    NARCIS (Netherlands)

    Metta, Emmy; Haisma, Hinke; Kessy, Flora; Geubbels, Eveline; Hutter, Inge; Bailey, Ajay

    2015-01-01

    Background: Diabetes is a chronic condition which requires many patients to use medications for the remainder of their lives. While this regimen is demanding, little research has been done on the experiences individuals have with diabetes medication use and the continuity of use, especially patients

  3. Development and evaluation of a simulation-based continuing medical education course: beyond lectures and credit hours.

    Science.gov (United States)

    Pugh, Carla M; Arafat, Fahd O; Kwan, Calvin; Cohen, Elaine R; Kurashima, Yo; Vassiliou, Melina C; Fried, Gerald M

    2015-10-01

    The aim of our study was to modify our previously developed laparoscopic ventral hernia (LVH) simulator to increase difficulty and then reassess validity and feasibility for using the simulator in a newly developed simulation-based continuing medical education course. Participants (N = 30) were practicing surgeons who signed up for a hands-on postgraduate laparoscopic hernia course. An LVH simulator, with prior validity evidence, was modified for the course to increase difficulty. Participants completed 1 of the 3 variations in hernia anatomy: incarcerated omentum, incarcerated bowel, and diffuse adhesions. During the procedure, course faculty and peer observers rated surgeon performance using Global Operative Assessment of Laparoscopic Skills-Incisional Hernia and Global Operative Assessment of Laparoscopic Skills rating scales with prior validity evidence. Rating scale reliability was reassessed for internal consistency. Peer and faculty raters' scores were compared. In addition, quality and completeness of the hernia repairs were rated. Internal consistency on the general skills performance (peer α = .96, faculty α = .94) and procedure-specific performance (peer α = .91, faculty α = .88) scores were high. Peers were more lenient than faculty raters on all LVH items in both the procedure-specific skills and general skills ratings. Overall, participants scored poorly on the quality and completeness of their hernia repairs (mean = 3.90/16, standard deviation = 2.72), suggesting a mismatch between course attendees and hernia difficulty and identifying a learning need. Simulation-based continuing medical education courses provide hands-on experiences that can positively affect clinical practice. Although our data appear to show a significant mismatch between clinical skill and simulator difficulty, these findings also underscore significant learning needs in the surgical community. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. A clinical nurse specialist-led intervention to enhance medication adherence using the plan-do-check-act cycle for continuous self-improvement.

    Science.gov (United States)

    Russell, Cynthia L

    2010-01-01

    A clinical nurse specialist-led intervention to improve medication adherence in chronically ill adults using renal transplant recipients as an exemplar population is proposed. Meta-analyses and systematic reviews of chronically ill and transplant patients indicate that patient-specific characteristics not only are poor and inconsistent predictors for medication nonadherence but also are not amenable to intervention. Adherence has not meaningfully improved, despite meta-analyses and systematic narrative reviews of randomized controlled trials (RCTs) dealing with medication nonadherence in acutely and chronically ill persons and RCTs dealing with transplant patients. Interventions with a superior potential to enhance medication adherence must be developed. Use of a clinical nurse specialist-led continuous self-improvement intervention with adult renal transplant recipients is proposed. Continuous self-improvement focuses on improving personal systems thinking and behavior using the plan-do-check-act process. Electronic medication monitoring reports, one of several objective measures of medication adherence, are used by the clinician to provide patient feedback during the check process on medication-taking patterns. Continuous self-improvement as an intervention holds promise in supporting patient self-management and diminishing the blame that clinicians place on patients for medication nonadherence. Using an objective measure of medication adherence such as an electronic monitoring report fosters collaborative patient-clinician discussions of daily medication-taking patterns. Through collaboration, ideas for improving medication taking can be explored. Changes can be followed and evaluated for effectiveness through the continuous self-improvement process. Future studies should include RCTs comparing educational and/or behavioral interventions to improve medication adherence.

  5. A COMPARISON OF INTERNET-BASED LEARNING AND TRADITIONAL CLASSROOM LECTURE TO LEARN CPR FOR CONTINUING MEDICAL EDUCATION

    Directory of Open Access Journals (Sweden)

    Naser HEMMATI

    2013-01-01

    Full Text Available The purpose of this study was to compare the satisfaction and effectiveness of Internet-based learning (IBL and traditional classroom lecture (TCL for continuing medical education (CME programs by comparing final resuscitation exam results of physicians who received the newest cardiopulmonary resuscitation (CPR curriculum guidelines training either by traditional or by an Internet-based CME. A randomized two-group pretest-posttest quasi-experimental design was used. Postgraduate general physician trainees of Iran medical schools were participated. Two methods were compared for teaching the newest curriculum guidelines of the American Heart Association: lecture method in which the teacher follows a Power point presentation with linear layout, and with interactive self-assessment and Scenario-based learning, feedback, multimedia with linear and nonlinear layout with the same power point presentation as lecture in terms of text and photography. The data on final CPR exam grades, collected both groups trained physicians, were obtained for a total of 80 physicians in 2011. An independent sample t-test analysis indicated that participants in the IBL format reported significantly higher mean ratings for this format (62.5 ±2.32 than TCL format (54.6±2.18 (p=.001. There were no significant differences between the two groups in cognitive gains (p<0.05. well-designed IBL content can be effective or a supplement component to CME.

  6. Are online learning modules an effective way to deliver hand trauma management continuing medical education to emergency physicians?

    Science.gov (United States)

    Williams, Jason G

    2014-01-01

    The enormity of modern medical knowledge and the rapidity of change have created increased need for ongoing or continuing medical education (CME) for physicians. Online CME is attractive for its availability at any time and any place, low cost and potentially increased effectiveness compared with traditional face-to-face delivery. To determine whether online CME modules are an effective method for delivering plastic surgery CME to primary care physicians. A needs assessment survey was conducted among all emergency and family physicians in Nova Scotia. Results indicated that this type of program was appealing, and that hand trauma related topics were most desired for CME. 7 Lesson Builder (SoftChalk LLC, www.softchalk.com) was used to construct a multimedia e-learning module that was distributed along with a pretest, post-test and feedback questionnaire. Quantitative (pre- and post-test scores) and qualitative (feedback responses) data were analyzed. The 32 participants who completed the study indicated that it was a positive and enjoyable experience, and that there was a need for more resources like this. Compared with pretest scores, there was a significant gain in knowledge following completion of the module (P=0.001). The present study demonstrated that an e-learning format is attractive for this population and effective in increasing knowledge. This positive outcome will lead to development of additional modules.

  7. Feasibility of scenario-based simulation training versus traditional workshops in continuing medical education: a randomized controlled trial

    Science.gov (United States)

    Kerr, Brendan; Hawkins, Trisha Lee-Ann; Herman, Robert; Barnes, Sue; Kaufmann, Stephanie; Fraser, Kristin; Ma, Irene W. Y.

    2013-01-01

    Introduction Although simulation-based training is increasingly used for medical education, its benefits in continuing medical education (CME) are less established. This study seeks to evaluate the feasibility of incorporating simulation-based training into a CME conference and compare its effectiveness with the traditional workshop in improving knowledge and self-reported confidence. Methods Participants (N=27) were group randomized to either a simulation-based workshop or a traditional case-based workshop. Results Post-training, knowledge assessment score neither did increase significantly in the traditional group (d=0.13; p=0.76) nor did significantly decrease in the simulation group (d= − 0.44; p=0.19). Self-reported comfort in patient assessment parameters increased in both groups (psimulation-based training was not associated with benefits in knowledge acquisition, knowledge retention, or comfort in patient assessment. It was associated with superior outcomes in comfort in patient management, but this benefit may be short-lived. Further studies are required to better define the conditions under which simulation-based training is beneficial. PMID:23870304

  8. continuing medical education

    African Journals Online (AJOL)

    joints and associated early-morning stiffness. He gave a history of leg ulcers 8 years ago. He had never been to school and never been sexually active. ... 2 376 µg/L, with normal iron levels. Urea and electrolyte levels and liver function tests were normal. Chromosomal studies were in keeping with Klinefelter's syndrome.

  9. Continuing Medical Education

    African Journals Online (AJOL)

    The PDF file you selected should load here if your Web browser has a PDF reader plug-in installed (for example, a recent version of Adobe Acrobat Reader). If you would like more information about how to print, save, and work with PDFs, Highwire Press provides a helpful Frequently Asked Questions about PDFs.

  10. Continuing Medical Education

    African Journals Online (AJOL)

    Anaphylaxis, the most serious of the allergic conditions, is a sudden, severe, potentially fatal systemic reaction. It may involve the skin, respiratory tract, gastrointestinal tract or cardiovascular system. Symptoms occur within minutes to two hours a er contact with the allergy-causing substance. CME January 2013 Vol. 31 No.

  11. Archives: Continuing Medical Education

    African Journals Online (AJOL)

    Items 1 - 50 of 88 ... AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners · Terms and Conditions of Use · Contact AJOL · News. OTHER RESOURCES... for Researchers · for Journals · for Authors · for Policy Makers · about Open Access ...

  12. Continuing Medical Education: Submissions

    African Journals Online (AJOL)

    When selecting topics and writing the articles keep in mind that it is aimed at those who are not specialists in the field. The guest editor, in consultation with the editor, is responsible for convening a team of authors, deciding on the subjects to be covered and for reviewing the manuscripts submitted. The suggestion is for five ...

  13. The effectiveness of holistic diabetic management between Siriraj Continuity of Care clinic and medical out-patient department.

    Science.gov (United States)

    Chalermsri, Chalobol; Paisansudhi, Supalerg; Kantachuvesiri, Pitchaporn; Pramyothin, Pornpoj; Washirasaksiri, Chaiwat; Srivanichakorn, Weerachai; Nopmaneejumruslers, Cherdchai; Chouriyagune, Charoen; Pandejpong, Denla; Phisalprapa, Pochamana

    2014-03-01

    Diabetes mellitus is one of the most common diseases in the Thai population, and it is well known that diabetic complications could be prevented with appropriate management. Despite published guidelines, most Thai patients with diabetes do not achieve treatment goals. Siriraj Continuity of Care clinic (CC clinic) was recently established in order to provide training for medical students and internal medicine residents. It is possible that the training component in the CC clinic may contribute to better overall outcomes in type 2 diabetes mellitus (type 2 DM) patients when compared with usual care at the medical out-patient department (OPD). To compare the effectiveness of diabetic management in type 2 diabetes mellitus patients who attended the CC clinic and the medical OPD. Retrospective chart review was performed in type 2 diabetes mellitus patients who were treated at either clinic at Siriraj Hospital in 2007-2011. Baseline demographics, treatment strategies and outcomes, and participation in an appropriate health maintenance program were assessed in both groups. Seven hundred and fifty seven medical records were reviewed, including 383 patients in the CC clinic group and 374 in the OPD group. Mean HbA1c was significantly lower in the CC clinic group compared with the OPD group (7.3 +/- 0.9% and 7.8 +/- 1.3%, respectively, < 0.001). The number of patients who achieved goal HbA1c of less than 7% in CC clinic group was 123 (32.1%) compared with 91 (24.3%) in the OPD group (p = 0.039). More patients were screened for diabetic complications in the CC clinic group compared with the OPD group, including screening for diabetic neuropathy (57.4% vs. 2.1%, p < 0.001), diabetic retinopathy (56.7% vs. 36.6%, p < 0.001), and diabetic nephropathy (80.9% vs. 36.9%, p < 0.001). Patients in the CC clinic group had a higher rate of age-appropriate cancer screening than those in the OPD group (54.2% vs. 13.3%, p < 0.001 for breast cancer; 24.0% vs. 0.9%, p < 0.001 for cervical

  14. Feasibility of scenario-based simulation training versus traditional workshops in continuing medical education: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Brendan Kerr

    2013-07-01

    Full Text Available Introduction: Although simulation-based training is increasingly used for medical education, its benefits in continuing medical education (CME are less established. This study seeks to evaluate the feasibility of incorporating simulation-based training into a CME conference and compare its effectiveness with the traditional workshop in improving knowledge and self-reported confidence. Methods: Participants (N=27 were group randomized to either a simulation-based workshop or a traditional case-based workshop. Results: Post-training, knowledge assessment score neither did increase significantly in the traditional group (d=0.13; p=0.76 nor did significantly decrease in the simulation group (d= − 0.44; p=0.19. Self-reported comfort in patient assessment parameters increased in both groups (p<0.05 in all. However, only the simulation group reported an increase in comfort in patient management (d=1.1, p=0.051 for the traditional group and d=1.3; p= 0.0003 for the simulation group. At 1 month, comfort measures in the traditional group increased consistently over time while these measures in the simulation group increased post-workshop but decreased by 1 month, suggesting that some of the effects of training with simulation may be short lived. Discussion: The use of simulation-based training was not associated with benefits in knowledge acquisition, knowledge retention, or comfort in patient assessment. It was associated with superior outcomes in comfort in patient management, but this benefit may be short-lived. Further studies are required to better define the conditions under which simulation-based training is beneficial.

  15. The importance of social and collaborative learning for online continuing medical education (OCME): directions for future development and research.

    Science.gov (United States)

    Sandars, John; Kokotailo, Patricia; Singh, Gurmit

    2012-01-01

    There is an increasing use of online continuing medical education (OCME), but the potential use of social and collaborative learning to change professional performance and improve patient care has yet to be fully realised. The integration of the main themes from the presentations and comments from participants at a symposium at AMEE 2011. Sociological perspectives on change in professional performance highlight the need for social and collaborative learning in OCME so that learners can share information (explicit knowledge) and opinion (tacit knowledge). The educational topic should be relevant to the complexity of professional practice and use iterative cycles of implementation and critical reflection in social networks so that proposed solutions can be tested in actual practice. The challenge of developing effective online discussions for collaborative learning is recognised. The provision of OCME requires a shift in both policy and practice to emphasise the importance of social and collaborative learning. Further research is recommended, especially to evaluate the implementation and impact of social and collaborative learning for OCME on patient care and the use of newer Web 2.0 approaches.

  16. Lab Safety and Bioterrorism Readiness Curricula Using Active Learning and Hands-on Strategies as Continuing Education for Medical Technologists

    Directory of Open Access Journals (Sweden)

    Steven Fiester

    2010-04-01

    Full Text Available Frequent reports of laboratory- (and hospital- acquired infection suggest a deficiency in safety training or lack of compliance. To assess the need for continuing education (CE addressing this problem, an original education needs assessment survey was designed and administered to medical technologists (med-techs in Northeast Ohio. Survey results were used to design a learner-centered training curriculum (for example, Lab Safety and Bioterrorism Readiness trainings that engaged med-techs in active learning, integrative peer-to-peer teaching, and hands-on exercises in order to improve microbiology safety knowledge and associated laboratory techniques. The Lab Safety training was delivered six times and the Bioterrorism Readiness training was delivered five times. Pre/posttesting revealed significant gains in knowledge and techniques specific to laboratory safety, security, risk assessment, and bioterrorism readiness amongst the majority of med-techs completing the CE trainings. The majority of participants felt that the hands-on exercises met their needs and that their personal laboratory practices would change as a result of the training course, as measured by attitudinal surveys. We conclude that active learning techniques and peer education significantly enhance microbiology learning amongst participating med-techs.

  17. Applicability of the theory of planned behavior in explaining the general practitioners eLearning use in continuing medical education.

    Science.gov (United States)

    Hadadgar, Arash; Changiz, Tahereh; Masiello, Italo; Dehghani, Zahra; Mirshahzadeh, Nahidossadat; Zary, Nabil

    2016-08-22

    General practitioners (GP) update their knowledge and skills by participating in continuing medical education (CME) programs either in a traditional or an e-Learning format. GPs' beliefs about electronic format of CME have been studied but without an explicit theoretical framework which makes the findings difficult to interpret. In other health disciplines, researchers used theory of planned behavior (TPB) to predict user's behavior. In this study, an instrument was developed to investigate GPs' intention to use e-Learning in CME based on TPB. The goodness of fit of TPB was measured using confirmatory factor analysis and the relationship between latent variables was assessed using structural equation modeling. A total of 148 GPs participated in the study. Most of the items in the questionnaire related well to the TPB theoretical constructs, and the model had good fitness. The perceived behavioral control and attitudinal constructs were included, and the subjective norms construct was excluded from the structural model. The developed questionnaire could explain 66 % of the GPs' intention variance. The TPB could be used as a model to construct instruments that investigate GPs' intention to participate in e-Learning programs in CME. The findings from the study will encourage CME managers and researchers to explore the developed instrument as a mean to explain and improve the GPs' intentions to use eLearning in CME.

  18. The Influence of a Continuing Medical Education Campaign on New Strategies to Improve Appropriate Use of Antibiotics

    Directory of Open Access Journals (Sweden)

    Brenda A. Bucklin

    2015-01-01

    Full Text Available Introduction. Widespread use of antibiotics has led to drug-resistant bacteria and reports of drug-resistant infections. A continuing medical education (CME campaign was used to improve antibiotic use among primary care providers. Methods. The Office of CME and Professional Development at the University of Colorado School of Medicine produces a semiannual, week-long course for primary care providers. A 2-year multifaceted CME campaign consisted of course content on antibiotic use, a practice audit, and two surveys to measure perceptions of the problem of antibiotic overuse, potential barriers to achieving appropriate use, and strategies to overcome barriers. Results. The overall response rate in the 2nd part of the campaign was 68.4%. Sixty-six percent of respondents had implemented at least one strategy to reduce antibiotic overuse. The rate was significantly higher among those who had attended previous reviews (81.0% compared with those who had attended neither (54%, p=0.0002. However, there was no “dose effect” on the rate of implementing a new strategy. Conclusions. Overuse of antibiotic therapy has important public health implications. Results suggest that mixed interactive and didactic CME program was effective in increasing awareness of antibiotic overuse and strategies for reducing antibiotic administration.

  19. The continuing medical education activities and attitudes of Australian doctors working in different clinical specialties and practice locations.

    Science.gov (United States)

    Stewart, Grant D; Khadra, Mohamed H

    2009-02-01

    Currently, it is not clear which continuing medical education (CME) methods are being used by senior doctors and what their attitudes towards them are. The aims of this study were to investigate which modes of CME delivery senior Australian doctors utilise, to assess doctors' attitudes towards CME and to determine any differences in modes used and attitudes between clinical specialties and practice locations. A 52-statement questionnaire enquiring about doctors' current CME activities and their attitudes towards CME was distributed to 1336 senior Australian doctors. 494 doctors responded to the questionnaire. Traditional forms of CME (eg, meetings, conferences, journals and lectures) were most commonly used. Doctors thought CME involving face-to-face interaction was superior to electronic forms of CME. All doctors, especially those in hospital practice, had a positive attitude towards CME but found lack of time a barrier to learning. Rural doctors found CME sessions more difficult to attend than did their metropolitan colleagues. Traditional forms of CME were more popular than modern CME approaches, such as e-learning. Australian doctors had a positive attitude towards undertaking CME despite struggling to find time to perform CME. The differences in attitudes towards CME demonstrated between specialties and different practice location will aid future CME planning.

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

    Science.gov (United States)

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

    2016-01-01

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

  1. Online continuing medical education as a key link for successful noncommunicable disease self-management: the CASALUD™ Model

    Directory of Open Access Journals (Sweden)

    Gallardo-Rincón H

    2017-10-01

    Full Text Available Héctor Gallardo-Rincón,1 Rodrigo Saucedo-Martínez,1 Ricardo Mujica-Rosales,1 Evan M Lee,2 Amy Israel,2 Braulio Torres-Beltran,3 Úrsula Quijano-González,3 Elena Rose Atkinson,3 Pablo Kuri-Morales,4 Roberto Tapia-Conyer1 1Fundación Carlos Slim, Mexico City, Mexico; 2Lilly Global Health, Eli Lilly and Company, Vernier, Switzerland; 3C230 Consultores, Mexico City, Mexico; 4Mexican Ministry of Health, Mexico City, Mexico Purpose: The purpose of this study is to evaluate how the benefits of online continuing medical education (CME provided to health care professionals traveled along a patient “educational chain”. In this study, the educational chain begins with the influence that CME can have on the quality of health care, with subsequent influence on patient knowledge, disease self-management, and disease biomarkers. Methods: A total of 422 patients with at least one noncommunicable disease (NCD treated in eight different Mexican public health clinics were followed over 3 years. All clinics were participants in the CASALUD Model, an NCD care model for primary care, where all clinic staff were offered CME. Data were collected through a questionnaire on health care, patient disease knowledge, and self-management behaviors; blood samples and anthropometric measurements were collected to measure patient disease biomarkers. Results: Between 2013 and 2015, the indexes measuring quality of health care, patient health knowledge, and diabetes self-management activities rose moderately but significantly (from 0.54 to 0.64, 0.80 to 0.84, and 0.62 to 0.67, respectively. Performing self-care activities – including owning and using a glucometer and belonging to a disease support group – saw the highest increase (from 0.65 to 0.75. A1C levels increased between 2013 and 2015 from 7.95 to 8.41% (63–68 mmol/mol (P<0.001, and blood pressure decreased between 2014 and 2015 from 143.7/76.8 to 137.5/74.4 (systolic/diastolic reported in mmHg (P<0

  2. A qualitative assessment of practitioner perspectives post-introduction of the first Continuous Professional Competence (CPC) guidelines for emergency medical technicians in Ireland.

    LENUS (Irish Health Repository)

    Knox, Shane

    2015-01-01

    In November 2013, the Irish Regulator for emergency medical technicians (EMTs) introduced the first mandatory requirement for registrants to demonstrate evidence of continuous professional development (CPD)\\/continuous professional competence (CPC). This qualitative study assessed the experience of practitioners with CPC-related materials provided to them by the Regulator in addition to identifying perceived or encountered practical challenges and suggested improvements six months following introduction of the requirement.

  3. USING ONLINE MARKETING TO INCREASE PARTICIPATION IN A WEB-BASED CONTINUING MEDICAL EDUCATION CULTURAL COMPETENCE CURRICULUM

    Science.gov (United States)

    Estrada, Carlos A.; Krishnamoorthy, Periyakaruppan; Smith, Ann; Staton, Lisa; Korf, Michele J.; Allison, Jeroan J.; Houston, Thomas K.

    2012-01-01

    Introduction CME providers may be interested in identifying effective marketing strategies to direct users to specific content. The use of online advertisements to recruit participants for clinical trials, public health programs, and Continuing Medical Education (CME) has been shown to be effective in some but not all studies. The purpose of this study was to compare the impact of two marketing strategies in the context of an online CME cultural competence curriculum (www.c-comp.org). Methods In an interrupted time-series quasi-experimental design, two marketing strategies were tested: a) wide dissemination to relevant organizations over a period of approximately four months, and b) Internet paid search using Google Ads (five consecutive eight-week periods--control 1, cultural/ CME advertisement, control 2, hypertension/ content advertisement, control 3). Outcome measures were CME credit requests, Web traffic (visits per day, page views, pages viewed per visit), and cost. Results Overall, the site was visited 19,156 times and 78,160 pages were viewed. During the wide dissemination phase, the proportion of visits requesting CME credit decreased between the first (5.3%) and second halves (3.3%) of this phase (p= .04). During the Internet paid search phase, the proportion of visits requesting CME credit was highest during the cultural/ CME advertisement period (control 1, 1.4%; cultural/CME ad, 4.3%; control 2, 1.5%; hypertension/content ad, 0.6%; control 3, 0.8%; p<.001). All measures of Web traffic changed during the Internet paid search phase (p<.01); however, changes were independent of the advertisement periods. The incremental cost for the cultural advertisement per CME credit requested was $0.64US. Discussion Internet advertisement focusing on cultural competence and CME was associated with about a three-fold increase in requests for CME credit at an incremental cost of under $1; however, Web traffic changes were independent of the advertisement strategy. PMID

  4. Retention in medication-assisted treatment programs in Ukraine-Identifying factors contributing to a continuing HIV epidemic.

    Science.gov (United States)

    Dumchev, Kostyantyn; Dvoryak, Sergii; Chernova, Olena; Morozova, Olga; Altice, Frederick L

    2017-10-01

    Opioid agonist treatments (OAT) are widely-used, evidence-based strategies for treating opioid dependence and reducing HIV transmission. The positive benefits of OAT are strongly correlated with time spent in treatment, making retention a key indicator for program quality. This study assessed patient retention and associated factors in Ukraine, where OAT was first introduced in 2004. Data from clinical records of 2916 patients enrolled in OAT at thirteen sites from 2005 to 2012 were entered into an electronic monitoring system. Survival analysis methods were used to determine the probability of retention and its correlates. Twelve-month retention was 65.8%, improving from 27.7% in 2005, to 70.9% in 2011. In multivariable analyses, the correlates of retention were receiving medium and high doses of medication (compared to low doses, dropout aHR=0.57 for both medium and high doses), having not been tested for HIV and tuberculosis (compared to not being tested, dropout aHR=4.44 and 3.34, respectively), and among those who were tested-a negative TB test result (compared to receiving a positive test result, dropout aHR=0.67). Retention in Ukrainian OAT programs, especially in recent years, is comparable to other countries. The results confirm the importance of adequate OAT dosing (≥60mg of methadone, ≥8mg of buprenorphine). Higher dosing, however, will require interventions that address negative attitudes toward OAT by patients and providers. Interruption of OAT, in the case developing tuberculosis, should incorporate continuity of OAT for TB patients through integrated care delivery systems. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Continuous bedside pressure mapping and rates of hospital-associated pressure ulcers in a medical intensive care unit.

    Science.gov (United States)

    Behrendt, Robert; Ghaznavi, Amir M; Mahan, Meredith; Craft, Susan; Siddiqui, Aamir

    2014-03-01

    Critically ill patients are vulnerable to the development of hospital-associated pressure ulcers (HAPUs). Positioning of patients is an essential component of pressure ulcer prevention because it off-loads areas of high pressure. However, the effectiveness of such positioning is debatable. A continuous bedside pressure mapping (CBPM) device can provide real-time feedback of optimal body position though a pressure-sensing mat that displays pressure images at a patient's bedside, allowing off-loading of high-pressure areas and possibly preventing HAPU formation. A prospective controlled study was designed to determine if CBPM would reduce the number of HAPUs in patients treated in our medical intensive care unit. In 2 months, 422 patients were enrolled and assigned to beds equipped with or without a CBPM device. Patients' skin was assessed daily and weekly to determine the presence and progress of HAPUs. All patients were turned every 2 hours. CBPM patients were repositioned to off-load high-pressure points during turning, according to a graphic display. The number of newly formed HAPUs was the primary outcome measured. A χ(2) test was then used to compare the occurrence of HAPUs between groups. HAPUs developed in 2 of 213 patients in the CBPM group (0.9%; both stage II) compared with 10 of 209 in the control group (4.8%; all stage II; P = .02). Significantly fewer HAPUs occurred in the CBPM group than the control group, indicating the effectiveness of real-time visual feedback in repositioning of patients to prevent the formation of new HAPUs.

  6. Factors affecting the intention of providers to deliver more effective continuing medical education to general practitioners: a pilot study

    Directory of Open Access Journals (Sweden)

    Higginbotham Nick

    2003-12-01

    Full Text Available Abstract Background Despite the importance of continuing medical education (CME for GPs, there has been little research into how providers decide what types of CME to deliver to GPs. This study aimed to identify factors affecting the intention of providers to provide more effective types of CME; and to design a survey instrument which can be used to test the applicability of Triandis' model of social behaviour to the provision of CME to general practitioners. Methods This was a cross-sectional study on a convenience sample of 11 Australian providers of CME for interviews and a random sample of 25 providers for the pilot test. Open-ended interviews structured on Triandis' theory were performed with key informants who provide CME to GPs. These were used to develop a pilot survey instrument to measure the factors affecting intention, resulting in a revised instrument for use in further research. Results There was a broad range of factors affecting providers' intention to deliver more effective forms of CME identified, and these were classifiable in a manner which was consistent with Triandis' model. Key factors affecting providers' intention were the attitude toward CME within organisations and the time and extra work involved. Conclusions We identified a range of potential factors influencing the intention of providers to provide more effective forms of CME, in all categories of Triandis model. Those interested in increasing the choice of more effective CME activities available to GPs may need to broaden the methods used in working with providers to influence them to use more effective CME techniques. The interview material and questionnaire analysis of the pilot survey support the use of Triandis model. Further research is needed to validate Triandis'model for the intention to deliver more effective forms of CME. Such research will inform future strategies aimed at increasing the amount and choice of effective CME activities available for GPs.

  7. Survey of practices around pharmaceutical company funding for continuing professional development among medical oncologists and trainees in Australia.

    Science.gov (United States)

    Lee, Yeh Chen; Kroon, René; Koczwara, Bogda; Haines, Ian; Francis, Kay; Millward, Michael; Kefford, Richard; Olver, Ian; Mileshkin, Linda

    2017-08-01

    The completion of continuing professional development (CPD) is mandatory for medical oncologists and trainees (MO&T). Pharmaceutical companies may fund some CPD activities, but there is increasing debate about the potential for conflicts of interest (COI). To assess current practices around funding to attend CPD activities. An electronic survey was distributed to Australian MO&T. The survey asked questions about current practices, institutional policies and perceptions about attending CPD funded by pharmaceutical companies. The design looked at comparing responses between MO&T as well as their understanding of and training around institutional and ethical process. A total of 157 of 653 (24%) responses was received, the majority from MO (76%). Most CPD activities attended by MO&T were self-funded (53%), followed by funding from institutions (19%), pharmaceutical companies (16%) and salary award (16%). Most institutions allowed MO&T to receive CPD funding from professional organisations (104/157, 66%) or pharmaceutical companies (90/157, 57%). A minority of respondents (13/157, 8%) reported that the process to use pharmaceutical funds had been considered by an ethics committee. Although 103/157 (66%) had received pharmaceutical funding for CPD, most (109/157, 69%) reported never receiving training about potential COI. The lack of education was more noticeable among trainees (odds ratio (OR) 8.61, P = 0.02). MO&T acknowledged the potential bias towards a pharmaceutical product (P = 0.05) but believed there was adequate separation between themselves and pharmaceutical companies (P < 0.01). Majority of CPD attended by MO&T is self-funded. There is lack of clarity in institutional policies regarding external funding support for CPD activities. Formal education about potential COI is lacking. © 2017 Royal Australasian College of Physicians.

  8. Efficacy of an integrated continuing medical education (CME) and quality improvement (QI) program on radiation oncologist (RO) clinical practice

    International Nuclear Information System (INIS)

    Leong, Cheng Nang; Shakespeare, Thomas Philip; Mukherjee, Rahul K.; Back, Michael F.; Lee, Khai Mun; Lu, Jiade Jay; Wynne, Christopher J.; Lim, Keith; Tang, Johann; Zhang Xiaojian

    2006-01-01

    Purpose: There has been little radiation oncologist (RO)-specific research in continuing medical education (CME) or quality improvement (QI) program efficacy. Our aim was to evaluate a CME/QI program for changes in RO behavior, performance, and adherence to department protocols/studies over the first 12 months of the program. Methods and Materials: The CME/QI program combined chart audit with feedback (C-AWF), simulation review AWF (SR-AWF), reminder checklists, and targeted CME tutorials. Between April 2003 and March 2004, management of 75 patients was evaluated by chart audit with feedback (C-AWF) and 178 patients via simulation review audit (SR-AWF) using a validated instrument. Scores were presented, and case management was discussed with individualized educational feedback. RO behavior and performance was compared over the first year of the program. Results: Comparing the first and second 6 months, there was a significant improvement in mean behavior (12.7-13.6 of 14, p = 0.0005) and RO performance (7.6-7.9 of 8, p = 0.018) scores. Protocol/study adherence significantly improved from 90.3% to 96.6% (p = 0.005). A total of 50 actions were generated, including the identification of learning needs to direct CME tutorials, the systematic change of suboptimal RO practice, and the alteration of deficient management of 3% of patients audited during the program. Conclusion: An integrated CME/QI program combining C-AWF, SR-AWF, QI reminders, and targeted CME tutorials effectively improved targeted RO behavior and performance over a 12-month period. There was a corresponding increase in departmental protocol and study adherence

  9. Educational needs of family physicians in the domains of health and conformity with continuing education in Fasa University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    NAHID ZARIF SANAIEY

    2015-04-01

    Full Text Available Introduction: Assessment and prioritization are the first steps of planning. According to the family physician’s idea, evaluating programs in order to improve them is one of the necessities of promoting quality and increases the efficiency and effectiveness of continuing education. This study aimed to determine family physicians’ educational needs regarding health and its applicability in continuous medical education in Fasa University of Medical Sciences. Methods: In this cross-sectional study, viewpoints of 45 general physicians working at Fasa University of Medical Sciences in 2013 were studied. Samples were selected through census. Data collection was done using a researcher-made questionnaire using 10-point Likert scale and a checklist with Delphi technique. Content validity of the questionnaire and its reliability were confirmed by the experts’ opinion and Cronbach’s alpha of 80%. The data were analyzed through SPSS software version 16, using both descriptive and inferential statistics (mean and standard deviation, standard score (SQ, t-test, ANOVAs. A significance level of 0.05. The most educational conformity with continuing education was in the diseases area (topic 27%, content 37%. In the areas of environmental and professional health and health education, compliance was zero. Conclusions: The physicians stated that mental health was the first educational need and environmental and professional health was the last one. According to the results, proper continuing medical programs should be coordinated with educational needs.

  10. Tracking Residents Through Multiple Residency Programs: A Different Approach for Measuring Residents' Rates of Continuing Graduate Medical Education in ACGME-Accredited Programs.

    Science.gov (United States)

    Byrne, Lauren M; Holt, Kathleen D; Richter, Thomas; Miller, Rebecca S; Nasca, Thomas J

    2010-12-01

    Increased focus on the number and type of physicians delivering health care in the United States necessitates a better understanding of changes in graduate medical education (GME). Data collected by the Accreditation Council for Graduate Medical Education (ACGME) allow longitudinal tracking of residents, revealing the number and type of residents who continue GME following completion of an initial residency. We examined trends in the percent of graduates pursuing additional clinical education following graduation from ACGME-accredited pipeline specialty programs (specialties leading to initial board certification). Using data collected annually by the ACGME, we tracked residents graduating from ACGME-accredited pipeline specialty programs between academic year (AY) 2002-2003 and AY 2006-2007 and those pursuing additional ACGME-accredited training within 2 years. We examined changes in the number of graduates and the percent of graduates continuing GME by specialty, by type of medical school, and overall. The number of pipeline specialty graduates increased by 1171 (5.3%) between AY 2002-2003 and AY 2006-2007. During the same period, the number of graduates pursuing additional GME increased by 1059 (16.7%). The overall rate of continuing GME increased each year, from 28.5% (6331/22229) in AY 2002-2003 to 31.6% (7390/23400) in AY 2006-2007. Rates differed by specialty and for US medical school graduates (26.4% [3896/14752] in AY 2002-2003 to 31.6% [4718/14941] in AY 2006-2007) versus international medical graduates (35.2% [2118/6023] to 33.8% [2246/6647]). The number of graduates and the rate of continuing GME increased from AY 2002-2003 to AY 2006-2007. Our findings show a recent increase in the rate of continued training for US medical school graduates compared to international medical graduates. Our results differ from previously reported rates of subspecialization in the literature. Tracking individual residents through residency and fellowship programs provides

  11. Impaired driving from medical conditions: a 70-year-old man trying to decide if he should continue driving.

    Science.gov (United States)

    Rizzo, Matthew

    2011-03-09

    Some medical disorders can impair performance, increasing the risk of driving safety errors that can lead to vehicle crashes. The causal pathway often involves a concatenation of factors or events, some of which can be prevented or controlled. Effective interventions can operate before, during, or after a crash occurs at the levels of driver capacity, vehicle and road design, and public policy. A variety of systemic, neurological, psychiatric, and developmental disorders put drivers at potential increased risk of a car crash in the short or long term. Medical diagnosis and age alone are usually insufficient criteria for determining fitness to drive. Strategies are needed for determining what types and levels of reduced function provide a threshold for disqualification in drivers with medical disorders. Evidence of decreased mileage, self-restriction to driving in certain situations, collisions, moving violations, aggressive driving, sleepiness, alcohol abuse, metabolic disorders, and multiple medications may trigger considerations of driver safety. A general framework for evaluating driver fitness relies on a functional evaluation of multiple domains (cognitive, motor, perceptual, and psychiatric) that are important for safe driving and can be applied across many disorders, including conditions that have rarely been studied with respect to driving, and in patients with multiple conditions and medications. Neurocognitive tests, driving simulation, and road tests provide complementary sources of evidence to evaluate driver safety. No single test is sufficient to determine who should drive and who should not.

  12. Impaired driving from medical conditions: A 70-year-old man trying to decide if he should continue driving

    Science.gov (United States)

    Rizzo, Matthew

    2012-01-01

    Some medical disorders can impair performance, increasing the risk of driving safety errors that can lead to vehicle crashes. The causal pathway often involves a concatenation of factors or events, some of which can be prevented or controlled. Effective interventions can operate before, during, or after a crash occurs at the levels of driver capacity, vehicle and road design, and public policy. A variety of systemic, neurological, psychiatric, and developmental disorders put drivers at potential increased risk of a car crash in the short or long term. Medical diagnosis and age alone are usually insufficient criteria for determining fitness to drive. Strategies are needed for determining what types and levels of reduced function provide a threshold for disqualification in drivers with medical disorders. Evidence of decreased mileage, self-restriction to driving in certain situations, collisions, moving violations, aggressive driving, sleepiness, alcohol abuse, metabolic disorders, and multiple medications may trigger considerations of driver safety. A general framework for evaluating driver fitness relies on a functional evaluation of multiple domains (cognitive, motor, perceptual, and psychiatric) that are important for safe driving and can be applied across many disorders, including conditions that have rarely been studied with respect to driving, and in patients with multiple conditions and medications. Neurocognitive tests, driving simulation, and road tests provide complementary sources of evidence to evaluate driver safety. No single test is sufficient to determine who should drive and who should not. PMID:21364126

  13. Educational needs of family physicians in the domains of health and conformity with continuing education in Fasa University of Medical Sciences.

    Science.gov (United States)

    Zarif Sanaiey, Nahid; Karamnejad, Sahar; Rezaee, Rita

    2015-04-01

    Assessment and prioritization are the first steps of planning. According to the family physician's idea, evaluating programs in order to improve them is one of the necessities of promoting quality and increases the efficiency and effectiveness of continuing education. This study aimed to determine family physicians' educational needs regarding health and its applicability in continuous medical education in Fasa University of Medical Sciences. In this cross-sectional study, viewpoints of 45 general physicians working at Fasa University of Medical Sciences in 2013 were studied. Samples were selected through census. Data collection was done using a researcher-made questionnaire using 10-point Likert scale and a checklist with Delphi technique.  Content validity of the questionnaire and its reliability were confirmed by the experts' opinion and Cronbach's alpha of 80%.  The data were analyzed through SPSS software version 16, using both descriptive and inferential statistics (mean and standard deviation, standard score (SQ), t-test, ANOVAs). A significance level of mental health (SQ= 0.38), and environmental and professional health was the lowest priority (SQ= _0.24). Additionally, within each of the areas above specific priorities were determined. Based on the results of this study, gender, graduation date, cooperation time, and university they were educated in did not affect expressing educational needs (p>0.05). The most educational conformity with continuing education was in the diseases area (topic 27%, content 37%). In the areas of environmental and professional health and health education, compliance was zero. The physicians stated that mental health was the first educational need and environmental and professional health was the last one. According to the results, proper continuing medical programs should be coordinated with educational needs.

  14. Processing of Continuously Provided Punishment and Reward in Children with ADHD and the Modulating Effects of Stimulant Medication: An ERP Study

    OpenAIRE

    Groen, Yvonne; Tucha, Oliver; Wijers, Albertus A.; Althaus, Monika

    2013-01-01

    OBJECTIVES: Current models of ADHD suggest abnormal reward and punishment sensitivity, but the exact mechanisms are unclear. This study aims to investigate effects of continuous reward and punishment on the processing of performance feedback in children with ADHD and the modulating effects of stimulant medication. METHODS: 15 Methylphenidate (Mph)-treated and 15 Mph-free children of the ADHD-combined type and 17 control children performed a selective attention task with three feedback conditi...

  15. Patterns and predictors of evidence-based medication continuation among hospitalized heart failure patients (from Get With the Guidelines-Heart Failure).

    Science.gov (United States)

    Krantz, Mori J; Ambardekar, Amrut V; Kaltenbach, Lisa; Hernandez, Adrian F; Heidenreich, Paul A; Fonarow, Gregg C

    2011-06-15

    Hospitalized patients with heart failure and decreased ejection fraction are at substantial risk for mortality and rehospitalization, yet no acute therapies are proven to decrease this risk. Therefore, in-hospital use of medications proved to decrease long-term mortality is a critical strategy to improve outcomes. Although endorsed in guidelines, predictors of initiation and continuation of angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), β blockers, and aldosterone antagonists have not been well studied. We assessed noncontraindicated use patterns for the 3 medications using the Get With the Guidelines-Heart Failure (GWTG-HF) registry from February 2009 through March 2010. Medication continuation was defined as treatment on admission and discharge. Multivariable logistic regression using generalized estimating equations was used to determine factors associated with discharge use. In total 9,474 patients were enrolled during the study period. Of those treated before hospitalization, overall continuation rates were 88.5% for ACE inhibitors/ARBs, 91.6% for β blockers, and 71.9% for aldosterone-antagonists. Of patients untreated before admission, 87.4% had ACE inhibitors/ARBs and 90.1% had β blocker initiated during hospitalization or at discharge, whereas only 25.2% were started on an aldosterone antagonist. In multivariate analysis, admission therapy was most strongly associated with discharge use (adjusted odds ratios 7.4, 6.0, and 20.9 for ACE inhibitors/ARBs, β blockers, and aldosterone antagonists, respectively). Western region, younger age, and academic affiliation were also associated with higher discharge use. Although ACE inhibitor/ARB and β-blocker continuation rates were high, aldosterone antagonist use was lower despite potential eligibility. In conclusion, being admitted on evidence-based medications is the most powerful, independent predictor of discharge use. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Benefits and Limitations of Text Messages to Stimulate Higher Learning Among Community Providers: Participants' Views of an mHealth Intervention to Support Continuing Medical Education in Vietnam.

    Science.gov (United States)

    Sabin, Lora L; Larson Williams, Anna; Le, Bao Ngoc; Herman, Augusta R; Viet Nguyen, Ha; Albanese, Rebecca R; Xiong, Wenjun; Shobiye, Hezekiah Oa; Halim, Nafisa; Tran, Lien Thi Ngoc; McNabb, Marion; Hoang, Hai; Falconer, Ariel; Nguyen, Tam Thi Thanh; Gill, Christopher J

    2017-06-27

    A randomized controlled trial was conducted in 2015 to evaluate a mobile continuing medical education (mCME) intervention that provided daily text messages to community-based physicians' assistants (CBPAs) in Thai Nguyen Province, Vietnam. Although the intervention failed to improve medical knowledge over a 6-month period, a companion qualitative study provided insights on the views and experiences of intervention participants. We conducted focus group discussions (FGDs) and in-depth interviews (IDIs) among participants randomized to receive text messages containing either simple medical facts or quiz questions. Trained interviewers collected data immediately following the conclusion of the trial in December 2015. Using semi-structured question guides, respondents were queried on their views of the intervention, positive and negative, and perceived impacts of the intervention. During analysis, after learning that the intervention had failed to increase knowledge among participants, we also examined reasons for lack of improvement in medical knowledge. All analyses were performed in NVivo using a thematic approach. A total of 70 CBPAs engaged in one of 8 FGDs or an IDI. One-half were men; average age among all respondents was 40 years. Most (81%) practiced in rural settings and most (51%) focused on general medicine. The mean length of work experience was 3 years. All respondents made positive comments about the intervention; convenience, relevance, and quick feedback (quiz format) were praised. Downsides encompassed lack of depth of information, weak interaction, technology challenges, and challenging/irrelevant messages. Respondents described perceived impacts encompassing increased motivation, knowledge, collegial discussions, Internet use to search for more information, and clinical skills. Overall, they expressed a desire for the intervention to continue and recommended expansion to other medical professionals. Overreliance on the text messages, lack of

  17. Impact of childlessness on life and attitudes towards continuation of medically assisted reproduction and/or adoption

    DEFF Research Database (Denmark)

    Petersen, Gitte L; Blenstrup, Lene T; Peterson, Brennan D

    2015-01-01

    Infertility and fertility treatment have the potential to impact and disrupt a couple's overall life. In order to study the associations between the impact of childlessness on one's life, and men and women's attitudes towards fertility treatment continuation and/or adoption, we analysed data from...... that they wished to continue fertility treatment, while 20.2% of women and 19.2% of men reported that they wished to pursue adoption. The attitudes of nearly 8 in 10 couples were congruent towards further fertility treatments, while nearly 7 in 10 couples were congruent in their attitudes to pursuing adoption...

  18. 20 CFR 416.996 - Continued disability or blindness benefits pending appeal of a medical cessation determination.

    Science.gov (United States)

    2010-04-01

    ..., unless you have completed a trial work period and are engaging in substantial gainful activity. If you... you. If you have returned to work, we will request additional information about this work activity. Unless your earnings cause your income to be too much to receive benefits, your continued benefits will...

  19. [Medical therapy of gastroesophageal reflux. Evaluation of the activity of clebopride by continuous intraluminal pH measurement].

    Science.gov (United States)

    Alvisi, V; Onofrio, W; Intrieri, L; D'Ambrosi, A

    1987-10-15

    Seven female and three male outpatients (mean age 45, range 37-54), suffering from gastroesophageal reflux underwent therapy with clebopride, a new selective antidopaminergic agent. Before and after treatment (1 mg b.i.d. for ten days) 24 h-continuous monitoring of esophageal pH was done. Clebopride significantly lowered the number and the extension of gastroesophageal acid refluxes.

  20. Use of Social Media to Promote Continuous Learning: A Phased Strategy for Graduate Medical Education Fellowship Implementation

    OpenAIRE

    Jaswant Singh Basraon; Deborah Simpson; Anjan Gupta

    2015-01-01

    Purpose: Clinical developments continue to grow at an accelerated rate, challenging the existing paradigm of information access, dissemination and learning by trainees. The aim of this study was to deliver relevant, concise and newly emerging information on cardiovascular disease using Twitter, and assess its impact. Methods: A Twitter account for our institution’s cardiovascular disease fellowship program was established. All fellows and faculty were encouraged to follow tweets for clini...

  1. Using an expanded outcomes framework and continuing education evidence to improve facilitation of patient-centered medical home recognition and transformation.

    Science.gov (United States)

    Van Hoof, Thomas J; Kelvey-Albert, Michele; Katz, Matthew; Lalime, Ken; Sacks, Ken; Meehan, Thomas P

    2014-01-01

    The patient-centered medical home is a model for delivering primary care in the United States. Primary care clinicians and their staffs require assistance in understanding the innovation and in applying it to practice. The purpose of this article is to describe and to critique a continuing education program that is relevant to, and will become more common in, primary care. A multifaceted educational strategy prepared 20 primary care private practices to achieve National Committee for Quality Assurance Level 3 recognition as Patient-Centered Medical Homes. Eighteen (90%) practices submitted an application to the National Committee for Quality Assurance. On the first submission attempt, 13 of 18 (72%) achieved Level 3 recognition and 5 (28%) achieved Level 1 recognition. An interactive multifaceted educational strategy can be successful in preparing primary care practices for Patient-Centered Medical Homes recognition, but the strategy may not ensure transformation. Future educational activities should consider an expanded outcomes framework and the evidence of effective continuing education to be more successful with recognition and transformation.

  2. Epileptic encephalopathy with continuous spike-waves during sleep: the need for transition from childhood to adulthood medical care appears to be related to etiology.

    Science.gov (United States)

    de Saint-Martin, Anne; Rudolf, Gabrielle; Seegmuller, Caroline; Valenti-Hirsch, Maria Paola; Hirsch, Edouard

    2014-08-01

    Epileptic encephalopathy with continuous diffuse spike-waves during slow-wave sleep (ECSWS) presents clinically with infrequent nocturnal focal seizures, atypical absences related to secondary bilateral synchrony, negative myoclonia, and atonic and rare generalized tonic-clonic seizures. The unique electroencephalography (EEG) pattern found in ECSWS consists of continuous, diffuse, bilateral spike-waves during slow-wave sleep. Despite the eventual disappearance of clinical seizures and EEG abnormalities by adolescence, the prognosis is guarded in most cases because of neuropsychological and behavioral deficits. ECSWS has a heterogeneous etiology (genetic, structural, and unknown). Because epilepsy and electroencephalography (EEG) abnormalities in epileptic encephalopathy with continuous diffuse spike-waves during slow-wave sleep (ECSWS) are self-limited and age related, the need for ongoing medical care and transition to adult care might be questioned. For adolescents in whom etiology remains unknown (possibly genetic) and who experience the disappearance of seizures and EEG abnormalities, there is rarely need for long-term neurologic follow-up, because often a relatively normal cognitive and social evolution follows. However, the majority of patients with structural and possibly "genetic syndromic" etiologies will have persistent cognitive deficits and will need suitable socioeducative care. Therefore, the transition process in ECSWS will depend mainly on etiology and its related features (epileptic active phase duration, and cognitive and behavioral evolution) and revolve around neuropsychological and social support rather than medical and pharmacologic follow-up. Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.

  3. Determination of the Relationship between the Quality of Working Life and Tendency for Continuing Education in the Nurses working in Selected Hospitals of Isfahan Medical University

    Directory of Open Access Journals (Sweden)

    Maryam Javidmoghadam

    2016-07-01

    Full Text Available In the past, the main role of nurses was providing care and comfort during nursing duties. However, today due to the changes in the health-related systems, more emphasis is put on the health promotion, disease prevention, and paying attention to the patient as a whole and considering all of his aspects (holistic care. Therefore, in the current societies, the nurses play a more varied roles and professional responsibilities which are expanding in line with the changes in society. The working life quality is among the important and effective factors on the nurses' productivity. Also, regarding the high sensitivity of the health-care fields which are directly related to the human life, their education, knowledge, and working ability for better performing the duties is vital. The current study aimed at evaluation and investigation of the working life quality on the tendency to continue education in the nurses working in Isfahan Medical University. the current study is of descriptive - cross sectional bivariate correlation type conducted on 123 nurses working in four departments as internal medicine, surgery, emergency and intensive care in five hospitals as Al-Zahra, Amin, Ayatollah Kashani, Noor, and Ali Asghar (pbuh, which were under supervision of Isfahan Medical University. The data collection instrument was a questionnaire including the demographic information, working life quality, job satisfaction, and tendency to continue education. For data analysis, In addition to the descriptive statistical indicators (mean and standard deviation, the Chi Square test was also used for qualitative variables as well as paired sample t-test for comparison between the means of the two groups. All the analysis were performed in SPSS with the significance level 0.05.there is significant relationship between the nurses' education and their working life quality however there were no relationships between the years in service and marital status with people working

  4. Making the Most of Continuing Medical Education: Evidence of Transformative Learning During a Course in Evidence-Based Medicine and Decision Making.

    Science.gov (United States)

    Sokol, Randi G; Shaughnessy, Allen F

    2018-01-01

    Continuing medical information courses have been criticized for not promoting behavior change among their participants. For behavior change to occur, participants often need to consciously reject previous ideas and transform their way of thinking. Transformational learning is a process that cultivates deep emotional responses and can lead to cognitive and behavioral change in learners, potentially facilitating rich learning experiences and expediting knowledge translation. We explored participants' experiences at a 2-day conference designed to support transformative learning as they encounter new concepts within Information Mastery, which challenge their previous frameworks around the topic of medical decision making. Using the lens of transformative learning theory, we asked: how does Information Mastery qualitatively promote perspective transformation and hence behavior change? We used a hermeneutic phenomenologic approach to capture the lived experience of 12 current and nine previous attendees of the "Information Mastery" course through individual interviews, focus groups, and observation. Data were thematically analyzed. Both prevoius and current conference attendees described how the delivery of new concepts about medical decision making evoked strong emotional responses, facilitated personal transformation, and propelled expedited behavior change around epistemological, moral, and information management themes, resulting in a newfound sense of self-efficacy, confidence, and ownership in their ability to make medical decisions. When the topic area holds the potential to foster a qualitative reframing of learners' guiding paradigms and worldviews, attention should be paid to supporting learners' personalized meaning-making process through transformative learning opportunities to promote translation into practice.

  5. Barriers and facilitators to the dissemination of DECISION+, a continuing medical education program for optimizing decisions about antibiotics for acute respiratory infections in primary care: A study protocol

    Directory of Open Access Journals (Sweden)

    Gagnon Marie-Pierre

    2011-01-01

    Full Text Available Abstract Background In North America, acute respiratory infections are the main reason for doctors' visits in primary care. Family physicians and their patients overuse antibiotics for treating acute respiratory infections. In a pilot clustered randomized trial, we showed that DECISION+, a continuing medical education program in shared decision making, has the potential to reduce the overuse of antibiotics for treating acute respiratory infections. DECISION+ learning activities consisted of three interactive sessions of three hours each, reminders at the point of care, and feedback to doctors on their agreement with patients about comfort with the decision whether to use antibiotics. The objective of this study is to identify the barriers and facilitators to physicians' participation in DECISION+ with the goal of disseminating DECISION+ on a larger scale. Methods/design This descriptive study will use mixed methods and retrospective and prospective components. All analyses will be based on an adapted version of the Ottawa Model of Research Use. First, we will use qualitative methods to analyze the following retrospective data from the pilot study: the logbooks of eight research assistants, the transcriptions of 15 training sessions, and 27 participant evaluations of the DECISION+ training sessions. Second, we will collect prospective data in semi-structured focus groups composed of family physicians to identify barriers and facilitators to the dissemination of a future training program similar to DECISION+. All 39 family physicians exposed to DECISION+ during the pilot project will be eligible to participate. We will use a self-administered questionnaire based on Azjen's Theory of Planned Behaviour to assess participants' intention to take part in future training programs similar to DECISION+. Discussion Barriers and facilitators identified in this project will guide modifications to DECISION+, a continuing medical education program in shared

  6. Characterization of continuous and pulsed emission modes of a hybrid micro focus x-ray source for medical imaging applications

    Energy Technology Data Exchange (ETDEWEB)

    Ghani, Muhammad U.; Wong, Molly D.; Ren, Liqiang; Wu, Di; Zheng, Bin [Center for Biomedical Engineering and School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019 (United States); Rong, John X. [Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX 77030 (United States); Wu, Xizeng [Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35249 (United States); Liu, Hong, E-mail: liu@ou.edu [Center for Biomedical Engineering and School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019 (United States)

    2017-05-01

    The aim of this study was to quantitatively characterize a micro focus x-ray tube that can operate in both continuous and pulsed emission modes. The micro focus x-ray source (Model L9181-06, Hamamatsu Photonics, Japan) has a varying focal spot size ranging from 16 µm to 50 µm as the source output power changes from 10 to 39 W. We measured the source output, beam quality, focal spot sizes, kV accuracy, spectra shapes and spatial resolution. Source output was measured using an ionization chamber for various tube voltages (kVs) with varying current (µA) and distances. The beam quality was measured in terms of half value layer (HVL), kV accuracy was measured with a non-invasive kV meter, and the spectra was measured using a compact integrated spectrometer system. The focal spot sizes were measured using a slit method with a CCD detector with a pixel pitch of 22 µm. The spatial resolution was quantitatively measured using the slit method with a CMOS flat panel detector with a 50 µm pixel pitch, and compared to the qualitative results obtained by imaging a contrast bar pattern. The focal spot sizes in the vertical direction were smaller than that of the horizontal direction, the impact of which was visible when comparing the spatial resolution values. Our analyses revealed that both emission modes yield comparable imaging performances in terms of beam quality, spectra shape and spatial resolution effects. There were no significantly large differences, thus providing the motivation for future studies to design and develop stable and robust cone beam imaging systems for various diagnostic applications. - Highlights: • A micro focus x-ray source that operates in both continuous and pulse emission modes was quantitatively characterized. • The source output, beam quality, focal spot measurements, kV accuracy, spectra analyses and spatial resolution were measured. • Our analyses revealed that both emission modes yield comparable imaging performances in terms of beam

  7. Characterization of continuous and pulsed emission modes of a hybrid micro focus x-ray source for medical imaging applications

    International Nuclear Information System (INIS)

    Ghani, Muhammad U.; Wong, Molly D.; Ren, Liqiang; Wu, Di; Zheng, Bin; Rong, John X.; Wu, Xizeng; Liu, Hong

    2017-01-01

    The aim of this study was to quantitatively characterize a micro focus x-ray tube that can operate in both continuous and pulsed emission modes. The micro focus x-ray source (Model L9181-06, Hamamatsu Photonics, Japan) has a varying focal spot size ranging from 16 µm to 50 µm as the source output power changes from 10 to 39 W. We measured the source output, beam quality, focal spot sizes, kV accuracy, spectra shapes and spatial resolution. Source output was measured using an ionization chamber for various tube voltages (kVs) with varying current (µA) and distances. The beam quality was measured in terms of half value layer (HVL), kV accuracy was measured with a non-invasive kV meter, and the spectra was measured using a compact integrated spectrometer system. The focal spot sizes were measured using a slit method with a CCD detector with a pixel pitch of 22 µm. The spatial resolution was quantitatively measured using the slit method with a CMOS flat panel detector with a 50 µm pixel pitch, and compared to the qualitative results obtained by imaging a contrast bar pattern. The focal spot sizes in the vertical direction were smaller than that of the horizontal direction, the impact of which was visible when comparing the spatial resolution values. Our analyses revealed that both emission modes yield comparable imaging performances in terms of beam quality, spectra shape and spatial resolution effects. There were no significantly large differences, thus providing the motivation for future studies to design and develop stable and robust cone beam imaging systems for various diagnostic applications. - Highlights: • A micro focus x-ray source that operates in both continuous and pulse emission modes was quantitatively characterized. • The source output, beam quality, focal spot measurements, kV accuracy, spectra analyses and spatial resolution were measured. • Our analyses revealed that both emission modes yield comparable imaging performances in terms of beam

  8. Use of Social Media to Promote Continuous Learning: A Phased Strategy for Graduate Medical Education Fellowship Implementation

    Directory of Open Access Journals (Sweden)

    Jaswant Singh Basraon

    2015-04-01

    Full Text Available Purpose: Clinical developments continue to grow at an accelerated rate, challenging the existing paradigm of information access, dissemination and learning by trainees. The aim of this study was to deliver relevant, concise and newly emerging information on cardiovascular disease using Twitter, and assess its impact. Methods: A Twitter account for our institution’s cardiovascular disease fellowship program was established. All fellows and faculty were encouraged to follow tweets for clinical developments. To assess Twitter use, participation rates and the number of tweets by topics and followers were tracked longitudinally. Impact on fellows was assessed through a brief evaluation survey and an emailed clinical vignette quiz that required the application of evidence to clinical questions. Results: Since project onset in September 2013, there have been 458 tweets, including 21 Health Insurance Portability and Accountability Act (HIPAA-compliant photos and videos, available to 48 followers, including 7 faculty and 20 current or former fellows. More than 60% of fellows achieved perfect quiz performance scores. Evaluations were completed by 94% of fellows (15/16, 25% of whom report checking for information at least every other day, 50% once a week and 25% once a month. Trainees report more frequent literature-based deliberations with faculty since Twitter inception. Conclusions: Twitter can deliver relevant, concise and newly emerging clinical information to trainees, impacting their ability to apply evidence to clinical problems. Trainee and faculty engagement with Twitter increases over time.

  9. Improving Dairy Organizational Communication from the Veterinarian's Perspective: Results of a Continuing Veterinary Medical Education Pilot Program.

    Science.gov (United States)

    Moore, Dale A; Sischo, William M; Kurtz, Suzanne; Siler, Julie D; Pereira, Richard V; Warnick, Lorin D; Davis, Margaret A

    2016-01-01

    The increasing size and complexity of US dairy farms could make it more difficult for a veterinary practitioner to effectively communicate protocol recommendations for prevention or treatment on the farm. A continuing education workshop was set up based on the results of research on dairy organizational communication on dairy farms, which resulted in a tool to assess dairy communication structure and flow. The workshop specifically focused on communication structure and whom to talk to when implementing health care changes in calf rearing. In addition, modern methods of veterinary-client communication knowledge and skills were provided. Primary outcomes of the workshops were to obtain feedback from participants about research findings and the communication model, to improve awareness about the complexity of communication structures on dairy farms, and to change participants' knowledge and skills associated with on-farm communication by providing communication theory and skills and an approach to evaluate and improve dairy organizational communication. Of the 37 participants completing the pre-program assessment, most recognized a need for themselves or their practice to improve communication with clients and farm employees. After the program, most participants were confident in their new communication skills and would consider using them. They highlighted specific new ideas they could apply in practice, such as conducting a "communication audit." The results from the assessment of this communication workshop, focused on dairy veterinarians, highlighted the need for communication training in this sector of the profession and practitioners' desire to engage in this type of training.

  10. The difficulty of professional continuation among female doctors in Japan: a qualitative study of alumnae of 13 medical schools in Japan

    Science.gov (United States)

    Nomura, Kyoko; Yamazaki, Yuka; Gruppen, Larry D; Horie, Saki; Takeuchi, Masumi; Illing, Jan

    2015-01-01

    Objectives To investigate the difficulties Japanese female doctors face in continuing professional practice. Design A qualitative study using the Kawakita Jiro method. Setting A survey conducted in 2011 of 13 private Japanese medical school alumni associations. Participants 359 female doctors. Primary outcome measures Barriers of balancing work and gender role. Results The female doctors reported that professional practice was a struggle with long working hours due to a current shortage of doctors in Japan. There was also a severe shortage of childcare facilities in the workplace. Some women appeared to have low confidence in balancing the physician's job and personal life, resulting in low levels of professional pursuit. There appeared to be two types of stereotypical gender roles, including one expected from society, stating that “child rearing is a woman's job”, and the other perceived by the women themselves, that some women had a very strong desire to raise their own children. Male doctors and some female doctors who were single or older were perceived to be less enthusiastic about supporting women who worked while raising children because these coworkers feared that they would have to perform additional work as a result of the women taking long periods of leave. Conclusions Important factors identified for promoting the continuation of professional practice among female doctors in Japan were the need to improve working conditions, including cutting back on long working hours, a solution to the shortage of nurseries, a need for the introduction of educational interventions to clarify professional responsibilities, and redefinition of the gender division of labour for male and female doctors. In addition, we identified a need to modernise current employment practices by introducing temporary posts to cover maternity leave and introducing flexible working hours during specialist training, thus supporting and encouraging more women to continue their medical

  11. The difficulty of professional continuation among female doctors in Japan: a qualitative study of alumnae of 13 medical schools in Japan.

    Science.gov (United States)

    Nomura, Kyoko; Yamazaki, Yuka; Gruppen, Larry D; Horie, Saki; Takeuchi, Masumi; Illing, Jan

    2015-03-27

    To investigate the difficulties Japanese female doctors face in continuing professional practice. A qualitative study using the Kawakita Jiro method. A survey conducted in 2011 of 13 private Japanese medical school alumni associations. 359 female doctors. Barriers of balancing work and gender role. The female doctors reported that professional practice was a struggle with long working hours due to a current shortage of doctors in Japan. There was also a severe shortage of childcare facilities in the workplace. Some women appeared to have low confidence in balancing the physician's job and personal life, resulting in low levels of professional pursuit. There appeared to be two types of stereotypical gender roles, including one expected from society, stating that "child rearing is a woman's job", and the other perceived by the women themselves, that some women had a very strong desire to raise their own children. Male doctors and some female doctors who were single or older were perceived to be less enthusiastic about supporting women who worked while raising children because these coworkers feared that they would have to perform additional work as a result of the women taking long periods of leave. Important factors identified for promoting the continuation of professional practice among female doctors in Japan were the need to improve working conditions, including cutting back on long working hours, a solution to the shortage of nurseries, a need for the introduction of educational interventions to clarify professional responsibilities, and redefinition of the gender division of labour for male and female doctors. In addition, we identified a need to modernise current employment practices by introducing temporary posts to cover maternity leave and introducing flexible working hours during specialist training, thus supporting and encouraging more women to continue their medical careers. Published by the BMJ Publishing Group Limited. For permission to use (where not

  12. mCME project V.2.0: randomised controlled trial of a revised SMS-based continuing medical education intervention among HIV clinicians in Vietnam.

    Science.gov (United States)

    Gill, Christopher J; Le, Ngoc Bao; Halim, Nafisa; Chi, Cao Thi Hue; Nguyen, Viet Ha; Bonawitz, Rachael; Hoang, Pham Vu; Nguyen, Hoang Long; Huong, Phan Thi Thu; Larson Williams, Anna; Le, Ngoc Anh; Sabin, Lora

    2018-01-01

    Continuing medical education (CME) is indispensable, but costs are a barrier. We tested the effectiveness of a novel mHealth intervention (mCME V.2.0) promoting CME among Vietnamese HIV clinicians. We enrolled HIV clinicians from three provinces near Hanoi. The 6-month intervention consisted of (1) daily short message service multiple-choice quiz questions, (2) daily linked readings, (3) links to online CME courses and (4) feedback messages describing the performance of the participant relative to the group. Control participants had equal access to the online CME courses. Our primary endpoint was utilisation of the online CME courses; secondary endpoints were self-study behaviour, performance on a standardised medical exam and job satisfaction. From 121 total HIV clinicians in the three provinces, 106 (87.6%) enrolled, and 48/53 intervention (90%) and 47/53 control (89%) participants completed the endline evaluations. Compared with controls, intervention participants were more likely to use the CME courses (risk ratio (RR) 2.3, 95% CI 1.4 to 3.8, accounting for 83% of course use (P<0.001)). Intervention participants increased self-study behaviours over controls in terms of use of medical textbooks (P<0.01), consulting with colleagues (P<0.01), searching on the internet (P<0.001), using specialist websites (P=0.02), consulting the Vietnam HIV/AIDS treatment guidelines (P=0.02) and searching the scientific literature (P=0.09). Intervention participants outperformed controls on the exam (+23% vs +12% score gains, P=0.05) and had higher job satisfaction. The mCME V.2.0 intervention improved self-study behaviour, medical knowledge and job satisfaction. This approach has potential for expansion in Vietnam and similar settings. NCT02381743.

  13. Predictive Value of the School-leaving Grade and Prognosis of Different Admission Groups for Academic Performance and Continuity in the Medical Course – a Longitudinal Study

    Science.gov (United States)

    Kadmon, Guni; Resch, Franz; Duelli, Roman; Kadmon, Martina

    2014-01-01

    Background: The school-leaving GPA and the time since completion of secondary education are the major criteria for admission to German medical schools. However, the predictive value of the school-leaving grade and the admission delay have not been thoroughly examined since the amendment of the Medical Licensing Regulations and the introduction of reformed curricula in 2002. Detailed information on the prognosis of the different admission groups is also missing. Aim: To examine the predictive values of the school-leaving grade and the age at enrolment for academic performance and continuity throughout the reformed medical course. Methods: The study includes the central admission groups “GPA-best” and “delayed admission” as well as the primary and secondary local admission groups of three consecutive cohorts. The relationship between the criteria academic performance and continuity and the predictors school-leaving GPA, enrolment age, and admission group affiliation were examined up to the beginning of the final clerkship year. Results: The academic performance and the prolongation of the pre-clinical part of undergraduate training were significantly related to the school-leaving GPA. Conversely, the dropout rate was related to age at enrolment. The students of the GPA-best group and the primary local admission group performed best and had the lowest dropout rates. The students of the delayed admission group and secondary local admission group performed significantly worse. More than 20% of these students dropped out within the pre-clinical course, half of them due to poor academic performance. However, the academic performance of all of the admission groups was highly variable and only about 35% of the students of each group reached the final clerkship year within the regular time. Discussion: The school-leaving grade and age appear to have different prognostic implications for academic performance and continuity. Both factors have consequences for the

  14. Scientific events of the Turner Scientific And Research Institute for children’s orthopedics as a form of continuous medical education for pediatric traumatologists

    Directory of Open Access Journals (Sweden)

    Karina S. Solovyova

    2017-03-01

    Full Text Available The experience of the Turner Scientific and Research Institute for Children's Orthopedics in educational activities for improvement of the professional knowledge of pediatric physicians was represented. The target audience of the continuous medical education include traumatologists, pediatric surgeons, and doctors of related specialties of Russia that are involved in diagnosis, treatment, and rehabilitation of children with injuries, congenital and acquired diseases of the musculoskeletal system. Since 1986, the Institute has organized 28 all-Russian scientific and practical conferences on topical issues of traumatology and orthopedics of pediatric age in 22 different cities across the country. In the interest of the institute, the school of pediatric orthopedists is constantly working for district orthopedists of children's polyclinics of St. Petersburg, and regular monothematic seminars are performed with the participation of leading Russian experts and visiting lecturers from abroad. These scientific and practical activities improve the professional skills of doctors and help them improve the provision of specialized care to children.

  15. Evidence for the Continued Use of Medieval Medical Prescriptions in the Sixteenth Century: A Fifteenth-Century Remedy Book and its Later Owner.

    Science.gov (United States)

    Connolly, Margaret

    2016-04-01

    This article examines a fifteenth-century remedy book, Oxford, Bodleian Library, Rawlinson c. 299, and describes its collection of 314 medieval medical prescriptions. The recipes are organised broadly from head to toe, and often several remedies are offered for the same complaint. Some individual recipes are transcribed with modern English translations. The few non-recipe texts are also noted. The difference between a remedy book and a leechbook is explained, and this manuscript is situated in relation to other known examples of late medieval medical anthologies. The particular feature that distinguishes Oxford, Bodleian Library, Rawlinson c. 299 from other similar volumes is the evidence that it continued to be used during the sixteenth century. This usage was of two kinds. Firstly, the London lawyer who owned it not only inscribed his name but annotated the original recipe collection in various ways, providing finding-aids that made it much more user-friendly. Secondly, he, and other members of his family, added another forty-three recipes to the original collection (some examples of these are also transcribed). These two layers of engagement with the manuscript are interrogated in detail in order to reveal what ailments may have troubled this family most, and to judge how much faith they placed in the old remedies contained in this old book. It is argued that the knowledge preserved in medieval books enjoyed a longevity that extended beyond the period of the manuscript book, and that manuscripts were read and valued long after the advent of printing.

  16. Endometriosis | Matebese | Continuing Medical Education

    African Journals Online (AJOL)

    Endometriosis is a benign disease defined as the presence of endometrial glands and stroma outside the uterus. Its pathogenesis and optimal management remain controversial, and its true prevalence is unknown. Endometriosis can be debilitating and can affect the psychosocial functioning of women. It is estimated to ...

  17. Continuing Medical Education: Advanced Search

    African Journals Online (AJOL)

    Search tips: Search terms are case-insensitive; Common words are ignored; By default only articles containing all terms in the query are returned (i.e., AND is implied); Combine multiple words with OR to find articles containing either term; e.g., education OR research; Use parentheses to create more complex queries; e.g., ...

  18. Continuing Medical Education: Editorial Policies

    African Journals Online (AJOL)

    Peer Review Process. The editor and guest editors solicit articles from selected authors who are recognised in their fields and are responsible for review of the submitted material. Further peer review may be requested on occasions. Publication Frequency. CME is published monthly with the exception of December i.e 11 ...

  19. Effect of a tailor-made continuous medical education program for primary care physicians on self-perception of physicians' roles and quality of care.

    Science.gov (United States)

    Twig, Gilad; Lahad, Amnon; Kochba, Ilan; Ezra, Vered; Mandel, Dror; Shina, Avi; Kreiss, Yitshak; Zimlichman, Eyal

    2010-09-01

    A survey conducted among Israel Defense Force primary care physicians in 2001 revealed that they consider patients' needs more than they do organizational needs and that the education PCPs currently receive is inadequate. In 2003 the medical corps initiated a multi-format continuous medical education program aimed at improving skills in primary care medicine. To measure and analyze the effect of the tailor-made CME program on PCPs' self-perception 3 years after its implementation and correlate it to clinical performance. In 2006 a questionnaire was delivered to a representative sample of PCPs in the IDF. The questionnaire included items on demographic and professional background, statements on self-perception issues, and ranking of roles. We compared the follow-up survey (2006) to the results of the original study (2001) and correlated the survey results with clinical performance as measured through objective indicators. In the 2006 follow-up survey PCPs scored higher on questions dealing with their perception of themselves as case managers (3.8 compared to 4.0 on the 2001 survey on a 5 point scale, P = 0.046), perceived quality of care and education (3.5 vs. 3.8, P = 0.06), and on questions dealing with organizational commitment (3.5 vs. 3.8, P = 0.01). PCPs received higher scores on clinical indicators in the later study (odds ratio 2.05, P < 0.001). PCPs in the IDF perceived themselves more as case managers as compared to the 2001 survey. A tailor-made CME program may have contributed to the improvement in skills and quality of care.

  20. A Survey of viewpoints of nurses employed in treatment and teaching centers of Kashan and suburb about continuing medical education (CME Priorities in 2010

    Directory of Open Access Journals (Sweden)

    S Behrouzifar

    2012-09-01

    Full Text Available Introduction: Needs’ assessment is the first stage in designing Continuing Medical Education (CME Programs. To obtain clients’ satisfaction with services of nurses as the largest group providing health and treatment services, designing and executing educational programs related to their needs is necessary. This study was conducted to determine CME priorities of nursing graduates employed in treatment and teaching centers of Kashan and suburb. Methods: A cross-sectional study was conducted on 238 nurses. Separate questionnaires were designed for different hospital wards. Every educational subject was scored on a Likert scale ranging from zero to ten. Data were extracted, classified and analyzed in SPSS using descriptive and inferential statistics. Results: In general (9.18±1.44, surgical (9.40±1.63 and emergency wards (9.32±1.79, the most important need identified was cardiopulmonary resuscitation. In intensive care units (ICU, dialysis units and pediatrics and neonatal ICU wards, identified items included deep vein thrombosis (DVT and pulmonary embolism (9.02±1.53, bone metabolic diseases (9.91±0.28, cardiopulmonary resuscitation (9.29±0.91 and asphyxia (9.78±0.41, respectively with the greatest mean scores. Conclusion: From viewpoint of studied nurses, the most important CME priorities were learning clinical skills about managing patients with unstable conditions and correct utilization of medical equipments which are related to their everyday practice. It is necessary that CME planners and policy makers to pay attention to nurses’ CME needs which are different across various wards.

  1. Predicting acute side effects of stimulant medication in pediatric attention deficit/hyperactivity disorder: data from quantitative electroencephalography, event-related potentials, and a continuous-performance test

    Directory of Open Access Journals (Sweden)

    Ogrim G

    2013-09-01

    Full Text Available Geir Ogrim,1–3 Knut A Hestad,3,4 Jan Ferenc Brunner,3,5,6 Juri Kropotov3,7,8 1Neuropsychiatric Unit, Østfold Hospital Trust, Fredrikstad, Norway; 2National Resource Center for ADHD, Tourettes' Syndrome and Narcolepsy, Oslo, Norway; 3Institute of Psychology, Norwegian University of Science and Technology (NTNU, Trondheim, Norway; 4Division of Mental Health, Innlandet Hospital Trust, Brumunddal, Norway; 5Department of Physical Medicine and Rehabilitation, St Olav's Hospital, Trondheim, Norway; 6Department of Neuroscience, NTNU, Trondheim, Norway; 7Institute of the Human Brain, Russian Academy of Sciences, Saint Petersburg, Russia; 8Department of Neuropsychology, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland Background: The aim of this study was to search for predictors of acute side effects of stimulant medication in pediatric attention deficit/hyperactivity disorder (ADHD, emphasizing variables from quantitative electroencephalography (QEEG, event-related potentials (ERPs, and behavior data from a visual continuous-performance test (VCPT. Methods: Seventy medication-naïve ADHD patients aged 7–16 years were tested with QEEG, including a go/no-go task condition (VCPT from which behavior data and ERPs were extracted, followed by a systematic trial on stimulant medication lasting at least 4 weeks. Based on data from rating scales and interviews, two psychologists who were blind to the QEEG/ERP test results independently rated the patients as having no or small side effects (n = 37 or troublesome side effects (n = 33. We determined if the side effects were related to sex, age, IQ, ADHD subtype, comorbidities, clinical outcome, and variables in QEEG, ERPs, and VCPT. Results: There was a moderate negative correlation between clinical outcome and side effects. Three variables were significantly associated with side effects in a multivariate logistic regression analysis. In the ERP independent component – contingent negative variation

  2. Detectability and acceptability of continuous pulse signals for the MemoPatch® device, an electronic skin patch intended to deliver tactile medication reminder signals

    Directory of Open Access Journals (Sweden)

    Abraham I

    2015-02-01

    Full Text Available Ivo Abraham,1–3 Jan De Geest,2 Wim De Geest,2 Elke De Troy,4 Karen MacDonald3 1Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA; 2TheraSolve, Diepenbeek, Belgium; 3Matrix45, Tucson, AZ, USA; 4Jessa Ziekenhuis, Hasselt, Belgium Background: Unintended forgetfulness is the most common cause of medication nonadherence. MemoPatch® is an electronic skin patch intended to deliver discreet tactile medication reminder stimuli. This study aimed 1 to evaluate, within an experimental setup, the detectability and acceptability of fifteen continuous bipolar pulse signals; 2 to identify variables, if any, associated with differential perception of the candidate reminder signals; and 3 to collect safety data as reported by subjects or observed by staff. Methods: This was a laboratory experiment involving 147 healthy adult volunteers (55.1% female, 98.0% Caucasian, with age 41.8±16.0 years, body mass index [BMI] 24.7±4.4, upper body adiposity 28.5%±8.3% body fat, and skin impedance 367.6±140.8Ω and using an experimental version of the MemoPatch®. Following four training signals administered in fixed order, subjects were exposed to a set of fifteen randomly sequenced signals varying in rise and fall time, width, and current, to be rated in terms of detectability ("too weak", "appropriate", or "too strong" and acceptability. Results: Ratings of "appropriate" were virtually independent of such variables as sex, BMI, upper body adiposity, and skin impedance at the patch location. Five signals were rated as "appropriate" by ≥67% of subjects and acceptable by ≥95% of subjects, virtually independently of the indicators of interest, and were retained as candidate signals for use in next stages of development and commercialization. Nine adverse events, none serious, were observed in six subjects. Conclusion: This study yielded five effective and safe candidate signals for potential use in the Memo

  3. Improving the Quality of Voluntary Medical Male Circumcision through Use of the Continuous Quality Improvement Approach: A Pilot in 30 PEPFAR-Supported Sites in Uganda

    Science.gov (United States)

    Opio, Alex; Calnan, Jacqueline; Njeuhmeli, Emmanuel

    2015-01-01

    Background Uganda adopted voluntary medical male circumcision (VMMC) (also called Safe Male Circumcision in Uganda), as part of its HIV prevention strategy in 2010. Since then, the Ministry of Health (MOH) has implemented VMMC mostly with support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) through its partners. In 2012, two PEPFAR-led external quality assessments evaluated compliance of service delivery sites with minimum quality standards. Quality gaps were identified, including lack of standardized forms or registers, lack of documentation of client consent, poor preparedness for emergencies and use of untrained service providers. In response, PEPFAR, through a USAID-supported technical assistance project, provided support in quality improvement to the MOH and implementing partners to improve quality and safety in VMMC services and build capacity of MOH staff to continuously improve VMMC service quality. Methods and Findings Sites were supported to identify barriers in achieving national standards, identify possible solutions to overcome the barriers and carry out improvement plans to test these changes, while collecting performance data to objectively measure whether they had bridged gaps. A 53-indicator quality assessment tool was used by teams as a management tool to measure progress; teams also measured client-level indicators through self-assessment of client records. At baseline (February-March 2013), less than 20 percent of sites scored in the “good” range (>80%) for supplies and equipment, patient counseling and surgical procedure; by November 2013, the proportion of sites scoring “good” rose to 67 percent, 93 percent and 90 percent, respectively. Significant improvement was noted in post-operative follow-up at 48 hours, sexually transmitted infection assessment, informed consent and use of local anesthesia but not rate of adverse events. Conclusion Public sector providers can be engaged to address the quality of

  4. Processing of continuously provided punishment and reward in children with ADHD and the modulating effects of stimulant medication: an ERP study.

    Science.gov (United States)

    Groen, Yvonne; Tucha, Oliver; Wijers, Albertus A; Althaus, Monika

    2013-01-01

    Current models of ADHD suggest abnormal reward and punishment sensitivity, but the exact mechanisms are unclear. This study aims to investigate effects of continuous reward and punishment on the processing of performance feedback in children with ADHD and the modulating effects of stimulant medication. 15 Methylphenidate (Mph)-treated and 15 Mph-free children of the ADHD-combined type and 17 control children performed a selective attention task with three feedback conditions: no-feedback, gain and loss. Event Related Potentials (ERPs) time-locked to feedback and errors were computed. All groups performed more accurately with gain and loss than without feedback. Feedback-related ERPs demonstrated no group differences in the feedback P2, but an enhanced late positive potential (LPP) to feedback stimuli (both gains and losses) for Mph-free children with ADHD compared to controls. Feedback-related ERPs in Mph-treated children with ADHD were similar to controls. Correlational analyses in the ADHD groups revealed that the severity of inattention problems correlated negatively with the feedback P2 amplitude and positively with the LPP to losses and omitted gains. The early selective attention for rewarding and punishing feedback was relatively intact in children with ADHD, but the late feedback processing was deviant (increased feedback LPP). This may explain the often observed positive effects of continuous reinforcement on performance and behaviour in children with ADHD. However, these group findings cannot be generalised to all individuals with the ADHD, because the feedback-related ERPs were associated with the severity of the inattention problems. Children with ADHD-combined type with more inattention problems showed both deviant early attentional selection of feedback stimuli, and deviant late processing of non-reward and punishment.

  5. Processing of continuously provided punishment and reward in children with ADHD and the modulating effects of stimulant medication: an ERP study.

    Directory of Open Access Journals (Sweden)

    Yvonne Groen

    Full Text Available OBJECTIVES: Current models of ADHD suggest abnormal reward and punishment sensitivity, but the exact mechanisms are unclear. This study aims to investigate effects of continuous reward and punishment on the processing of performance feedback in children with ADHD and the modulating effects of stimulant medication. METHODS: 15 Methylphenidate (Mph-treated and 15 Mph-free children of the ADHD-combined type and 17 control children performed a selective attention task with three feedback conditions: no-feedback, gain and loss. Event Related Potentials (ERPs time-locked to feedback and errors were computed. RESULTS: All groups performed more accurately with gain and loss than without feedback. Feedback-related ERPs demonstrated no group differences in the feedback P2, but an enhanced late positive potential (LPP to feedback stimuli (both gains and losses for Mph-free children with ADHD compared to controls. Feedback-related ERPs in Mph-treated children with ADHD were similar to controls. Correlational analyses in the ADHD groups revealed that the severity of inattention problems correlated negatively with the feedback P2 amplitude and positively with the LPP to losses and omitted gains. CONCLUSIONS: The early selective attention for rewarding and punishing feedback was relatively intact in children with ADHD, but the late feedback processing was deviant (increased feedback LPP. This may explain the often observed positive effects of continuous reinforcement on performance and behaviour in children with ADHD. However, these group findings cannot be generalised to all individuals with the ADHD, because the feedback-related ERPs were associated with the severity of the inattention problems. Children with ADHD-combined type with more inattention problems showed both deviant early attentional selection of feedback stimuli, and deviant late processing of non-reward and punishment.

  6. Improving the Quality of Voluntary Medical Male Circumcision through Use of the Continuous Quality Improvement Approach: A Pilot in 30 PEPFAR-Supported Sites in Uganda.

    Science.gov (United States)

    Byabagambi, John; Marks, Pamela; Megere, Humphrey; Karamagi, Esther; Byakika, Sarah; Opio, Alex; Calnan, Jacqueline; Njeuhmeli, Emmanuel

    2015-01-01

    Uganda adopted voluntary medical male circumcision (VMMC) (also called Safe Male Circumcision in Uganda), as part of its HIV prevention strategy in 2010. Since then, the Ministry of Health (MOH) has implemented VMMC mostly with support from the United States President's Emergency Plan for AIDS Relief (PEPFAR) through its partners. In 2012, two PEPFAR-led external quality assessments evaluated compliance of service delivery sites with minimum quality standards. Quality gaps were identified, including lack of standardized forms or registers, lack of documentation of client consent, poor preparedness for emergencies and use of untrained service providers. In response, PEPFAR, through a USAID-supported technical assistance project, provided support in quality improvement to the MOH and implementing partners to improve quality and safety in VMMC services and build capacity of MOH staff to continuously improve VMMC service quality. Sites were supported to identify barriers in achieving national standards, identify possible solutions to overcome the barriers and carry out improvement plans to test these changes, while collecting performance data to objectively measure whether they had bridged gaps. A 53-indicator quality assessment tool was used by teams as a management tool to measure progress; teams also measured client-level indicators through self-assessment of client records. At baseline (February-March 2013), less than 20 percent of sites scored in the "good" range (>80%) for supplies and equipment, patient counseling and surgical procedure; by November 2013, the proportion of sites scoring "good" rose to 67 percent, 93 percent and 90 percent, respectively. Significant improvement was noted in post-operative follow-up at 48 hours, sexually transmitted infection assessment, informed consent and use of local anesthesia but not rate of adverse events. Public sector providers can be engaged to address the quality of VMMC using a continuous quality improvement approach.

  7. Evaluation of the Users’ Continuous Intention to Use PACS Based on the Expectation Confirmation Model in Teaching Hospitals of Shiraz University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Mohtaram Nematolahi

    2017-01-01

    Full Text Available Introduction: Users’ behavioral intention to use the Picture Archiving and Communication System (PACS is important in the systems’ success and is an indicator of the users’ satisfaction with commitment and dependence on information systems. The present study aimed to evaluate the users’ continuous intention to use PACS based on the expectation confirmation model in educational hospitals of Shiraz University of Medical Sciences. Method: This cross-sectional study was conducted in Nemazee and Shahid Faghihi hospitals, Shiraz, Iran in 2014. The subjects were 50 general practitioners, residents and specialists selected through stratified random sampling. The study data were collected using a researcher-made questionnaire. The content validity of the questionnaire items was confirmed by five experts in health information management. To evaluate the accuracy of relationships among the measurement models, reliability criteria, including Cronbach’s alpha and composite reliability, convergent and divergent validity were used which showed acceptable reliability and validity. The data were entered into Smart PLS software, version 3.1.9 and analyzed through Structural Equation Modeling (SEM by using Partial Least Squares (PLS approach. Results: The results showed appropriate fitness of reliability indices (Cronbach’s alpha >0.7, composite reliability >0.7, loading >0.7, validity indices (AVE >0.5, structural model (redundancy =0.395, Q2CI=0.364, f2H5=0.524, R2CI=0.687, and the total model (GoF=0.518. Moreover, all the research hypotheses, except H1 (the relationship between expectation confirmation and perceived usefulness with T-value of 1.96. Conclusion: Expectation confirmation, perceived usefulness, and satisfaction were effective in continuous intention to use PACS. Thus, these factors should be considered by designers, developers, and managers while designing and implementing information systems to guarantee their success and improve the

  8. Does an offer for a free on-line continuing medical education (CME) activity increase physician survey response rate? A randomized trial.

    Science.gov (United States)

    Viera, Anthony J; Edwards, Teresa

    2012-03-07

    Achieving a high response rate in a physician survey is challenging. Monetary incentives increase response rates but obviously add cost to a survey project. We wondered whether an offer of a free continuing medical education (CME) activity would be effective in improving survey response rate. As part of a survey of a national sample of physicians, we randomized half to an offer for a free on-line CME activity upon completion of a web-based survey and the other half to no such offer. We compared response rates between the groups. A total of 1214 out of 8477 potentially eligible physicians responded to our survey, for an overall response rate of 14.3%. The response rate among the control group (no offer of CME credit) was 16.6%, while among those offered the CME opportunity, the response rate was 12.0% (p offer for a free on-line CME activity did not improve physician survey response rate. On the contrary, the offer for a free CME activity actually appeared to worsen the response rate. © 2011 Viera et al; licensee BioMed Central Ltd.

  9. Abolishment of 24-hour continuous medical call duty in quebec: a quality of life survey of general surgical residents following implementation of the new work-hour restrictions.

    Science.gov (United States)

    Hamadani, Fadi T; Deckelbaum, Dan; Sauve, Alexandre; Khwaja, Kosar; Razek, Tarek; Fata, Paola

    2013-01-01

    The implementation of work hour restrictions across North America have resulted in decreased levels of self injury and medical errors for Residents. An arbitration ruling in Quebec has led to further curtailment of work hours beyond that proposed by the ACGME. This may threaten Resident quality of life and in turn decrease the educational quality of surgical residency training. We administered a quality of life questionnaire with an integrated education quality assessment tool to all General Surgery residents training at McGill 6 months after the work hour restrictions. Across several strata respondents reveal a decreased sense of educational quality and quality of life. The arbitration argued that work- hour restrictions would be necessary to improve quality of life for trainees and hence improve patient safety. Results from this study demonstrate the exact opposite in a large majority of respondents, who report a poorer quality of life and a self-reported inability on their part to provide continuous and safe patient care. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  10. The Impact of Financial Disclosure on Attendee Assessment of Objectivity in Continuing Medical Education Programs in Psychiatry: A Randomized, Controlled Trial.

    Science.gov (United States)

    Jibson, Michael D; Cobourn, Lisa A; Seibert, Jennifer K

    2016-04-01

    The purpose of financial conflict of interest disclosures by speakers at continuing medical education (CME) programs is to assist attendees in their assessment of the objectivity of the information presented. This empirical study was undertaken to determine what level of disclosure is optimal to achieve this goal. Attendees at five CME programs were randomly assigned to receive either a standard financial disclosure, an intermediate level that included whether speakers received more or less than 5% of their income from each company they disclosed, or a high level of disclosure that included the percent of their income derived from each company. A total of 169 attendees (85.4% response rate) completed a questionnaire regarding the objectivity of the CME presentation they attended. Attendees receiving the highest level of disclosure came significantly closer to the ratings of speaker bias made by peer reviewers than did attendees receiving medium or low levels of disclosure (p = 0.03; effect size 0.31). Among the minority of attendees who received the highest level of disclosure but whose assessment of bias differed from that of peer reviewers, however, there was a tendency to underestimate bias (5.9 vs 31.4%; p financial disclosure than are currently required for CME programs.

  11. Use of a National Continuing Medical Education Meeting to Provide Simulation-Based Training in Temporary Hemodialysis Catheter Insertion Skills: A Pre-Test Post-Test Study

    Directory of Open Access Journals (Sweden)

    Edward G Clark

    2014-10-01

    Full Text Available Background: Simulation-based-mastery-learning (SBML is an effective method to train nephrology fellows to competently insert temporary, non-tunneled hemodialysis catheters (NTHCs. Previous studies of SBML for NTHC-insertion have been conducted at a local level. Objectives: Determine if SBML for NTHC-insertion can be effective when provided at a national continuing medical education (CME meeting. Describe the correlation of demographic factors, prior experience with NTHC-insertion and procedural self-confidence with simulated performance of the procedure. Design: Pre-test – post-test study. Setting: 2014 Canadian Society of Nephrology annual meeting. Participants: Nephrology fellows, internal medicine residents and medical students. Measurements: Participants were surveyed regarding demographics, prior NTHC-insertion experience, procedural self-confidence and attitudes regarding the training they received. NTHC-insertion skills were assessed using a 28-item checklist. Methods: Participants underwent a pre-test of their NTHC-insertion skills at the internal jugular site using a realistic patient simulator and ultrasound machine. Participants then had a training session that included a didactic presentation and 2 hours of deliberate practice using the simulator. On the following day, trainees completed a post-test of their NTHC-insertion skills. All participants were required to meet or exceed a minimum passing score (MPS previously set at 79%. Trainees who did not reach the MPS were required to perform more deliberate practice until the MPS was achieved. Results: Twenty-two individuals participated in SBML training. None met or exceeded the MPS at baseline with a median checklist score of 20 (IQR, 7.25 to 21. Seventeen of 22 participants (77% completed post-testing and improved their scores to a median of 27 (IQR, 26 to 28; p < 0.001. All met or exceeded the MPS on their first attempt. There were no significant correlations between demographics

  12. Use of a national continuing medical education meeting to provide simulation-based training in temporary hemodialysis catheter insertion skills: a pre-test post-test study.

    Science.gov (United States)

    Clark, Edward G; Paparello, James J; Wayne, Diane B; Edwards, Cedric; Hoar, Stephanie; McQuillan, Rory; Schachter, Michael E; Barsuk, Jeffrey H

    2014-01-01

    Simulation-based-mastery-learning (SBML) is an effective method to train nephrology fellows to competently insert temporary, non-tunneled hemodialysis catheters (NTHCs). Previous studies of SBML for NTHC-insertion have been conducted at a local level. Determine if SBML for NTHC-insertion can be effective when provided at a national continuing medical education (CME) meeting. Describe the correlation of demographic factors, prior experience with NTHC-insertion and procedural self-confidence with simulated performance of the procedure. Pre-test - post-test study. 2014 Canadian Society of Nephrology annual meeting. Nephrology fellows, internal medicine residents and medical students. Participants were surveyed regarding demographics, prior NTHC-insertion experience, procedural self-confidence and attitudes regarding the training they received. NTHC-insertion skills were assessed using a 28-item checklist. Participants underwent a pre-test of their NTHC-insertion skills at the internal jugular site using a realistic patient simulator and ultrasound machine. Participants then had a training session that included a didactic presentation and 2 hours of deliberate practice using the simulator. On the following day, trainees completed a post-test of their NTHC-insertion skills. All participants were required to meet or exceed a minimum passing score (MPS) previously set at 79%. Trainees who did not reach the MPS were required to perform more deliberate practice until the MPS was achieved. Twenty-two individuals participated in SBML training. None met or exceeded the MPS at baseline with a median checklist score of 20 (IQR, 7.25 to 21). Seventeen of 22 participants (77%) completed post-testing and improved their scores to a median of 27 (IQR, 26 to 28; p < 0.001). All met or exceeded the MPS on their first attempt. There were no significant correlations between demographics, prior experience or procedural self-confidence with pre-test performance. Small sample-size and

  13. Analysis on Continuing Education of Medical Ethics in Hospitals and Its Pitching- in Path%浅析医院医学伦理继续教育及其切入路径

    Institute of Scientific and Technical Information of China (English)

    况丽; 叶明; 燕敏; 郑时芹; 况成云

    2011-01-01

    一些医院把医学伦理继续教育等同于医德医风教育,使得这种教育活动无法回应医疗服务市场取向背景下的伦理诉求和医务人员医疗伦理决策意识与人格形成的需要.医院医学伦理继续教育的切入路径应以伦理认知、规则伦理、美德伦理、服务伦理、交际伦理和契约伦理教育为导向.%In some hospitals, continuing education of medical ethics is mistaken as an equivalent to medical professionalism education. Under this circumstance, continuing education of medical ethics cannot meet the ethical demand in the market - oriented context of medical service and the requirements of ethical decision - making and personality formation of medical staff. Pitching - in path of continuing education of medical ethics in hospitals should be oriented by ethical awareness, theory of rule, virtue theory, service theory, communication theory, and contract theory.

  14. Play-back theatre, theatre laboratory, and role-playing: new tools in investigating the patient-physician relationship in the context of continuing medical education courses.

    Science.gov (United States)

    Piccoli, G; Rossetti, M; Dell'Olio, R; Perrotta, L; Mezza, E; Burdese, M; Maddalena, E; Bonetto, A; Jeantet, A; Segoloni, G P

    2005-06-01

    The aim of this study was to report on the validation of a role-playing approach, using play-back and theatre laboratory in the context of a continuing medical education (CME) course on predialysis and transplantation, to discuss the patient-physician relationship. The course was developed with the help of a theatre director. The role-playing 2-day course was designed to be highly interactive for a small group (15-20 participants), based on a core of case reports (dialysis, transplantation, and return to dialysis after graft failure). Two stages were included: play-back theatre in which experiences told by the participants were mimed by a group of actors, and theatre laboratory in which different aspects of voice and touch were explored. Opinions were gathered by an anonymous semistructured questionnaire completed by all participants. The course obtained a high score from The Ministry of Health (14 credits, 1 per teaching hour). The opinions of the 18 participants were highly positive; all liked the courses. Sixteen of 18 asked to repeat the experience. The strong emotional involvement was an advantage for 15 of 18, sharing emotional aspects of the profession for 10 of 18, and usefulness in clarifying opinions on "dark sides" of our profession for 10 of 18. The positive opinions recorded during this experience, the first experiment with a "psycho-theatrical approach" developed in a CME course in our country, suggest the benefit of implementing nonconventional, educational approaches in a multidisciplinary discussion of the patient-physician relationship in transplantation medicine.

  15. The future of continuing medical education: the roles of medical professional societies and the health care industry: Position paper prepared with contributions from the European Society of Cardiology Committees for Advocacy, Education and Industry Relations, Endorsed by the Board of the European Society of Cardiology.

    Science.gov (United States)

    2018-02-28

    In recent years, wide ranging biomedical innovation has provided powerful new approaches for prevention, diagnosis and management of diseases. In order to translate such innovation into effective practice, physicians must frequently update their knowledge base and skills through continuing medical education and training. Medical Professional Societies, run as not-for-profit organizations led by peers, are uniquely placed to deliver balanced, disease oriented and patient centred education. The medical industry has a major role in the development of new, improved technology, devices and medication. In fact, the best innovations have been achieved through collaboration with scientists, clinical academics and practicing physicians. Industry has for many years been committed to ensure the optimal and safe application of its products by providing unrestricted support of medical education developed and delivered by international and national learned societies. Recently adopted Codes of Practice for the Pharmaceutical and Device industry were intended to enhance public trust in the relationship between biomedical industry and physicians. Unexpectedly, changes resulting from adoption of the Codes have limited the opportunity for unconditional industry support of balanced medical education in favour of a more direct involvement of industry in informing physicians about their products. We describe the need for continuing medical education in Cardiovascular Medicine in Europe, interaction between the medical profession and medical industry, and propose measures to safeguard the provision of high quality, balanced medical education.

  16. An Analysis of the Demographic, Educational, and Employment Characteristics of Participants in the Continuing Education Program of the Medical Library Association, Denver, Colorado, June 1968 *

    Science.gov (United States)

    Rees, Alan M.; Rothenberg, Lesliebeth

    1970-01-01

    A survey was performed to elicit details about attendees of the continuing education program given in Denver at the 1968 MLA Annual Meeting. Factors considered included sex, age, geographic distribution, professional mobility, educational background, current jobs, and interest in further continuing education. PMID:5439905

  17. An analysis of the demographic, educational, and employment characteristics of participants in the continuing education program of the Medical Library Association, Denver, Colorado, June 1968.

    Science.gov (United States)

    Rees, A M; Rothenberg, L

    1970-04-01

    A survey was performed to elicit details about attendees of the continuing education program given in Denver at the 1968 MLA Annual Meeting. Factors considered included sex, age, geographic distribution, professional mobility, educational background, current jobs, and interest in further continuing education.

  18. [Role of a credit system in the development of continuous postgraduate training of physicians within the framework of the innovation educational space formation program of the I. M. Sechenov Moscow Medical Academy].

    Science.gov (United States)

    Vyzhigina, M A; Buniatian, A A; Sizova, Zh M; Protopopova, T A; Zaugol'nikova, T V; Zhukova, S G

    2007-01-01

    Russia 's joining the European higher educational space and an increase in the international competitive capacity of the European higher educational system envisage first of all that the European credit test system (ECTS) should be accepted and introduced into all national higher educational schools, which ensures both credit test and cumulative functions and guarantees the academic recognition of the education abroad. The issues of modernization of approaches to reforming the continuous postgraduate training of physicians, by using the credit test system, as well as new forms and technologies for an educational process in accordance with the European educational system principles are under discussion. The novelty of the proposed development is that the credit test system is first applied to the continuous postgraduate training of physicians within the framework of the Russian higher medical educational system. The Russian continuous postgraduate medical training pattern that is common in form and content is proposed in accordance with the Bologna declaration principles; approaches have been developed to incorporating the European educational traditions into the Russian national continuous postgraduate medical training system, by employing the credit test system; criteria have been elaborated for adapting the European credit test system at all stages of reformation of the Russian educational system; guidelines have been worked out for the conversion of academic load of various forms of the continuous postgraduate training of physicians to the credit test system; ways of introducing the new forms and technologies into an educational process have been proposed in accordance with the European education system principles, by taking into account the credit test system. The introduction of new technologies of an educational process, by using the credit test system will contribute to personality formation in a physician who has a high competence, a capacity for valuable

  19. Continuous auditing & continuous monitoring : Continuous value?

    NARCIS (Netherlands)

    van Hillo, Rutger; Weigand, Hans; Espana, S; Ralyte, J; Souveyet, C

    2016-01-01

    Advancements in information technology, new laws and regulations and rapidly changing business conditions have led to a need for more timely and ongoing assurance with effectively working controls. Continuous Auditing (CA) and Continuous Monitoring (CM) technologies have made this possible by

  20. Processing of Continuously Provided Punishment and Reward in Children with ADHD and the Modulating Effects of Stimulant Medication : An ERP Study

    NARCIS (Netherlands)

    Groen, Yvonne; Tucha, Oliver; Wijers, Albertus A.; Althaus, Monika

    2013-01-01

    Objectives: Current models of ADHD suggest abnormal reward and punishment sensitivity, but the exact mechanisms are unclear. This study aims to investigate effects of continuous reward and punishment on the processing of performance feedback in children with ADHD and the modulating effects of

  1. [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.

  2. [The health policy of the "Council of the People's Representatives": the German revolution 1918/1919 in medical historical perspective II: health policy as a factor of continuity and stability].

    Science.gov (United States)

    Kratzsch, Tilman

    2005-01-01

    Most important for the events at the turn of 1918/19 was the coincidence of the revolution and the end of the war. This meant that in a very short time the troops had to be withdrawn from the front, the size of the army had to be reduced, and the wartime economy had to be transformed into a peace economy. Apart from the resulting economical and social problems, military demobilisation was closely linked with medical and health political difficulties. The revolutionary government saw itself as a provisional arrangement to ensure the unity of the state and the functioning of the German Reich. The maintenance of medical care and provision of a minimum of foodstuffs made health policy important during the months of revolution. Despite a positive balance of payments and a "health policy of continuity", the revolutionary government was unable to win the medical profession for its aims, because it failed to dispel suspicions that the medical profession was going to be socialised.

  3. Medicine promotional literature as a source of updated information in Bangladesh: Do those advertising literature promote continued medical education or deceptive advertising?

    Directory of Open Access Journals (Sweden)

    Rayhana Sharmin

    2017-01-01

    Full Text Available Background: Drug promotional literature (DPLs is an integral part of pharmaceutical marketing strategy. This marketing approach influences, a physician to prescribe definite variety of medicine from a particular company. Many physicians bank on exclusively in DPLs. This research was intended to appraise the DPLs available in Bangladesh for accuracy, consistency, and validity of the information in accordance with the WHO rules and regulations. Materials and Methods: This was a cross-sectional study was conducted in Uttara Adhunik Medical College, Dhaka, Bangladesh after collecting DPLs from the different outpatient department. The data was analyzed Microsoft Excel 2016. Results: None of the national and multinational DPLs fulfilled all the WHO criteria. Among the national and multinational DPLs, 94.7% and 100% presented with claims respectively. Out of 284 national and multinational DPLs references citation were presented in 82.04% and 100% respectively. Among the DPLs of national and multinational companies' relevant, irrelevant, and partially relevant pictures were presented in 48.79%, 24.65%, 26.76% and 31.58%, 26.32%, and 42.11%, respectively. Conclusion: DPLs of Bangladesh did not comply with the WHO guidelines while promoting their products. Evidence provided in those DPLs were mostly biased and persuasive since it is focusing mainly on the positive aspect of drug therapy. Accordingly, studied DPLs were principally aiming to maximizes industries' financial benefit rather than fulfill the educational aspects. The Government of Bangladesh should develop very stringent policy and practices regarding DPLs based on science and the WHO guideline as the literature very often act as a primary source of information among medical doctors.

  4. Speaking the right language: the scientific method as a framework for a continuous quality improvement program within academic medical research compliance units.

    Science.gov (United States)

    Nolte, Kurt B; Stewart, Douglas M; O'Hair, Kevin C; Gannon, William L; Briggs, Michael S; Barron, A Marie; Pointer, Judy; Larson, Richard S

    2008-10-01

    The authors developed a novel continuous quality improvement (CQI) process for academic biomedical research compliance administration. A challenge in developing a quality improvement program in a nonbusiness environment is that the terminology and processes are often foreign. Rather than training staff in an existing quality improvement process, the authors opted to develop a novel process based on the scientific method--a paradigm familiar to all team members. The CQI process included our research compliance units. Unit leaders identified problems in compliance administration where a resolution would have a positive impact and which could be resolved or improved with current resources. They then generated testable hypotheses about a change to standard practice expected to improve the problem, and they developed methods and metrics to assess the impact of the change. The CQI process was managed in a "peer review" environment. The program included processes to reduce the incidence of infections in animal colonies, decrease research protocol-approval times, improve compliance and protection of animal and human research subjects, and improve research protocol quality. This novel CQI approach is well suited to the needs and the unique processes of research compliance administration. Using the scientific method as the improvement paradigm fostered acceptance of the project by unit leaders and facilitated the development of specific improvement projects. These quality initiatives will allow us to improve support for investigators while ensuring that compliance standards continue to be met. We believe that our CQI process can readily be used in other academically based offices of research.

  5. Continuous Problem of Function Continuity

    Science.gov (United States)

    Jayakody, Gaya; Zazkis, Rina

    2015-01-01

    We examine different definitions presented in textbooks and other mathematical sources for "continuity of a function at a point" and "continuous function" in the context of introductory level Calculus. We then identify problematic issues related to definitions of continuity and discontinuity: inconsistency and absence of…

  6. Verfügbarkeit elektronischer Lehr- und Lernmodule für die Aus- und Weiterbildung in der Humanmedizin [Availability of learning objects for graduate and continuing medical education

    Directory of Open Access Journals (Sweden)

    Stausberg, Jürgen

    2008-11-01

    Full Text Available [english] A great number of learning objects is available for graduate and continuing medical education. Nevertheless, it is not known how well the range of available learning objects covers the needs of the various medical fields. To get an idea of this, the content of two catalogs of learning objects (LRSMed and KELDAmed was compared with the study regulations of the medical faculty of the University of Duisburg-Essen on the one hand and with the 2006 directory of certified medical specialists on the other hand. Spearman’s rank correlation coefficient was used as concordance measure in addition to a qualitative assessment. Correlation coefficients of 0.495 (LRSMed and 0.510 (KELDAmed show a relevant concordance with study regulations, while correlation coefficients of 0.300 and –0.182 reveal a worse concordance with continuing medical education. Therefore, the offers for graduate medical education correspond well with the medical fields, based on number of hours per semester per course. The absolute number of 1,822 learning objects from LRSMed and 1,769 from KELDAmed is excellent as well. The gap for continuing medical education can now be closed by means of funding from professional organizations and medical faculties and through healthcare policies. The quality of the learning objects offered by LRSMed and KELDAmed remains unknown, as there is yet no reliable and valid approach for assessing their quality. [german] Elektronische Lehr- und Lernmodule stehen inzwischen in großer Zahl für Aus- und Weiterbildung in der Humanmedizin zur Verfügung. Ob das Angebot die Fachgebiete in der erforderlichen Breite abdeckt ist unbekannt. Für eine erste Einschätzung wurden die Ressourcen von zwei umfassenden Katalogen, dem Learning Resource Server Medizin (LRSMed und der Kommentierten E-Learning Datenbank Medizin (KELDAmed, der Studienordnung der Medizinischen Fakultät der Universität Duisburg-Essen sowie der Ärztestatistik 2006 zu

  7. Pediatrics Department of the Russian Medical Academy of Continuous Professional Education and Moscow Research Clinical Institute of Pediatry and Children Surgery – half century hand in hand

    Directory of Open Access Journals (Sweden)

    I. N. Zakharova

    2018-01-01

    Full Text Available The long-term cooperation of the two scientific institutions contributing to the professional development of pediatricians is based on the long-term scientific relations of the Department of Pediatrics of the Russian Medical Academy of Continuing Professional Education and the Moscow Research Institute of Pediatrics and Pediatric Surgery (now the Research Institute of Pediatrics named after Academician Yu.E.Veltischev. The role of remarkable pediatric scientists – G.N. Speransky, Yu.E. Veltstschev, M.S. Ignatova, N.A. Korovina in the development of these links and pediatric science in Russia. 

  8. The comparison of different medication project of continuous epidural analgesia for the patient after lumbar vertebra operation%腰椎手术病人连续硬膜外镇痛的不同用药方案比较

    Institute of Scientific and Technical Information of China (English)

    王成才; 袁红兵; 王新华

    2002-01-01

    Objective Comparing different medication project of continuous epidural analgesia for the patient after lumbar vertebra operation, to decrease the complications and promote analgesia effects. Methods 150 cases with ASAⅠ~Ⅱ grade, lumbar intervertebral disc extirpation and /or vertebral canal decompression, were divided into 5 groups. A group: 0.0625% bupivacaine; B group: 0.125% bupivacaine; C group: 0.0625% bupivacaine and 1 mg morphine; D group: 0.125% bupivacaine and 1 mg morphine; E group: no analgesia. Record the occurrence of RR,MAP,HR,VAS score and side effects. Results The analgesia effects of all groups were satisfying, but the occurrence of urine retention increased in B,C,D group, and the occurrence of nausea and vomit increased obviously in C,D group. Conclusions The continuous epidural analgesia with simple 0.0625% for patients after lumbar vertebral operation is best.

  9. [The importance of simulation in team training on obstetric emergencies: results of the first phase of the national plan for continuous medical training].

    Science.gov (United States)

    Maio Matos, Francisco; Sousa Gomes, Andrea; Costa, Fernando Jorge; Santos Silva, Isabel; Carvalhas, Joana

    2012-01-01

    Obstetric emergencies are unexpected and random. The traditional model for medical training of these acute events has included lectures combined with sporadic clinical experiences, but this educational method has inherent limitations. Given the variety of manual skills that must be learned and high-risk environment, Obstetrics is uniquely suited for simulation. New technological educational tools provide an opportunity to learn and master technical skills needed in emergent situations as well as the opportunity to rehearse and learn from mistakes without risks to patients. The goals of this study are to assess which are the factors that trainees associate to human fallibility before and after clinical simulation based training; to compare the confidence level to solve emergent obstetric situations between interns and experts with up to 5 years of experience before and after training, and to determine the value that trainees give to simulation as a teaching tool on emergent events. 31 physicians participated at this course sessions. After the course, we verified changes in the factores that trainees associate to human fallibility, an increase in confidence level to solve emergent obstetric and an increase in the value that trainees give to simulation as a teaching tool.

  10. Assessing the learning potential of an interactive digital game versus an interactive-style didactic lecture: the continued importance of didactic teaching in medical student education.

    Science.gov (United States)

    Courtier, Jesse; Webb, Emily M; Phelps, Andrew S; Naeger, David M

    2016-12-01

    Games with educational intent offer a possible advantage of being more interactive and increasing learner satisfaction. We conducted a two-armed experiment to evaluate student satisfaction and content mastery for an introductory pediatric radiology topic, taught by either an interactive digital game or with a traditional didactic lecture. Medical students participating in a fourth-year radiology elective were invited to participate. Student cohorts were alternatively given a faculty-supervised 1h session playing a simple interactive digital Tic-tac-toe quiz module on pediatric gastrointestinal radiology or a 1h didactic introductory lecture on the same topic. Survey questions assessed the learners' perceived ability to recall the material as well as their satisfaction with the educational experience. Results of an end-of-rotation exam were reviewed to evaluate a quantitative measure of learning between groups. Survey responses were analyzed with a chi-squared test. Exam results for both groups were analyzed with a paired Student's t-test. Students in the lecture group had higher test scores compared to students in the game group (4.0/5 versus 3.6/5, P = 0.045). Students in the lecture group reported greater understanding and recall of the material than students in the game group (P digital interactive materials reported by students in the game group (P = 0.146). Our experience supported the use of a traditional lecture over a digital game module. While these results might be affected by the specific lecture and digital content in any given comparison, a digital module is not always the superior option.

  11. Business continuity

    International Nuclear Information System (INIS)

    Breunhoelder, Gert

    2002-01-01

    This presentation deals with the following keypoints: Information Technology (IT) Business Continuity and Recovery essential for any business; lessons learned after Sept. 11 event; Detailed planning, redundancy and testing being the key elements for probability estimation of disasters

  12. Continuous tokamaks

    International Nuclear Information System (INIS)

    Peng, Y.K.M.

    1978-04-01

    A tokamak configuration is proposed that permits the rapid replacement of a plasma discharge in a ''burn'' chamber by another one in a time scale much shorter than the elementary thermal time constant of the chamber first wall. With respect to the chamber, the effective duty cycle factor can thus be made arbitrarily close to unity minimizing the cyclic thermal stress in the first wall. At least one plasma discharge always exists in the new tokamak configuration, hence, a continuous tokamak. By incorporating adiabatic toroidal compression, configurations of continuous tokamak compressors are introduced. To operate continuous tokamaks, it is necessary to introduce the concept of mixed poloidal field coils, which spatially groups all the poloidal field coils into three sets, all contributing simultaneously to inducing the plasma current and maintaining the proper plasma shape and position. Preliminary numerical calculations of axisymmetric MHD equilibria in continuous tokamaks indicate the feasibility of their continued plasma operation. Advanced concepts of continuous tokamaks to reduce the topological complexity and to allow the burn plasma aspect ratio to decrease for increased beta are then suggested

  13. 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 ...

  14. Continuous Dropout.

    Science.gov (United States)

    Shen, Xu; Tian, Xinmei; Liu, Tongliang; Xu, Fang; Tao, Dacheng

    2017-10-03

    Dropout has been proven to be an effective algorithm for training robust deep networks because of its ability to prevent overfitting by avoiding the co-adaptation of feature detectors. Current explanations of dropout include bagging, naive Bayes, regularization, and sex in evolution. According to the activation patterns of neurons in the human brain, when faced with different situations, the firing rates of neurons are random and continuous, not binary as current dropout does. Inspired by this phenomenon, we extend the traditional binary dropout to continuous dropout. On the one hand, continuous dropout is considerably closer to the activation characteristics of neurons in the human brain than traditional binary dropout. On the other hand, we demonstrate that continuous dropout has the property of avoiding the co-adaptation of feature detectors, which suggests that we can extract more independent feature detectors for model averaging in the test stage. We introduce the proposed continuous dropout to a feedforward neural network and comprehensively compare it with binary dropout, adaptive dropout, and DropConnect on Modified National Institute of Standards and Technology, Canadian Institute for Advanced Research-10, Street View House Numbers, NORB, and ImageNet large scale visual recognition competition-12. Thorough experiments demonstrate that our method performs better in preventing the co-adaptation of feature detectors and improves test performance.

  15. Continuity theory

    CERN Document Server

    Nel, Louis

    2016-01-01

    This book presents a detailed, self-contained theory of continuous mappings. It is mainly addressed to students who have already studied these mappings in the setting of metric spaces, as well as multidimensional differential calculus. The needed background facts about sets, metric spaces and linear algebra are developed in detail, so as to provide a seamless transition between students' previous studies and new material. In view of its many novel features, this book will be of interest also to mature readers who have studied continuous mappings from the subject's classical texts and wish to become acquainted with a new approach. The theory of continuous mappings serves as infrastructure for more specialized mathematical theories like differential equations, integral equations, operator theory, dynamical systems, global analysis, topological groups, topological rings and many more. In light of the centrality of the topic, a book of this kind fits a variety of applications, especially those that contribute to ...

  16. Continuation calculus

    NARCIS (Netherlands)

    Geron, B.; Geuvers, J.H.; de'Liguoro, U.; Saurin, A.

    2013-01-01

    Programs with control are usually modeled using lambda calculus extended with control operators. Instead of modifying lambda calculus, we consider a different model of computation. We introduce continuation calculus, or CC, a deterministic model of computation that is evaluated using only head

  17. Essential learning tools for continuing medical education for physicians, geneticists, nurses, allied health professionals, mental health professionals, business administration professionals, and reproductive endocrinology and infertility (REI) fellows: the Midwest Reproductive Symposium International.

    Science.gov (United States)

    Collins, Gretchen G; Jeelani, Roohi; Beltsos, Angeline; Kearns, William G

    2018-04-01

    Essential learning tools for continuing medical education are a challenge in today's rapidly evolving field of reproductive medicine. The Midwest Reproductive Symposium International (MRSi) is a yearly conference held in Chicago, IL. The conference is targeted toward physicians, geneticists, nurses, allied health professionals, mental health professionals, business administration professionals, and reproductive endocrinology and infertility (REI) fellows engaged in the practice of reproductive medicine. In addition to the scientific conference agenda, there are specific sessions for nurses, mental health professionals, and REI fellows. Unique to the MRSi conference, there is also a separate "Business Minds" session to provide education on business acumen as it is an important element to running a department, division, or private clinic.

  18. Screening for diabetic retinopathy | Rice | Continuing Medical ...

    African Journals Online (AJOL)

    Good glucose control and the treatment of hypertension and hyperlipidaemia remain the key strategies in preventing diabetic retinopathy and its progression. Unfortunately, some degree of retinopathy will eventually develop in almost all type 1 diabetics and over 60% of type 2 diabetics over a 20-year period.

  19. Colorectal cancer screening | Schneider | Continuing Medical ...

    African Journals Online (AJOL)

    Colorectal cancer (CRC) is one of the most common cancers in the Western world, with an estimated incidence of 148 810 cases in the USA in 2008, and about 50 000 deaths from this disease. If detected early, patients with disease localised to the colonic wall have a 5-year survival of 90%. The 5-year survival for patients ...

  20. Continuation calculus

    Directory of Open Access Journals (Sweden)

    Bram Geron

    2013-09-01

    Full Text Available Programs with control are usually modeled using lambda calculus extended with control operators. Instead of modifying lambda calculus, we consider a different model of computation. We introduce continuation calculus, or CC, a deterministic model of computation that is evaluated using only head reduction, and argue that it is suitable for modeling programs with control. It is demonstrated how to define programs, specify them, and prove them correct. This is shown in detail by presenting in CC a list multiplication program that prematurely returns when it encounters a zero. The correctness proof includes termination of the program. In continuation calculus we can model both call-by-name and call-by-value. In addition, call-by-name functions can be applied to call-by-value results, and conversely.

  1. Uso de medicamentos contínuos e fatores associados em idosos de Quixadá, Ceará Continuous-use medication and associated factors in the elderly living in Quixadá, Ceará, Brazil

    Directory of Open Access Journals (Sweden)

    Gilmar de Oliveira Barros Silva

    2012-06-01

    Full Text Available OBJETIVO: Analisar a polifarmácia (uso diário de dois ou mais de medicamentos contínuos e seus fatores associados em idosos. MÉTODOS: Estudo seccional realizado com idosos residentes em área urbana do município de Quixadá-CE, no período de maio a dezembro de 2009. A amostra compôs-se de 384 indivíduos, com 60 anos ou mais, usuários de medicamentos contínuos. As variáveis estudadas foram as sociodemográficas, econômicas e das características de saúde e referentes ao uso de medicamentos. Para a análise da associação entre a variável dependente polifarmácia de medicamentos contínuos e as variáveis independentes foi elaborado um modelo de regressão logística. RESULTADOS: Os resultados mostram predominância de idosos do sexo feminino, faixa etária entre 60 e 69 anos, casados, ensino fundamental incompleto, sem exercer atividade remunerada, renda familiar de até um salário mínimo, habitando em moradia própria, residindo com até três pessoas. Constatou-se uma prevalência de 70,6% de polifarmácia em idosos, sendo mais elevada no sexo feminino (66,4%. Os fatores associados positivamente ao uso de dois ou mais medicamentos contínuos foram: renda familiar acima de um salário mínimo (OR 2,83; IC95% = 1,54-5,32; duas ou mais condições crônicas autorreferidas (OR 17,71; IC95% = 9,80-31,990 e autopercepção da qualidade de vida regular e ruim (OR 2,85; IC95% = 1,60-5,07. CONCLUSÕES: Constatou-se uma prática de polifarmácia de medicamentos contínuos em idosos com renda familiar superior a um salário mínimo, que apresenta duas ou mais condições crônicas e autopercepção da sua qualidade de vida entre regular e ruim. Situação que remete a questões relativas aos aspectos social, cultural, econômico e de saúde.OBJECTIVE: To analyze polypharmacy (daily use of two or more of continuous use medication and its associated factors in the elderly. METHODS: A cross sectional study conducted with elderly individuals

  2. 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.

  3. Medical laboratory professional's perceptions of continuous medical education

    Directory of Open Access Journals (Sweden)

    Asmaa Alyaemni

    2017-01-01

    Conclusion: Most laboratory technicians in our study reported favourable perceptions of CME programmes, feeling that they increased professional confidence and competency. We recommend that core competencies be integrated into credentialing using profession-specific CME in a workplace setting. In addition, MLTs should be involved in designing the programmes as well. Further studies in a multicentre institution are needed to analyse the difference in perception among those who have attended CME and those who have not.

  4. Implantable Nanosensors: Towards Continuous Physiologic Monitoring

    OpenAIRE

    Ruckh, Timothy T.; Clark', Heather A.

    2013-01-01

    Continuous physiologic monitoring would add greatly to both home and clinical medical treatment for chronic conditions. Implantable nanosensors are a promising platform for designing continuous monitoring systems. This feature reviews design considerations and current approaches towards such devices.

  5. 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.

  6. 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

  7. Sibling bereavement and continuing bonds.

    Science.gov (United States)

    Packman, Wendy; Horsley, Heidi; Davies, Betty; Kramer, Robin

    2006-11-01

    Historically, from a Freudian and medical model perspective, emotional disengagement from the deceased was seen as essential to the successful adaptation of bereavement. A major shift in the bereavement literature has occurred and it is now generally accepted that despite the permanence of physical separation, the bereaved remains involved and connected to the deceased and can be emotionally sustained through continuing bonds. The majority of literature has focused on adults and on the nature of continuing bonds following the death of a spouse. In this article, the authors demonstrate how the continuing bonds concept applies to the sibling relationship. We describe the unique continued relationship formed by bereaved children and adolescents following a sibling loss, highlight the factors that influence the siblings continuing bonds expressions, and offer clinical interventions. In our view, mental health professionals can play an important role in helping parents encourage activities that may facilitate the creation and maintenance of continuing bonds in their children.

  8. Feasibility of a randomised trial of a continuing medical education program in shared decision-making on the use of antibiotics for acute respiratory infections in primary care: the DECISION+ pilot trial

    Directory of Open Access Journals (Sweden)

    Laurier Claudine

    2011-01-01

    Full Text Available Abstract Background The misuse and limited effectiveness of antibiotics for acute respiratory infections (ARIs are well documented, and current approaches targeting physicians or patients to improve appropriate use have had limited effect. Shared decision-making could be a promising strategy to improve appropriate antibiotic use for ARIs, but very little is known about its implementation processes and outcomes in clinical settings. In this matter, pilot studies have played a key role in health science research over the past years in providing information for the planning, justification, and/or refinement of larger studies. The objective of our study was to assess the feasibility and acceptability of the study design, procedures, and intervention of the DECISION+ program, a continuing medical education program in shared decision-making among family physicians and their patients on the optimal use of antibiotics for treating ARIs in primary care. Methods A pilot clustered randomised trial was conducted. Family medicine groups (FMGs were randomly assigned, to either the DECISION+ program, which included three 3-hour workshops over a four- to six-month period, or a control group that had a delayed exposure to the program. Results Among 21 FMGs contacted, 5 (24% agreed to participate in the pilot study. A total of 39 family physicians (18 in the two experimental and 21 in the three control FMGs and their 544 patients consulting for an ARI were recruited. The proportion of recruited family physicians who participated in all three workshops was 46% (50% for the experimental group and 43% for the control group, and the overall mean level of satisfaction regarding the workshops was 94%. Conclusions This trial, while aiming to demonstrate the feasibility and acceptability of conducting a larger study, has identified important opportunities for improving the design of a definitive trial. This pilot trial is informative for researchers and clinicians

  9. Teamwork, Leadership, and Continuous Improvement

    NARCIS (Netherlands)

    Keijser, Wouter Alexander; Glaudemans, Andor; Medema, Jitze; Dierckx, Rudi; Ahaus, Kees

    2017-01-01

    In this chapter, we describe the enhanced TeamSTEPPS® curriculum as fundament to creating a “culture of continuous improvement” in nuclear medicine. This evidence-based and modular teamwork system is deployed in concordance with a novel medical leadership development program. It provides a

  10. Comprehensive geriatric assessment | Lipschitz | Continuing ...

    African Journals Online (AJOL)

    Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 25, No 9 (2007) > ... EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL.

  11. 21 CFR 868.5895 - Continuous ventilator.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Continuous ventilator. 868.5895 Section 868.5895...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5895 Continuous ventilator. (a) Identification. A continuous ventilator (respirator) is a device intended to mechanically control or assist...

  12. Between strong continuity and almost continuity

    Directory of Open Access Journals (Sweden)

    J.K. Kohli

    2010-04-01

    Full Text Available As embodied in the title of the paper strong and weak variants of continuity that lie strictly between strong continuity of Levine and almost continuity due to Singal and Singal are considered. Basic properties of almost completely continuous functions (≡ R-maps and δ-continuous functions are studied. Direct and inverse transfer of topological properties under almost completely continuous functions and δ-continuous functions are investigated and their place in the hier- archy of variants of continuity that already exist in the literature is out- lined. The class of almost completely continuous functions lies strictly between the class of completely continuous functions studied by Arya and Gupta (Kyungpook Math. J. 14 (1974, 131-143 and δ-continuous functions defined by Noiri (J. Korean Math. Soc. 16, (1980, 161-166. The class of almost completely continuous functions properly contains each of the classes of (1 completely continuous functions, and (2 al- most perfectly continuous (≡ regular set connected functions defined by Dontchev, Ganster and Reilly (Indian J. Math. 41 (1999, 139-146 and further studied by Singh (Quaestiones Mathematicae 33(2(2010, 1–11 which in turn include all δ-perfectly continuous functions initi- ated by Kohli and Singh (Demonstratio Math. 42(1, (2009, 221-231 and so include all perfectly continuous functions introduced by Noiri (Indian J. Pure Appl. Math. 15(3 (1984, 241-250.

  13. 10 CFR 55.21 - Medical examination.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 2 2010-01-01 2010-01-01 false Medical examination. 55.21 Section 55.21 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) OPERATORS' LICENSES Medical Requirements § 55.21 Medical examination. An applicant for a license shall have a medical examination by a physician. A licensee shall have a medical...

  14. Completely continuous and weakly completely continuous abstract ...

    Indian Academy of Sciences (India)

    An algebra A is called right completely continuous (right weakly completely continuous) ... Moreover, some applications of these results in group algebras are .... A linear subspace S(G) of L1(G) is said to be a Segal algebra, if it satisfies the.

  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. 42 CFR 456.231 - Continued stay review required.

    Science.gov (United States)

    2010-10-01

    ... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan... a review of each recipient's continued stay in the mental hospital to decide whether it is needed...

  17. Providing Continuous Assurance

    NARCIS (Netherlands)

    Kocken, Jonne; Hulstijn, Joris

    2017-01-01

    It has been claimed that continuous assurance can be attained by combining continuous monitoring by management, with continuous auditing of data streams and the effectiveness of internal controls by an external auditor. However, we find that in existing literature the final step to continuous

  18. Status of medical mycology education.

    Science.gov (United States)

    Steinbach, William J; Mitchell, Thomas G; Schell, Wiley A; Espinel-Ingroff, Ana; Coico, Richard F; Walsh, Thomas J; Perfect, John R

    2003-12-01

    The number of immunocompromised patients and subsequent invasive fungal infections continues to rise. However, the education of future medical mycologists to engage this growing problem is diminishing. While there are an increasing number of publications and grants awarded in mycology, the time and detail devoted to teaching medical mycology in United States medical schools are inadequate. Here we review the history in medical mycology education and the current educational opportunities. To accurately gauge contemporary teaching we also conducted a prospective survey of microbiology and immunology departmental chairpersons in United States medical schools to determine the amount and content of contemporary education in medical mycology.

  19. Business Continuity Management Plan

    Science.gov (United States)

    2014-12-01

    NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA MBA PROFESSIONAL REPORT BUSINESS CONTINUITY MANAGEMENT PLAN December 2014......maximum 200 words) Navy Supply Systems Command (NAVSUP) lacks a business process framework for the development of Business Continuity Management

  20. Smarandache Continued Fractions

    OpenAIRE

    Ibstedt, H.

    2001-01-01

    The theory of general continued fractions is developed to the extent required in order to calculate Smarandache continued fractions to a given number of decimal places. Proof is given for the fact that Smarandache general continued fractions built with positive integer Smarandache sequences baving only a finite number of terms equal to 1 is convergent. A few numerical results are given.

  1. Plants under continuous light

    NARCIS (Netherlands)

    Velez Ramirez, A.I.; Ieperen, van W.; Vreugdenhill, D.; Millenaar, F.F.

    2011-01-01

    Continuous light is an essential tool for understanding the plant circadian clock. Additionally, continuous light might increase greenhouse food production. However, using continuous light in research and practice has its challenges. For instance, most of the circadian clock-oriented experiments

  2. Costs of conventional radical radiotherapy versus continuous hyperfractionated accelerated radiotherapy (CHART) in the treatment of patients with head and neck cancer or carcinoma of the bronchus. Medical Research Council CHART Steering Committee.

    Science.gov (United States)

    Coyle, D; Drummond, M F

    1997-01-01

    The objective of this study was to compare the costs of treatment with continuous hyperfractionated accelerated radiotherapy (CHART) and those of conventional radiotherapy for patients with (1) head and neck cancer and (2) carcinoma of the bronchus. The study was conducted concurrently with two multicentre randomized controlled trials. Data were collected on the use of hospital and community service resources and patients' travel for treatment. Data on resource use up to 3 months after entry to the study were available for 526 head and neck patients (314 receiving CHART and 212 conventional therapy) and 284 bronchus patients (175 CHART and 109 conventional therapy). For patients with head and neck cancer, CHART cost Pounds 1092 (P hostel facilities. The results of this cost analysis will help to facilitate a decision about whether the benefits of CHART, as determined by the clinical trials, are worth the additional costs of hospital-based resource use. The collection of detailed patient-specific resource-use data from a number of centres allows the determination of ways for reducing the cost differential between therapies and making CHART a more cost effective treatment alternative.

  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. A community continuity programme: volunteer faculty mentors and continuity learning.

    Science.gov (United States)

    McGeehan, John; English, Richard; Shenberger, Keith; Tracy, Gerald; Smego, Raymond

    2013-02-01

    Longitudinal generalist preceptorship experiences early in medical education can have beneficial effects on how students practise the art and science of medicine, regardless of their eventual career choices. We evaluated the first 2 years of implementation of an integrated, regional campus-based, early clinical experience programme, the Community Continuity Program, at our new community-based medical school that is under the supervision of volunteer primary care faculty members acting as continuity mentors (CMs). Curricular components for years 1 and 2 consisted of three annual 1-week community-based experiences with CMs, extensive physical diagnosis practice, interprofessional learning activities, a multigenerational family care experience, a mandatory Community Health Research Project (CHRP) in year 1 and a mandatory Quality Improvement Project in year 2. Outcome measures included student, faculty member and programme evaluations, student reflective narratives in portal-based e-journals, a Liaison Committee on Medical Education (LCME) self-study student survey and serial level-of-empathy surveys.   Students found all elements of this integrated community experience programme beneficial and worthwhile, especially the CMs and the use of standardised and real-life patients. CMs noted effective and professional student-patient interactions. The number of reflective e-journal postings per student during year1 ranged from 14 to 81 (mean, 47). Serial empathy questionnaires administered over 2 years demonstrated preservation of student empathy, and students believed that the programme had a positive effect on their personal level of empathy.   An integrative, longitudinal, community-based, early clinical experience programme driven by volunteer CMs provides patient-centered instruction for preclinical students in the clinical, social, behavioural, ethical and research foundations of medicine. © Blackwell Publishing Ltd 2013.

  5. Microfluidics for medical applications

    NARCIS (Netherlands)

    van den Berg, Albert; van den Berg, A.; Segerink, L.I.; Segerink, Loes Irene; Unknown, [Unknown

    2015-01-01

    Lab-on-a-chip devices for point of care diagnostics have been present in clinics for several years now. Alongside their continual development, research is underway to bring the organs and tissue on-a-chip to the patient, amongst other medical applications of microfluidics. This book provides the

  6. 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 ...

  7. 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...

  8. [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.

  9. 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 ...

  10. Humility Through Humiliation in Continuity Clinic.

    Science.gov (United States)

    Lelkes, Efrat

    2016-01-01

    For freshly minted MDs, residency represents a period of transition from being a medical student to becoming a physician. This evolution is often fraught. Continuity clinic-a mandatory component of pediatric residency training-can be a battleground for this tribulation. This essay explores the author's journey from the first days of her continuity clinic to the last. The author recounts her struggles, her fears, her certainty of being an imposter, and her steps towards becoming a pediatrician.

  11. The training of medical students.

    Science.gov (United States)

    Llewellyn-Jones, D

    1976-03-01

    A continuing preoccupation, perhaps an occupational neurosis, of Deans and of Medical Faculties seems to be curricular change. It is fashionable, it is progressive, it demonstrates to outsiders the educational dynamic of medicine.

  12. Cutting Out Continuations

    DEFF Research Database (Denmark)

    Bahr, Patrick; Hutton, Graham

    2016-01-01

    In the field of program transformation, one often transforms programs into continuation-passing style to make their flow of control explicit, and then immediately removes the resulting continuations using defunctionalisation to make the programs first-order. In this article, we show how these two...... transformations can be fused together into a single transformation step that cuts out the need to first introduce and then eliminate continuations. Our approach is calculational, uses standard equational reasoning techniques, and is widely applicable....

  13. Medical supervision of radiation workers

    International Nuclear Information System (INIS)

    Santani, S.B.; Nandakumar, A.N.; Subramanian, G.

    1982-01-01

    The basic elements of an occupational medical supervision programme for radiation workers are very much the same as those relevant to other professions with some additional special features. This paper cites examples from literature and recommends measures such as spot checks and continuance of medical supervision even after a radiation worker leaves this profession. (author)

  14. Generalized analytic continuation

    CERN Document Server

    Ross, William T

    2002-01-01

    The theory of generalized analytic continuation studies continuations of meromorphic functions in situations where traditional theory says there is a natural boundary. This broader theory touches on a remarkable array of topics in classical analysis, as described in the book. This book addresses the following questions: (1) When can we say, in some reasonable way, that component functions of a meromorphic function on a disconnected domain, are "continuations" of each other? (2) What role do such "continuations" play in certain aspects of approximation theory and operator theory? The authors use the strong analogy with the summability of divergent series to motivate the subject. In this vein, for instance, theorems can be described as being "Abelian" or "Tauberian". The introductory overview carefully explains the history and context of the theory. The authors begin with a review of the works of Poincaré, Borel, Wolff, Walsh, and Gončar, on continuation properties of "Borel series" and other meromorphic func...

  15. Continuing professional development | Hellenberg | South African ...

    African Journals Online (AJOL)

    It would be unlikely that many of today\\'s practicing family doctors have not been involved in Continuing Medical Education (CME) activities. It would be equally unlikely, however, that these activities were part of any contextually structured educational plan towards professional development. Often driven by external need ...

  16. 42 CFR 456.236 - Continued stay review process.

    Science.gov (United States)

    2010-10-01

    ... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan... each continued stay of a recipient in the mental hospital, the committee, subgroup or designee reviews... committee, subgroup or designee finds that a recipient's continued stay in the mental hospital is needed...

  17. Medical marijuana: California update.

    Science.gov (United States)

    James, J S

    1996-08-23

    The Cannabis Buyers' Club in San Francisco remains closed after it was raided by the office of California Attorney General Dan Lungren. Many individuals with serious illnesses such as AIDS and cancer are without safe access to medical marijuana to relieve the symptoms of their diseases. The need for access to medicinal marijuana, the return of the confiscated confidential medical records held at the buyers' club, and the passage of California Proposition 215 in the November election, which allows for the legitimate use of marijuana for medical purposes are of immediate concern. Since the raid, the Cannabis Buyers' Club has denied charges that it sold marijuana to teenagers, saying the drug was sold to a teen's mother, an undercover narcotics officer. However, the club admitted to sales to non-medical individuals who used fraudulent documents in order to obtain the drug and acknowledges the need to tighten procedures. Individuals may be able to obtain marijuana at other buyers' clubs if they have documentation of a medical need. While literature on the medical use of marijuana is lacking, the Federal government continues to block any efforts toward medical research on this issue. A list of other cannabis buyers' clubs in California is included, as well as a list of organizations working for Proposition 215.

  18. What is a medical physicist?

    International Nuclear Information System (INIS)

    Endo, Masahiro

    2011-01-01

    The modern radiotherapy requires a medical physicist who optimizes treatment plans, assures delivered dose equal to prescription, and performs QA (quality assurance) of radiotherapy equipments. However, medical physicist has not been established as a medical profession in Japan mainly because importance of radiotherapy was not sufficiently recognized until recently. Between 2000 and 2004, several accidents of radiotherapy including hundreds of patients were found and these accidents were mainly caused by lack of QA. The necessity and importance of medical physicist were recognized by these accidents as well as by the advent of high-precision radiotherapy such as IMRT (intensity modulation radiation therapy). JRS (Japan Radiological Society) that certified medical physicists with the help of JSMP (Japan Society of Medical Physics), decided to extend eligibility in order to increase certified medical physicists rapidly in 2003. After the decision certified medical physicists were rapidly increased in number. The government supports this tendency to enact that certified medical physicists is necessary to reimbursement for high-precision therapy. It also started to supply grants for medical physics training in physical and health science graduate schools. In this program several universities have started medical physics course in their graduate schools. If these movements continue, medical physicist will be established as a medical profession in the near future. (author)

  19. Continuity of care: some experiences and thoughts.

    Science.gov (United States)

    Volpe, F J

    1994-09-01

    Continuity of health care is a goal to be achieved. Most are for it. Many claim to provide it. But how do we know we have it? What are the key features of continuity? While dictionaries do not define the phrase "continuity of health care," we do find definitions of "continuity." The Oxford English Dictionary, Second Edition, includes in its definitions: "the state or quality of being uninterrupted in sequence or succession, or in essence or idea; connectedness, coherence, unbroken..." Stedman's Medical Dictionary includes: "absence of interruption, a succession of parts intimately united..." These definitions stress an uninterrupted succession and include the concept that there needs to be a connection to the parts. Without that connection, continuity, in health care delivery or elsewhere, does not exist.

  20. Medical Humanities in Nepal: Present Scenario.

    Science.gov (United States)

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

    2014-01-01

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

  1. 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...

  2. Trieste will continue

    International Nuclear Information System (INIS)

    1968-01-01

    Trieste will continue to be the home of the International Centre for Theoretical Physics for the foreseeable future. An agreement signed in Vienna during December between the Italian Government and the Agency brought this assurance. (author)

  3. Nocturnal continuous glucose monitoring

    DEFF Research Database (Denmark)

    Bay, Christiane; Kristensen, Peter Lommer; Pedersen-Bjergaard, Ulrik

    2013-01-01

    Abstract Background: A reliable method to detect biochemical nocturnal hypoglycemia is highly needed, especially in patients with recurrent severe hypoglycemia. We evaluated reliability of nocturnal continuous glucose monitoring (CGM) in patients with type 1 diabetes at high risk of severe...

  4. Continual improvement plan

    Science.gov (United States)

    1994-01-01

    NASA's approach to continual improvement (CI) is a systems-oriented, agency-wide approach that builds on the past accomplishments of NASA Headquarters and its field installations and helps achieve NASA's vision, mission, and values. The NASA of the future will fully use the principles of continual improvement in every aspect of its operations. This NASA CI plan defines a systematic approach and a model for continual improvement throughout NASA, stressing systems integration and optimization. It demonstrates NASA's constancy of purpose for improvement - a consistent vision of NASA as a worldwide leader in top-quality science, technology, and management practices. The CI plan provides the rationale, structures, methods, and steps, and it defines NASA's short term (1-year) objectives for improvement. The CI plan presents the deployment strategies necessary for cascading the goals and objectives throughout the agency. It also provides guidance on implementing continual improvement with participation from top leadership and all levels of employees.

  5. Branching trajectory continual integral

    International Nuclear Information System (INIS)

    Maslov, V.P.; Chebotarev, A.M.

    1980-01-01

    Heuristic definition of the Feynman continual integral over branching trajectories is suggested which makes it possible to obtain in the closed form the solution of the Cauchy problem for the model Hartree equation. A number of properties of the solution is derived from an integral representation. In particular, the quasiclassical asymptotics, exact solution in the gaussian case and perturbation theory series are described. The existence theorem for the simpliest continual integral over branching trajectories is proved [ru

  6. The RBMFC and the challenge of continuing medical education

    OpenAIRE

    Armando Henrique Norman

    2013-01-01

    Imagine um país cujas escolas médicas não ensinam sistematicamente a seus estudantes a disciplina clínica na qual a maioria deles irá atuar. Imagine que tal país também falhe em conduzir pesquisas sobre problemas clínicos e organizacionais que tanto pacientes como médicos enfrentam dentro dessa disciplina. Embora isso seja impensável atualmente, o Reino Unido era assim quando o NHS começou. Frank Sullivan1 Chair, Heads of Departments Group SAPC Society for Academic Primary Care Este primeiro ...

  7. [Continuing medical education and the Social Balance Sheet].

    Science.gov (United States)

    Gatti, Giorgio

    2010-06-01

    The social balance sheet is an instrument used to obtain a clear and transparent account, that helps to develop an analysis of the budget from the point of view of the stakeholders; this is not all that is required by law, but it takes into account the ability of the health institutions to obtain a collaboration with the neighboring environment and with the social issues that enter into the relationship. This could be a valuable tool also for educational purposes; it is an useful task to be performed by the health workers, and an opportunity to redefine the information needs through the analysis of the results achieved.

  8. Jaundice and an itch following a fall | Nghona | Continuing Medical ...

    African Journals Online (AJOL)

    Jaundice and an itch following a fall. N Nghona, MW Sonderup, CWN Spearman. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's ...

  9. Continuing Medical Education - Vol 31, No 3 (2013)

    African Journals Online (AJOL)

    Minor head trauma – when does it become a major headache? EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD ... Cervical spondylotic myelopathy – natural history and role of surgery · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. T Morgado, D ...

  10. Work-related asthma | Jeebhay | Continuing Medical Education

    African Journals Online (AJOL)

    Occupational lung diseases such as asthma, COPD and pneumoconioses caused by exposure to airborne particulates are a major contributor to mortality and disability globally. However, work-related asthma remains under-recognised, poorly managed and inadequately compensated.

  11. Continuing Medical Education - Vol 31, No 4 (2013)

    African Journals Online (AJOL)

    Astute and safe use of topical ocular corticosteroids in general practice: Practical guidelines · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. E Janse van Rensburg, 127-129. The paediatric ophthalmic examination · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT

  12. The ABC of benign breast disease | Ndhluni | Continuing Medical ...

    African Journals Online (AJOL)

    Benign breast disease is common, although the incidence is sparsely documented in the literature and is probably quite underestimated. The main reason is that it is regarded as unimportant, with far more attention being focused on breast cancer. However, benign breast disease is far more common than breast cancer.

  13. An approach to the neck mass | Thandar | Continuing Medical ...

    African Journals Online (AJOL)

    An approach to the neck mass. MA Thandar, NE Jonas. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL ...

  14. Update on type 2 diabetes | Dave | Continuing Medical Education

    African Journals Online (AJOL)

    Type 2 diabetes is increasingly common and we need to offer our patients better outcomes. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More ...

  15. Continuing Medical Education - Vol 28, No 4 (2010)

    African Journals Online (AJOL)

    Principles of management of vascular problems in the diabetic foot: A multidisciplinary approach accounting for the complex pathobiology and biomechanics of the diabetic foot is crucial to decrease the rate of amputations. EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL ...

  16. Continuing Medical Education - Vol 29, No 1 (2011)

    African Journals Online (AJOL)

    Principles of management of vascular problems in the diabetic foot: A multidisciplinary approach accounting for the complex pathobiology and biomechanics of the diabetic foot is crucial to decrease the rate of amputations · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL ...

  17. HIV and the eye | Visser | Continuing Medical Education

    African Journals Online (AJOL)

    In an area of high HIV prevalence, HIV-related ocular lesions are relatively common. It is estimated that there are 5.6 million people in South Africa living with the human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS). A relatively small percentage of them are on highly active ...

  18. Continuing Medical Education - Vol 29, No 7 (2011)

    African Journals Online (AJOL)

    Advances in pain control in palliative care: Pain in palliative care needs to be carefully assessed before treatment · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. R Krause, J Stanford. Ethics and palliative care: It is helpful to have a good understanding of the ...

  19. Continuing Medical Education - Vol 28, No 10 (2010)

    African Journals Online (AJOL)

    Routine monitoring of diabetes mellitus in adults at primary health care level, and self-monitoring of blood glucose (SMBG) · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. T Kemp ...

  20. Continuing Medical Education - Vol 29, No 5 (2011)

    African Journals Online (AJOL)

    viral infections of the central nervous system: Viral infections of the CNS are caused by a broad range of viruses · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. M Erasmus ...

  1. Continuing Medical Education - Vol 29, No 11-12 (2011)

    African Journals Online (AJOL)

    Pattern recognition in paediatric ECGs: The hidden secrets to clinical diagnosis · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. L Andrag, R De Decker, 452-455 ...

  2. [The continuous intrusion of subjectivity in medical decisions].

    Science.gov (United States)

    Lifshitz, Alberto

    2016-01-01

    La medicina contemporánea tiene su sustento más sólido en la ciencia positivista que pretende excluir la subjetividad y centrarse en el conocimiento sólido, objetivo, duro, demostrable, reproducible, verificable y falseable. Este enfoque ha generado beneficios indudables en tanto que en las decisiones se eluden muchas ideas que dominaron el pensamiento médico como la magia, el prejuicio, la casualidad, las fuerzas sobrenaturales, los dogmas y las creencias.

  3. Continuing Medical Education - Vol 31, No 8 (2013)

    African Journals Online (AJOL)

    Nuclear medicine in oncology 1: Lymphoma, and cancer of the lung, colon, and oesophagus · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. A Ellmann, J Holness, 279-283. Nuclear medicine in oncology 2: Breast, prostate, and cervical cancer, melanoma, and ...

  4. Fat as fuel during exercise | Goedecke | Continuing Medical Education

    African Journals Online (AJOL)

    Carbohydrate (CHO) and fat serve as the two main substrates for the production of energy during prolonged muscle contraction. Although CHO and fat are oxidised simultaneously, the relative contribution of these substrates to oxidative metabolism during exercise varies, and is dependent on a variety of factors, including ...

  5. 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…

  6. Medical Ethics in Radiology

    International Nuclear Information System (INIS)

    Kim, Kyung Won; Park, Jae Hyung; Yoon, Soon Ho

    2010-01-01

    According to the recent developments in radiological techniques, the role of radiology in the clinical management of patients is ever increasing and in turn, so is the importance of radiology in patient management. Thus far, there have been few open discussions about medical ethics related to radiology in Korea. Hence, concern about medical ethics as an essential field of radiology should be part of an improved resident training program and patient management. The categories of medical ethics related with radiology are ethics in the radiological management of patient, the relationship of radiologists with other medical professionals or companies, the hazard level of radiation for patients and radiologists, quality assurance of image products and modalities, research ethics, and other ethics issues related to teleradiology and fusion imaging. In order to achieve the goal of respectful progress in radiology as well as minimizing any adverse reaction from other medical professions or society, we should establish a strong basis of medical ethics through the continuous concern and self education

  7. Continuous Markovian Logics

    DEFF Research Database (Denmark)

    Mardare, Radu Iulian; Cardelli, Luca; Larsen, Kim Guldstrand

    2012-01-01

    Continuous Markovian Logic (CML) is a multimodal logic that expresses quantitative and qualitative properties of continuous-time labelled Markov processes with arbitrary (analytic) state-spaces, henceforth called continuous Markov processes (CMPs). The modalities of CML evaluate the rates...... of the exponentially distributed random variables that characterize the duration of the labeled transitions of a CMP. In this paper we present weak and strong complete axiomatizations for CML and prove a series of metaproperties, including the finite model property and the construction of canonical models. CML...... characterizes stochastic bisimilarity and it supports the definition of a quantified extension of the satisfiability relation that measures the "compatibility" between a model and a property. In this context, the metaproperties allows us to prove two robustness theorems for the logic stating that one can...

  8. 21 CFR 892.2040 - Medical image hardcopy device.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Medical image hardcopy device. 892.2040 Section... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.2040 Medical image hardcopy device. (a) Identification. A medical image hardcopy device is a device that produces a visible printed record of a medical...

  9. Continuing bonds and place.

    Science.gov (United States)

    Jonsson, Annika; Walter, Tony

    2017-08-01

    Where do people feel closest to those they have lost? This article explores how continuing bonds with a deceased person can be rooted in a particular place or places. Some conceptual resources are sketched, namely continuing bonds, place attachment, ancestral places, home, reminder theory, and loss of place. The authors use these concepts to analyze interview material with seven Swedes and five Britons who often thought warmly of the deceased as residing in a particular place and often performing characteristic actions. The destruction of such a place, by contrast, could create a troubling, haunting absence, complicating the deceased's absent-presence.

  10. Introduction to Continuous Optimization

    DEFF Research Database (Denmark)

    Andreasson, Niclas; Evgrafov, Anton; Patriksson, Michael

    optimal solutions for continuous optimization models. The main part of the mathematical material therefore concerns the analysis and linear algebra that underlie the workings of convexity and duality, and necessary/sufficient local/global optimality conditions for continuous optimization problems. Natural...... algorithms are then developed from these optimality conditions, and their most important convergence characteristics are analyzed. The book answers many more questions of the form “Why?” and “Why not?” than “How?”. We use only elementary mathematics in the development of the book, yet are rigorous throughout...

  11. Continuous Platform Development

    DEFF Research Database (Denmark)

    Nielsen, Ole Fiil

    low risks and investments but also with relatively fuzzy results. When looking for new platform projects, it is important to make sure that the company and market is ready for the introduction of platforms, and to make sure that people from marketing and sales, product development, and downstream......, but continuous product family evolution challenges this strategy. The concept of continuous platform development is based on the fact that platform development should not be a one-time experience but rather an ongoing process of developing new platforms and updating existing ones, so that product family...

  12. Studies on continuous fermentation

    Energy Technology Data Exchange (ETDEWEB)

    Ueda, K

    1958-01-01

    Continuous fermentation of molasses with a combined system of agitated vessel and flow pipe is studied. A new apparatus was designed. The rate of the fermentation was faster with this apparatus than with the former apparatus which was composed of two vessels.

  13. Continuous Reinforced Concrete Beams

    DEFF Research Database (Denmark)

    Hoang, Cao Linh; Nielsen, Mogens Peter

    1996-01-01

    This report deals with stress and stiffness estimates of continuous reinforced concrete beams with different stiffnesses for negative and positive moments e.g. corresponding to different reinforcement areas in top and bottom. Such conditions are often met in practice.The moment distribution...

  14. Continuous Adductor Canal Blocks

    DEFF Research Database (Denmark)

    Monahan, Amanda M; Sztain, Jacklynn F; Khatibi, Bahareh

    2016-01-01

    on cutaneous knee sensation in volunteers. METHODS: Bilateral adductor canal catheters were inserted in 24 volunteers followed by ropivacaine 0.2% administration for 8 hours. One limb of each subject was assigned randomly to a continuous infusion (8 mL/h) or automated hourly boluses (8 m...

  15. Continuous Personal Improvement.

    Science.gov (United States)

    Emiliani, M. L.

    1998-01-01

    Suggests that continuous improvement tools used in the workplace can be applied to self-improvement. Explains the use of such techniques as one-piece flow, kanban, visual controls, and total productive maintenance. Points out misapplications of these tools and describes the use of fishbone diagrams to diagnose problems. (SK)

  16. Continuity and Change.

    Science.gov (United States)

    Istance, David

    1985-01-01

    Examines issues related to continuity in education and educational change. Indicates that although schools must be responsive to changing social and economic conditions (and contribute to them), they must also be protected against fluctuating swings of educational fashion and safeguard their long-term mission, even when buffeted by short-term…

  17. Promoting Continuing Education Programs.

    Science.gov (United States)

    Hendrickson, Gayle A.

    This handbook is intended for use by institutions in marketing their continuing education programs. A section on "Devising Your Strategy" looks at identifying a target audience, determining the marketing approach, and developing a marketing plan and promotional techniques. A discussion of media options looks at the advantages and…

  18. Continuous quality improvement

    NARCIS (Netherlands)

    Rohlin, Madeleine; Schaub, Rob M.H.; Holbrook, Peter; Leibur, Edvitar; Lévy, Gérard; Roubalikova, Lenka; Nilner, Maria; Roger-Leroi, Valerie; Danner, Gunter; Iseri, Haluk; Feldman, Cecile

    2002-01-01

    Versch. in: Eur J Dent Educ; 6 (Suppl. 3): 67–77 Continuous quality improvement (CQI) can be envisaged as a circular process of goal-setting, followed by external and internal evaluations resulting in improvements that can serve as goals for a next cycle. The need for CQI is apparent, because of

  19. Continuous digital health

    NARCIS (Netherlands)

    Van Halteren, Aart; Gay, Vaĺerie

    2015-01-01

    A transformation is underway regarding how we deal with our health, not only because mobile Internet technology has made it possible to have continuous access to personal health information, but also because breaking the trend of ever-growing healthcare costs is increasingly necessary. Connectivity,

  20. Continuous quality improvement

    International Nuclear Information System (INIS)

    Bourne, P.B.

    1985-01-01

    This paper describes the various statistical tools used at the Hanford Engineering Development Laboratory to achieve continuous quality improvement in the development of Breeder Reactor Technology and in reactor operations. The role of the quality assurance professionals in this process, including quantifiable measurements using actual examples, is provided. The commitment to quality improvement through top management involvement is dramatically illustrated

  1. Continuous feedback fluid queues

    NARCIS (Netherlands)

    Scheinhardt, Willem R.W.; van Foreest, N.D.; Mandjes, M.R.H.

    2003-01-01

    We investigate a fluid buffer which is modulated by a stochastic background process, while the momentary behavior of the background process depends on the current buffer level in a continuous way. Loosely speaking the feedback is such that the background process behaves `as a Markov process' with

  2. Continuous subcutaneous insulin infusion therapy in type 1 diabetes ...

    African Journals Online (AJOL)

    2013-01-14

    Jan 14, 2013 ... Metabolism and Diabetes of South Africa (SEMDSA),. Paediatric and Adolescent ... lifestyle in terms of meal times and physical exercise. It: • Enhances the .... in continuing medical education activity relating to. CSII annually.

  3. Paediatric triage in South Africa: Where are we? | Buys | Continuing ...

    African Journals Online (AJOL)

    Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 31, No 1 (2013) >. Log in or Register to get access to full text downloads.

  4. 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 ...

  5. 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 ...

  6. 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.)

  7. 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)

  8. 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.

  9. 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...

  10. 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)

  11. 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.

  12. Medications Development for Opioid Abuse

    Science.gov (United States)

    Negus, S. Stevens; Banks, Matthew L.

    2013-01-01

    Here we describe methods for preclinical evaluation of candidate medications to treat opioid abuse and dependence. Our perspective is founded on the propositions that (1) drug self-administration procedures provide the most direct method for assessment of medication effects, (2) procedures that assess choice between opioid and nondrug reinforcers are especially useful, and (3) the states of opioid dependence and withdrawal profoundly influence both opioid reinforcement and the effects of candidate medications. Effects of opioid medications on opioid choice in nondependent and opioid-dependent subjects are reviewed. Various nonopioid medications have also been examined, but none yet have been identified that safely and reliably reduce opioid choice. Future research will focus on (1) strategies for increasing safety and/or effectiveness of opioid medications, and (2) continued development of nonopioids such as inhibitors of endocannabinoid catabolic enzymes or inhibitors of opioid-induced glial activation. PMID:23125072

  13. Continuous Intravenous Milrinone Therapy in Pediatric Outpatients.

    Science.gov (United States)

    Curley, Michelle; Liebers, Jill; Maynard, Roy

    Milrinone is a phosphodiesterase 3 inhibitor with both positive inotropic and vasodilator properties. Administered as a continuous infusion, milrinone is indicated for the short-term treatment of patients with acute decompensated heart failure. Despite limited data supporting long-term milrinone therapy in adults with congestive heart failure, children managed as outpatients may benefit from continuous milrinone as a treatment for cardiac dysfunction, as a destination therapy for cardiac transplant, or as palliative therapy for cardiomyopathy. The aim of this article is to review the medical literature and describe a home infusion company's experience with pediatric outpatient milrinone therapy.

  14. Continuous venovenous haemodialysis

    DEFF Research Database (Denmark)

    Jensen, Dorte Møller; Bistrup, C; Pedersen, R S

    1996-01-01

    A simple three-pump-based system for the performance of continuous venovenous haemodialysis is described. The method employs access to the circulation via a double-lumen catheter, and by means of a standard extracorporeal peristaltic pump the blood is circulated through a haemofiltration filter....... Standard solutions for peritoneal dialysis are administered in a single-pass manner countercurrent to the blood flow. To control the dialysate flow through the filter, two separate pumps designed for intravenous infusion are used. Anticoagulation is achieved by means of continuous heparin infusion....... This three-pump system is effective in controlling the fluid balance and the level of azotemia. Furthermore, this system makes haemodialysis possible in spite of severe haemodynamic instability. The system is easy to use and inexpensive. 3 patients participated in the study....

  15. Continuous Fiber Ceramic Composites

    Energy Technology Data Exchange (ETDEWEB)

    Fareed, Ali [Honeywell Advanced Composites Inc. (HACI), Newark, DE (United States); Craig, Phillip A. [Honeywell Advanced Composites Inc. (HACI), Newark, DE (United States)

    2002-09-01

    Fiber-reinforced ceramic composites demonstrate the high-temperature stability of ceramics--with an increased fracture toughness resulting from the fiber reinforcement of the composite. The material optimization performed under the continuous fiber ceramic composites (CFCC) included a series of systematic optimizations. The overall goals were to define the processing window, to increase the robustinous of the process, to increase process yield while reducing costs, and to define the complexity of parts that could be fabricated.

  16. Deconstructing continuous flash suppression

    OpenAIRE

    Yang, Eunice; Blake, Randolph

    2012-01-01

    In this paper, we asked to what extent the depth of interocular suppression engendered by continuous flash suppression (CFS) varies depending on spatiotemporal properties of the suppressed stimulus and CFS suppressor. An answer to this question could have implications for interpreting the results in which CFS influences the processing of different categories of stimuli to different extents. In a series of experiments, we measured the selectivity and depth of suppression (i.e., elevation in co...

  17. Safety Campaign Continues

    CERN Multimedia

    2002-01-01

    If you see this poster, stop and read it! This is the third poster produced by TIS Division as part of its information campaign on health and safety in the workplace. It provides statistics on occupational accidents at CERN. You will see that, as in the rest of Europe, falls, slips and trips continue to be the main cause of accident. So, eyes open and take care! For more information : http://safety.cern.ch/

  18. Robust continuous clustering.

    Science.gov (United States)

    Shah, Sohil Atul; Koltun, Vladlen

    2017-09-12

    Clustering is a fundamental procedure in the analysis of scientific data. It is used ubiquitously across the sciences. Despite decades of research, existing clustering algorithms have limited effectiveness in high dimensions and often require tuning parameters for different domains and datasets. We present a clustering algorithm that achieves high accuracy across multiple domains and scales efficiently to high dimensions and large datasets. The presented algorithm optimizes a smooth continuous objective, which is based on robust statistics and allows heavily mixed clusters to be untangled. The continuous nature of the objective also allows clustering to be integrated as a module in end-to-end feature learning pipelines. We demonstrate this by extending the algorithm to perform joint clustering and dimensionality reduction by efficiently optimizing a continuous global objective. The presented approach is evaluated on large datasets of faces, hand-written digits, objects, newswire articles, sensor readings from the Space Shuttle, and protein expression levels. Our method achieves high accuracy across all datasets, outperforming the best prior algorithm by a factor of 3 in average rank.

  19. Polymeric materials in medication

    CERN Document Server

    Carraher, Charles

    1985-01-01

    The art of using chemical agents for medication dates back into antiquity, although most of the earliest examples used plants, herbs, and other natural materials. The old Egyptian medical papyri, which date from before 1400 B. C. , contain dozens of examples of such medicinal plants and animal extracts. In the Old Testament of the Bible, we can find references to using oil to soften the skin and sores (Isaiah 1:6), the use of tree leaves for medicine (Ezekiel 47:12) and various medical balms (Jeremiah 8:22). Not all these recipes were effective in curing the ailments for which they were used and sometimes the treatment was worse than the disease. Nevertheless, the art of using chemical derived agents for medicines continued to develop and received great impetus during the present century with the rise of synthetic organic chemistry. One of the most vexing problems has always been to achieve specifici­ ty with the medications. While some medical agents do indeed possess a relatively high degree of specificity...

  20. Ireland's medical brain drain: migration intentions of Irish medical students.

    LENUS (Irish Health Repository)

    Gouda, Pishoy

    2015-12-01

    To provide the optimum level of healthcare, it is important that the supply of well-trained doctors meets the demand. However, despite many initiatives, Ireland continues to have a shortfall of physicians, which has been projected to persist. Our study aimed to investigate the migration intentions of Irish medical students and identify the factors that influence their decisions in order to design appropriate interventions to sustain the supply of trained doctors in order to maintain a viable medical system.

  1. Medical marijuana: medical necessity versus political agenda.

    Science.gov (United States)

    Clark, Peter A; Capuzzi, Kevin; Fick, Cameron

    2011-12-01

    Marijuana is classified by the Drug Enforcement Agency (DEA) as an illegal Schedule I drug which has no accepted medical use. However, recent studies have shown that medical marijuana is effective in controlling chronic non-cancer pain, alleviating nausea and vomiting associated with chemotherapy, treating wasting syndrome associated with AIDS, and controlling muscle spasms due to multiple sclerosis. These studies state that the alleviating benefits of marijuana outweigh the negative effects of the drug, and recommend that marijuana be administered to patients who have failed to respond to other therapies. Despite supporting evidence, the DEA refuses to reclassify marijuana as a Schedule II drug, which would allow physicians to prescribe marijuana to suffering patients. The use of medical marijuana has continued to gain support among states, and is currently legal in 16 states and the District of Columbia. This is in stark contrast to the federal government's stance of zero-tolerance, which has led to a heated legal debate in the United States. After reviewing relevant scientific data and grounding the issue in ethical principles like beneficence and nonmaleficence, there is a strong argument for allowing physicians to prescribe marijuana. Patients have a right to all beneficial treatments and to deny them this right violates their basic human rights.

  2. Medical marijuana: Medical necessity versus political agenda

    Science.gov (United States)

    Clark, Peter A.; Capuzzi, Kevin; Fick, Cameron

    2011-01-01

    Summary Marijuana is classified by the Drug Enforcement Agency (DEA) as an illegal Schedule I drug which has no accepted medical use. However, recent studies have shown that medical marijuana is effective in controlling chronic non-cancer pain, alleviating nausea and vomiting associated with chemotherapy, treating wasting syndrome associated with AIDS, and controlling muscle spasms due to multiple sclerosis. These studies state that the alleviating benefits of marijuana outweigh the negative effects of the drug, and recommend that marijuana be administered to patients who have failed to respond to other therapies. Despite supporting evidence, the DEA refuses to reclassify marijuana as a Schedule II drug, which would allow physicians to prescribe marijuana to suffering patients. The use of medical marijuana has continued to gain support among states, and is currently legal in 16 states and the District of Columbia. This is in stark contrast to the federal government’s stance of zero-tolerance, which has led to a heated legal debate in the United States. After reviewing relevant scientific data and grounding the issue in ethical principles like beneficence and nonmaleficence, there is a strong argument for allowing physicians to prescribe marijuana. Patients have a right to all beneficial treatments and to deny them this right violates their basic human rights. PMID:22129912

  3. A student's perspective on medical ethics education.

    Science.gov (United States)

    Terndrup, Christopher

    2013-12-01

    Despite many efforts to increase ethics education in US medical schools, barriers continue to arise that impede the production of morally driven physicians who practice medicine with ideal empathy. Research has shown that, particularly during the clinical years, medical students lose the ability both to recognize ethical dilemmas and to approach such situations with compassionate reasoning. This article summarizes the current status of ethics education in US medical schools, described through the eyes of and alongside the story of a graduating medical student.

  4. 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.

  5. 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...

  6. Continuous multivariate exponential extension

    International Nuclear Information System (INIS)

    Block, H.W.

    1975-01-01

    The Freund-Weinman multivariate exponential extension is generalized to the case of nonidentically distributed marginal distributions. A fatal shock model is given for the resulting distribution. Results in the bivariate case and the concept of constant multivariate hazard rate lead to a continuous distribution related to the multivariate exponential distribution (MVE) of Marshall and Olkin. This distribution is shown to be a special case of the extended Freund-Weinman distribution. A generalization of the bivariate model of Proschan and Sullo leads to a distribution which contains both the extended Freund-Weinman distribution and the MVE

  7. Continuity and consensus

    DEFF Research Database (Denmark)

    Abrahamson, Peter

    2010-01-01

    maternal leave. These changes can be explained as adjustments to post-industrial conditions within a political culture relying on class compromises and a broad consensus informed by expert advice coming from civil servants and ad hoc policy commissions. The paper concludes that changes in Danish family...... policy reflect changing conditions for employment and the minding of children and that there has been a high degree of continuity and consensus about the change, as indicated by the strong increase in female labour market involvement....

  8. Continuous Integration in CFMGR

    CERN Document Server

    Frohlingsdorf, David

    2017-01-01

    Cfmgr is a managing tool for network devices. At the moment there is no way to automatically check the working behaviour of the tool, meaning that a lot of effort is spend into manually testing the tool after an update. During my stay at CERN I developed a black-box testing framework for Cfmgr according to Continuous Integration practices and successfully deployed the framework using Jenkins and Docker. This report discusses in detail how the framework works and how it can be configured, and equally gives a broad problem description and outlines future work directions.

  9. Continuous-infusion adriamycin

    International Nuclear Information System (INIS)

    Benjamin, R.S.; Chawla, S.P.; Ewer, M.S.; Hortobagyi, G.N.

    1986-01-01

    This chapter discusses the diminished cardiotoxicity as well as diminished nausea and vomiting with continuous infusions of adriamycin to patients undergoing radiation therapy, particularly with infusions of 48 hours or longer, and best with 96-hour infusions, the longest duration that has been studied systematically. In breast cancer, data show that more adriamycin is better, but only for a selected subgroup of patients: those with complete remission. The diminished cardiotoxicity makes the use of adriamycin more attractive in the adjuvant situation, where increased safety will decrease the chances of long-term complications and make retreatment easy for cured patients who develop second malignancies

  10. Continuous Shearlet Tight Frames

    KAUST Repository

    Grohs, Philipp

    2010-10-22

    Based on the shearlet transform we present a general construction of continuous tight frames for L2(ℝ2) from any sufficiently smooth function with anisotropic moments. This includes for example compactly supported systems, piecewise polynomial systems, or both. From our earlier results in Grohs (Technical report, KAUST, 2009) it follows that these systems enjoy the same desirable approximation properties for directional data as the previous bandlimited and very specific constructions due to Kutyniok and Labate (Trans. Am. Math. Soc. 361:2719-2754, 2009). We also show that the representation formulas we derive are in a sense optimal for the shearlet transform. © 2010 Springer Science+Business Media, LLC.

  11. Continuing education for performance improvement: a creative approach.

    Science.gov (United States)

    Collins, Patti-Ann; Hardesty, Ilana; White, Julie L; Zisblatt, Lara

    2012-10-01

    In an effort to improve patient safety and health care outcomes, continuing medical education has begun to focus on performance improvement initiatives for physician practices. Boston University School of Medicine's (BUSM) Continuing Nursing Education Accredited Provider Unit has begun a creative project to award nursing contact hours for nurses' participation in performance improvement activities. This column highlights its initial efforts. Copyright 2012, SLACK Incorporated.

  12. Landsat Data Continuity Mission

    Science.gov (United States)

    ,

    2012-01-01

    The Landsat Data Continuity Mission (LDCM) is a partnership formed between the National Aeronautics and Space Administration (NASA) and the U.S. Geological Survey (USGS) to place the next Landsat satellite in orbit in January 2013. The Landsat era that began in 1972 will become a nearly 41-year global land record with the successful launch and operation of the LDCM. The LDCM will continue the acquisition, archiving, and distribution of multispectral imagery affording global, synoptic, and repetitive coverage of the Earth's land surfaces at a scale where natural and human-induced changes can be detected, differentiated, characterized, and monitored over time. The mission objectives of the LDCM are to (1) collect and archive medium resolution (30-meter spatial resolution) multispectral image data affording seasonal coverage of the global landmasses for a period of no less than 5 years; (2) ensure that LDCM data are sufficiently consistent with data from the earlier Landsat missions in terms of acquisition geometry, calibration, coverage characteristics, spectral characteristics, output product quality, and data availability to permit studies of landcover and land-use change over time; and (3) distribute LDCM data products to the general public on a nondiscriminatory basis at no cost to the user.

  13. Integrated, Continuous Emulsion Creamer.

    Science.gov (United States)

    Cochrane, Wesley G; Hackler, Amber L; Cavett, Valerie J; Price, Alexander K; Paegel, Brian M

    2017-12-19

    Automated and reproducible sample handling is a key requirement for high-throughput compound screening and currently demands heavy reliance on expensive robotics in screening centers. Integrated droplet microfluidic screening processors are poised to replace robotic automation by miniaturizing biochemical reactions to the droplet scale. These processors must generate, incubate, and sort droplets for continuous droplet screening, passively handling millions of droplets with complete uniformity, especially during the key step of sample incubation. Here, we disclose an integrated microfluidic emulsion creamer that packs ("creams") assay droplets by draining away excess oil through microfabricated drain channels. The drained oil coflows with creamed emulsion and then reintroduces the oil to disperse the droplets at the circuit terminus for analysis. Creamed emulsion assay incubation time dispersion was 1.7%, 3-fold less than other reported incubators. The integrated, continuous emulsion creamer (ICEcreamer) was used to miniaturize and optimize measurements of various enzymatic activities (phosphodiesterase, kinase, bacterial translation) under multiple- and single-turnover conditions. Combining the ICEcreamer with current integrated microfluidic DNA-encoded library bead processors eliminates potentially cumbersome instrumentation engineering challenges and is compatible with assays of diverse target class activities commonly investigated in drug discovery.

  14. Continuously adjustable Pulfrich spectacles

    Science.gov (United States)

    Jacobs, Ken; Karpf, Ron

    2011-03-01

    A number of Pulfrich 3-D movies and TV shows have been produced, but the standard implementation has inherent drawbacks. The movie and TV industries have correctly concluded that the standard Pulfrich 3-D implementation is not a useful 3-D technique. Continuously Adjustable Pulfrich Spectacles (CAPS) is a new implementation of the Pulfrich effect that allows any scene containing movement in a standard 2-D movie, which are most scenes, to be optionally viewed in 3-D using inexpensive viewing specs. Recent scientific results in the fields of human perception, optoelectronics, video compression and video format conversion are translated into a new implementation of Pulfrich 3- D. CAPS uses these results to continuously adjust to the movie so that the viewing spectacles always conform to the optical density that optimizes the Pulfrich stereoscopic illusion. CAPS instantly provides 3-D immersion to any moving scene in any 2-D movie. Without the glasses, the movie will appear as a normal 2-D image. CAPS work on any viewing device, and with any distribution medium. CAPS is appropriate for viewing Internet streamed movies in 3-D.

  15. 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.

  16. 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,

  17. 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...

  18. 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 ...

  19. [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.

  20. Discrete and continuous simulation theory and practice

    CERN Document Server

    Bandyopadhyay, Susmita

    2014-01-01

    When it comes to discovering glitches inherent in complex systems-be it a railway or banking, chemical production, medical, manufacturing, or inventory control system-developing a simulation of a system can identify problems with less time, effort, and disruption than it would take to employ the original. Advantageous to both academic and industrial practitioners, Discrete and Continuous Simulation: Theory and Practice offers a detailed view of simulation that is useful in several fields of study.This text concentrates on the simulation of complex systems, covering the basics in detail and exploring the diverse aspects, including continuous event simulation and optimization with simulation. It explores the connections between discrete and continuous simulation, and applies a specific focus to simulation in the supply chain and manufacturing field. It discusses the Monte Carlo simulation, which is the basic and traditional form of simulation. It addresses future trends and technologies for simulation, with par...

  1. Physics aids new medical techniques

    CERN Document Server

    CERN. Geneva

    2001-01-01

    Since the discovery of X-rays, fundamental physics has been a source of ideas for radiography and medical imaging. A new imaging method firmly rooted in particle physics was chosen by Time magazine as one of its "Inventions of the Year 2000". The award-winning invention in the medical science category was a scanner that combined the advantages of computer tomography with positron emission tomography. The use of these techniques, which depend on detecting and analysing electromagnetic radiation (X-rays or gamma rays respectively), show that detection techniques from particle physics have made, and continue to make, essential contributions to medical science. (0 refs).

  2. Integral-Value Models for Outcomes over Continuous Time

    DEFF Research Database (Denmark)

    Harvey, Charles M.; Østerdal, Lars Peter

    Models of preferences between outcomes over continuous time are important for individual, corporate, and social decision making, e.g., medical treatment, infrastructure development, and environmental regulation. This paper presents a foundation for such models. It shows that conditions on prefere...... on preferences between real- or vector-valued outcomes over continuous time are satisfied if and only if the preferences are represented by a value function having an integral form......Models of preferences between outcomes over continuous time are important for individual, corporate, and social decision making, e.g., medical treatment, infrastructure development, and environmental regulation. This paper presents a foundation for such models. It shows that conditions...

  3. Continuous alcoholic fermentation

    Energy Technology Data Exchange (ETDEWEB)

    Smidrkal, M; Nejedly, A

    1956-01-01

    Results are given of investigations on the continuous production of ethanol on a laboratory and on a semi-commercial scale. The suggested devices are particularly described. Under constant conditions the production cycle required 12 to 17 days, the acidity being 4.0 to 415 ml. 0.1 N NaOH/100 ml and the concentration of fermented wort 10.5 to 11%. The maximum production from 1 h of fermentation space during 24 h was 8.67 l of absolute alcohol when the efflux was divided into several basins; when the efflux of sweet wort was collected into one basin only, the maximum production was 7.20 l of absolute alcohol. The amount of alcohol produced was 62.20 l/100 kg sugar.

  4. Spaces of continuous functions

    CERN Document Server

    Groenewegen, G L M

    2016-01-01

    The space C(X) of all continuous functions on a compact space X carries the structure of a normed vector space, an algebra and a lattice. On the one hand we study the relations between these structures and the topology of X, on the other hand we discuss a number of classical results according to which an algebra or a vector lattice can be represented as a C(X). Various applications of these theorems are given. Some attention is devoted to related theorems, e.g. the Stone Theorem for Boolean algebras and the Riesz Representation Theorem. The book is functional analytic in character. It does not presuppose much knowledge of functional analysis; it contains introductions into subjects such as the weak topology, vector lattices and (some) integration theory.

  5. Continuous spinal anesthesia.

    Science.gov (United States)

    Moore, James M

    2009-01-01

    Continuous spinal anesthesia (CSA) is an underutilized technique in modern anesthesia practice. Compared with other techniques of neuraxial anesthesia, CSA allows incremental dosing of an intrathecal local anesthetic for an indefinite duration, whereas traditional single-shot spinal anesthesia usually involves larger doses, a finite, unpredictable duration, and greater potential for detrimental hemodynamic effects including hypotension, and epidural anesthesia via a catheter may produce lesser motor block and suboptimal anesthesia in sacral nerve root distributions. This review compares CSA with other anesthetic techniques and also describes the history of CSA, its clinical applications, concerns regarding neurotoxicity, and other pharmacologic implications of its use. CSA has seen a waxing and waning of its popularity in clinical practice since its initial description in 1907. After case reports of cauda equina syndrome were reported with the use of spinal microcatheters for CSA, these microcatheters were withdrawn from clinical practice in the United States but continued to be used in Europe with no further neurologic sequelae. Because only large-bore catheters may be used in the United States, CSA is usually reserved for elderly patients out of concern for the risk of postdural puncture headache in younger patients. However, even in younger patients, sometimes the unique clinical benefits and hemodynamic stability involved in CSA outweigh concerns regarding postdural puncture headache. Clinical scenarios in which CSA may be of particular benefit include patients with severe aortic stenosis undergoing lower extremity surgery and obstetric patients with complex heart disease. CSA is an underutilized technique in modern anesthesia practice. Perhaps more accurately termed fractional spinal anesthesia, CSA involves intermittent dosing of local anesthetic solution via an intrathecal catheter. Where traditional spinal anesthesia involves a single injection with a

  6. Medical physics 1981

    International Nuclear Information System (INIS)

    Bunde, E.

    1982-01-01

    This volume continues the series of congress publications with which the Deutsche Gesellschaft fuer Medizinische Physik has been completely documenting its annual meetings for some years. The meeting was aimed to show the complexity not only of the scientific specialty medical physics but also of the practical activities of medical physicists, or at least give some idea of it. The conference was centred on the following points: Possibilities of optimization and methods for re-examination of techniques used in X-ray diagnostics, nuclear diagnostics and ultrasonographic diagnostics; bases of dosimetry in practical radiotherapy, especially with a view to the plans to make gauging of therapeutical dosemeters compulsory; current state of neutron therapy and dosimetry; safety and constancy of irradiation devices in operation; planning and equipment of modern radiotherapy departments. Furthermore topics from medical optics and nuclearbiological research were dealt with. Reports were given on the clinical use of whole-body counters. Climatology and surgical research were marginally dealt with in two synoptical papers. Short reports on work currently under way completed the subject groups given and allowed insight into further topical fields of work of medical physicists in science and practice. Finally, the question of education received particular interest. (orig./MG) [de

  7. 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 ...

  8. 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

  9. 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.

  10. 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 ...

  11. Current challenges in medical education in Nigeria | Ezeanolue ...

    African Journals Online (AJOL)

    Medical education may be classified into 3 sectors viz, (a) basic medical education; (b) postgraduate medical education/Residency Training and (c) continuing professional development (CPD). There are challenges in establishing an ideal medical educational system that educates, develops and enhances the skills and ...

  12. 21 CFR 515.10 - Medicated feed mill license applications.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Medicated feed mill license applications. 515.10... (CONTINUED) ANIMAL DRUGS, FEEDS, AND RELATED PRODUCTS MEDICATED FEED MILL LICENSE Applications § 515.10 Medicated feed mill license applications. (a) Medicated feed mill license applications (Forms FDA 3448) may...

  13. Continuous composite riser

    Energy Technology Data Exchange (ETDEWEB)

    Slagsvold, L. [ABB Offshore Systems (Norway)

    2002-12-01

    The industry is now looking at developing reserves in waters depths of up to 3000 m (10000 ft). When moving into deeper waters the un-bonded flexible riser becomes very heavy and introduces large hang-off forces on the vessel. We are therefore investigating riser concepts incorporating new materials and with a simpler cross section that can be used for floating production. Advanced composite materials have properties such as, low weight, high strength, good durability and very good fatigue performance. Composite materials are slowly being exploited in the oil industry; they are being prototype tested for drilling risers and small diameter lines. Part of the process for the industry to accept larger diameter production risers made out of composite materials is to understand both the advantages and limitations. A new continuous composite riser system is being developed which capitalizes on the technical benefits of this material while addressing the known constraints. The fully bonded riser is being developed for ultra deep waters and its' characteristics include high temperature (160 deg C), high pressure (500 barg min), light weight, chemical resistant, good insulation, excellent fatigue characteristics and installation by reeling. The concept is based on the use of a thermoplastic liner together with a thermoplastic carbon fibre composite. This paper summarises the ongoing development, which has a goal to manufacture and qualify an 8'' riser, and includes all the steps in a production process from material qualification to the winding process and analytical modelling. (author)

  14. Continuous cell recycle fermentation

    Energy Technology Data Exchange (ETDEWEB)

    Warren, R K; Hill, G A; MacDonald, D G

    1991-10-01

    A cell recycle fermentor using a cross-flow membrane filter has been operated for extended periods. Productivities as high as 70 g/l/h were obtained at a cell concentration of 120 g/l and a product concentration of 70 g/l. The experimental results were then fitted to previously derived biokinetic models (Warren et al., 1990) for a continuous stirred tank fermentor. A good fit for growth rate was found and the cell yield was shown to decrease with product concentration. The product yield, however, was found to remain nearly constant at all cell, substrate and product concentrations. These biokinetics, along with a previous model for the membrane filter (Warren et al., 1991) were then used in a simulalation to estimate the costs of producing ethanol in a large scale system. This simulation was optimized using a variant of the steepest descent method from which a fermentor inlet substrate concentration of 150 g/l and a net cost of $CAN 253.5/1000 L ethanol were projected. From a sensitivity analysis, the yield parameters were found to have the greatest effect on ethanol net cost of the fermentor parameters, while the operating costs and the profit was found to be most sensitive to the wheat raw material cost and to the dried grains by-product value. 55 refs., 11 tabs., 7figs.

  15. Deconstructing continuous flash suppression.

    Science.gov (United States)

    Yang, Eunice; Blake, Randolph

    2012-03-08

    In this paper, we asked to what extent the depth of interocular suppression engendered by continuous flash suppression (CFS) varies depending on spatiotemporal properties of the suppressed stimulus and CFS suppressor. An answer to this question could have implications for interpreting the results in which CFS influences the processing of different categories of stimuli to different extents. In a series of experiments, we measured the selectivity and depth of suppression (i.e., elevation in contrast detection thresholds) as a function of the visual features of the stimulus being suppressed and the stimulus evoking suppression, namely, the popular "Mondrian" CFS stimulus (N. Tsuchiya & C. Koch, 2005). First, we found that CFS differentially suppresses the spatial components of the suppressed stimulus: Observers' sensitivity for stimuli of relatively low spatial frequency or cardinally oriented features was more strongly impaired in comparison to high spatial frequency or obliquely oriented stimuli. Second, we discovered that this feature-selective bias primarily arises from the spatiotemporal structure of the CFS stimulus, particularly within information residing in the low spatial frequency range and within the smooth rather than abrupt luminance changes over time. These results imply that this CFS stimulus operates by selectively attenuating certain classes of low-level signals while leaving others to be potentially encoded during suppression. These findings underscore the importance of considering the contribution of low-level features in stimulus-driven effects that are reported under CFS.

  16. Proactive pharmaceutical care interventions decrease patients' nonadherence to osteoporosis medication

    NARCIS (Netherlands)

    Stuurman-Bieze, A G G; Hiddink, E G; van Boven, J F M; Vegter, S

    UNLABELLED: Using a protocolled intervention program, pharmacists can decrease nonadherence to osteoporosis medication, by continuous monitoring and tailored counseling sessions, starting at treatment initiation. In the usual care group, 32.8% of patients initiating osteoporosis medication

  17. Medical Research for All Americans

    Science.gov (United States)

    ... we want to offer you and your family good, helpful health information that is based on the very best medical research conducted by and for the National Institutes of Health (NIH). This issue focuses on several topics in which NIH-funded research continues to make ...

  18. Sudan Journal of Medical Sciences

    African Journals Online (AJOL)

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

  19. Classification and evaluation of medical devices

    Directory of Open Access Journals (Sweden)

    Edina Vranić

    2003-05-01

    Full Text Available Medical devices and medical disposables contribute significantly to the quality and effectiveness of the health care system. It is necessary to commit scientifically sound regulatory environment that will provide consumers with the best medical care. This includes continued services to small manufacturers, readily available guidance on FDA requirements, predictable and reasonable response times on applications for marketing, and equitable enforcement. But in the public interest, this commitment to the industry must be coupled with a reciprocal commitment: that medical device firms will meet high standards in the design, manufacture, and evaluation of their products. The protections afforded our consumer, and the benefits provided the medical device industry, cannot be underestimated.

  20. 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

  1. Redefining continuing education delivery.

    Science.gov (United States)

    Carlton, K H

    1997-01-01

    individual health-care worker consumer. A number of national and world-wide trends are propelling rapid changes in the delivery modalities and types of emerging providers for health-care CE. Examples of these advanced telecommunications applications of CE opportunities for health-care personnel are becoming more prevalent in the literature and the pattern of CE marketing, and delivery evolution can be seen readily on the Internet. Continued program success and viability will belong to the individuals and organizations who are able to conceptualize and envision the positive transformations and opportunities that can occur from the evolving paradigm of education for the lifelong learner of the 21st century.

  2. 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.

  3. 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.

  4. [Generation continuity and integration].

    Science.gov (United States)

    Zakhvatkin, Iu A

    2008-01-01

    Transformation of the cyclic morphoprocesses in Protista toward the terminal-cyclic morphoprocesses in Metazoa had lead to integration of the fomer's life circles into the latter's ontogenesis and began to supply the newly emerging ecosystems with the regular income of mortomasses. According to the palintomic hypothesis of A.A. Zakhvatkin, it was the egg that became a means of the metazoan generation continuity, and not the half set of organells acquired by descendants of a divided maternal cell in Protozoa. Origin of Metazoa and of their ontogenesis was accomplished by hypetrophic distomy and subsequent palintomic division of the protist parental cell, these processes being comparable to the ovogenesis and ovocyte division in the Metazoa. Division process in the most primitive metazoans, Leptolida and Calcarea, retained certains features of its palintomic nature that are clear in the Ctenophora, the latter though specific being most similar in this respect to the spongs and not to the Coelenterata whith whom they were united in the same phylum formerly. The ovogenesis perfection controlled by the maternal organism and leading to an increment of the nuclear-plasmic tension due to enrichment of egg with the yolk, promoted the embrionization of development and formation of the egg morphogenetic environment providing for the earlier formation processes without participation of the parental recombined genotypes. With all this, far earlier appearence of symmetry elements of definitive forms is embriogenesis along the ascending trend from the lower Metazoa to the most advanced insects. The unordered correspondence of the polarity axis of egg and the oral-aboral axis of blastula-like larva (1) is replaced by protaxony (2) in which these axes coincide, all formation processes reaching their perfection in the homoquadrant spiral division of annelids, which became a means of ovoplasma segregation. Afterward, a herequadrant division and plagioxony are developed in the course

  5. Continuous Positive Airway Pressure (CPAP)

    Science.gov (United States)

    ... ENT Doctor Near You Continuous Positive Airway Pressure (CPAP) Continuous Positive Airway Pressure (CPAP) Patient Health Information ... relations staff at newsroom@entnet.org . What Is CPAP? The most common and effective nonsurgical treatment for ...

  6. 21 CFR 640.62 - Medical supervision.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 7 2010-04-01 2010-04-01 false Medical supervision. 640.62 Section 640.62 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) BIOLOGICS ADDITIONAL STANDARDS FOR HUMAN BLOOD AND BLOOD PRODUCTS Source Plasma § 640.62 Medical supervision. A qualified licensed physician shall be on the...

  7. A Dynamic Continuation-Passing Style for Dynamic Delimited Continuations

    DEFF Research Database (Denmark)

    Biernacki, Dariusz; Danvy, Olivier; Millikin, Kevin Scott

    2005-01-01

    We present a new abstract machine that accounts for dynamic delimited continuations. We prove the correctness of this new abstract machine with respect to a pre-existing, definitional abstract machine. Unlike this definitional abstract machine, the new abstract machine is in defunctionalized form......, which makes it possible to state the corresponding higher-order evaluator. This evaluator is in continuation+state passing style and threads a trail of delimited continuations and a meta-continuation. Since this style accounts for dynamic delimited continuations, we refer to it as `dynamic continuation......-passing style.' We show that the new machine operates more efficiently than the definitional one and that the notion of computation induced by the corresponding evaluator takes the form of a monad. We also present new examples and a new simulation of dynamic delimited continuations in terms of static ones....

  8. Medications (for IBS)

    Medline Plus

    Full Text Available ... July 2017 Print Jump to Topic Medications for IBS Laxatives Anticholinergic/Antispasmodic Agents Antidiarrheal Agents Antidepressant Medications Newer IBS Medications Probiotics and Antibiotics Pharmacologic, ...

  9. Smoking cessation medications

    Science.gov (United States)

    Smoking cessation - medications; Smokeless tobacco - medications; Medications for stopping tobacco ... Smoking cessation medicines can: Help with the craving for tobacco. Help you with withdrawal symptoms. Keep you ...

  10. Radioisotopes for medical applications

    International Nuclear Information System (INIS)

    Carr, S.

    1998-01-01

    For more than 3 decades, the Australian Nuclear Science and Technology Organisation has been the country's main supplier of radioisotopes for medical applications. The use of radioisotopes in medicine has revolutionised the diagnosis, management and treatment of many serious diseases such as cancer, heart disease and stroke. It is also beginning to play a key role in neurological disorders such as Parkinson and Alzheimers disease and epilepsy. More recently there has been considerable growth in the application of nuclear medicine to treat sport-related injuries - especially wrist, ankle and knees where more common techniques do not always enable accurate diagnosis. Australia is a recognised leader in nuclear medicine. This can be partially attributed to the close relationship between ANSTO and the medical community in providing opportunities to develop and evaluate new agents to support more effective patient care. A list of commercial isotopes produced in the reactor or the cyclotron and used in medical applications is given. Nuclear medicine plays an important role in the clinical environment and the timely supply of radioisotopes is a key element. ANSTO will continue to be the premier supplier of currently available and developing isotopes to support the health and well being of the Australian community

  11. Radioisotopes for medical applications

    Energy Technology Data Exchange (ETDEWEB)

    Carr, S. [Australian Nuclear Science and Technology Organisation, Lucas Heights, NSW (Australia). Radiopharmaceuticals Division

    1998-03-01

    For more than 3 decades, the Australian Nuclear Science and Technology Organisation has been the country`s main supplier of radioisotopes for medical applications. The use of radioisotopes in medicine has revolutionised the diagnosis, management and treatment of many serious diseases such as cancer, heart disease and stroke. It is also beginning to play a key role in neurological disorders such as Parkinson and Alzheimers disease and epilepsy. More recently there has been considerable growth in the application of nuclear medicine to treat sport-related injuries - especially wrist, ankle and knees where more common techniques do not always enable accurate diagnosis. Australia is a recognised leader in nuclear medicine. This can be partially attributed to the close relationship between ANSTO and the medical community in providing opportunities to develop and evaluate new agents to support more effective patient care. A list of commercial isotopes produced in the reactor or the cyclotron and used in medical applications is given. Nuclear medicine plays an important role in the clinical environment and the timely supply of radioisotopes is a key element. ANSTO will continue to be the premier supplier of currently available and developing isotopes to support the health and well being of the Australian community 2 tabs., 1 fig.

  12. Medical humanities in the undergraduate medical curriculum.

    Science.gov (United States)

    Supe, Avinash

    2012-01-01

    The medical humanities have been introduced in medical curricula over the past 30 years in the western world. Having medical humanities in a medical school curriculum can nurture positive attitudes in the regular work of a clinician and contribute equally to personality development. Though substantial evidence in favour of a medical humanities curriculum may be lacking, the feedback is positive. It is recommended that medical humanities be introduced into the curriculum of every medical school with the purpose of improving the quality of healthcare, and the attitudes of medical graduates.

  13. Commercializing medical technology.

    Science.gov (United States)

    Scanlon, Kevin J; Lieberman, Mark A

    2007-04-01

    As medicine moves into the 21st century, life saving therapies will move from inception into medical products faster if there is a better synergy between science and business. Medicine appears to have 50-year innovative cycles of education and scientific discoveries. In the 1880's, the chemical industry in Germany was faced with the dilemma of modernization to exploit the new scientific discoveries. The solution was the spawning of novel technical colleges for training in these new chemical industries. The impact of those new employees and their groundbreaking compounds had a profound influence on medicine and medical education in Germany between 1880 and 1930. Germany dominated international science during this period and was a training center for scientists worldwide. This model of synergy between education and business was envied and admired in Europe, Asia and America. British science soon after evolved to dominate the field of science during the prewar and post World War (1930's-1970's) because the German scientists fled Hitler's government. These expatriated scientists had a profound influence on the teaching and training of British scientists, which lead to advances in medicine such as antibiotics. After the Second World War, the US government wisely funded the development of the medical infrastructure that we see today. British and German scientists in medicine moved to America because of this bountiful funding for their research. These expatriated scientists helped drive these medical advances into commercialized products by the 1980's. America has been the center of medical education and advances of biotechnology but will it continue? International scientists trained in America have started to return to Europe and Asia. These American-trained scientists and their governments are very aware of the commercial potential of biotechnology. Those governments are now more prepared to play an active role this new science. Germany, Ireland, Britain, Singapore

  14. Exoplanets: The Hunt Continues!

    Science.gov (United States)

    2001-04-01

    Swiss Telescope at La Silla Very Successful Summary The intensive and exciting hunt for planets around other stars ( "exoplanets" ) is continuing with great success in both hemispheres. Today, an international team of astronomers from the Geneva Observatory and other research institutes [1] is announcing the discovery of no less than eleven new, planetary companions to solar-type stars, HD 8574, HD 28185, HD 50554, HD 74156, HD 80606, HD 82943, HD 106252, HD 141937, HD 178911B, HD 141937, among which two new multi-planet systems . The masses of these new objects range from slightly less than to about 10 times the mass of the planet Jupiter [2]. The new detections are based on measured velocity changes of the stars [3], performed with the CORALIE spectrometer on the Swiss 1.2-m Leonard Euler telescope at the ESO La Silla Observatory , as well as with instruments on telescopes at the Haute-Provence Observatory and on the Keck telescopes on Mauna Kea (Hawaii, USA). Some of the new planets are unusual: * a two-planet system (around the star HD 82943) in which one orbital period is nearly exactly twice as long as the other - cases like this (refered to as "orbital resonance") are well known in our own solar system; * another two-planet system (HD 74156), with a Jupiter-like planet and a more massive planet further out; * a planet with the most elongated orbit detected so far (HD 80606), moving between 5 and 127 million kilometers from the central star; * a giant planet moving in an orbit around its Sun-like central star that is very similar to the one of the Earth and whose potential satellites (in theory, at least) might be "habitable". At this moment, there are 63 know exoplanet candidates with minimum masses below 10 Jupiter masses, and 67 known objects with minimum masses below 17 Jupiter masses. The present team of astronomers has detected about half of these. PR Photo 13a/01 : Radial-velocity measurements of HD 82943, a two-planet system . PR Photo 13b/01 : Radial

  15. The random continued fraction transformation

    Science.gov (United States)

    Kalle, Charlene; Kempton, Tom; Verbitskiy, Evgeny

    2017-03-01

    We introduce a random dynamical system related to continued fraction expansions. It uses random combinations of the Gauss map and the Rényi (or backwards) continued fraction map. We explore the continued fraction expansions that this system produces, as well as the dynamical properties of the system.

  16. Evaluación de un programa de educación médica continua para la atención primaria en la prescripción de hipoglucémicos An evaluation of a continuing medical education program for primary care services in the hypoglycemic agent’s prescription in diabetes mellitus type 2

    Directory of Open Access Journals (Sweden)

    Angélica Castro-Ríos

    2008-01-01

    Full Text Available OBJETIVO: Evaluar el efecto en la prescripción de hipoglucémicos de un programa de educación médica continua en unidades de medicina familiar (UMF. MATERIAL Y MÉTODOS: Se realizó un estudio observacional que comparó dos grupos (con y sin programa con dos cortes transversales (antes y después. La unidad de análisis fue la consulta. El periodo de análisis comprendió seis meses anteriores y seis posteriores a la institución del programa. La principal variable de resultado fue la prescripción adecuada, evaluada mediante dos criterios: elección e indicación correctas. El análisis incluyó modelos de regresión logística, se aplicó la técnica de dobles diferencias y se ajustó por variables relativas al paciente, la consulta y la UMF; las más relevantes fueron sexo, obesidad, otras afecciones, número de consultas, número de medicamentos, tamaño de la clínica, grupo y etapa. RESULTADOS: Se obtuvo un incremento atribuible al programa de 0.6% en la probabilidad de prescripción adecuada y de 11% en la elección correcta en pacientes obesos.OBJECTIVE: To evaluate the impact of a continuing medical education program on family doctors to improve prescription of hypoglycemic drugs. MATERIAL AND METHODS: An observational study was conducted with two groups of comparison (with-without program and before-after periods. The unit of analysis was the visit. The period of evaluation comprised six months before and six after implementing the program. The outcome variable was the appropriateness of prescription that was based upon two criteria: appropriate selection and proper indication of the drug. Logistic regression models and the double differences technique were used to analyze the information. Models were adjusted by independent variables related with the patient, the visit and the PCC, the more relevant ones were: sex, obesity, conditions other than diabetes, number of visits in the analyzed period, number of drugs prescribed, size of

  17. Medical telesensors

    Science.gov (United States)

    Ferrell, Trinidad L.; Crilly, P. B.; Smith, S. F.; Wintenberg, Alan L.; Britton, Charles L., Jr.; Morrison, Gilbert W.; Ericson, M. N.; Hedden, D.; Bouldin, Donald W.; Passian, A.; Downey, Todd R.; Wig, A. G.; Meriaudeau, Fabrice

    1998-05-01

    Medical telesensors are self-contained integrated circuits for measuring and transmitting vital signs over a distance of approximately 1-2 meters. The circuits are unhoused and contain a sensor, signal processing and modulation electronics, a spread-spectrum transmitter, an antenna and a thin-film battery. We report on a body-temperature telesensor, which is sufficiently small to be placed on a tympanic membrane in a child's ear. We also report on a pulse-oximeter telesensor and a micropack receiver/long- range transmitter unit, which receives form a telesensor array and analyzes and re-transmits the vital signs over a longer range. Signal analytics are presented for the pulse oximeter, which is currently in the form of a finger ring. A multichip module is presented as the basic signal-analysis component. The module contains a microprocessor, a field=programmable gate array, memory elements and other components necessary for determining trauma and reporting signals.

  18. [MEDICAL CANNABIS].

    Science.gov (United States)

    Naftali, Timna

    2016-02-01

    The cannabis plant has been known to humanity for centuries as a remedy for pain, diarrhea and inflammation. Current research is inspecting the use of cannabis for many diseases, including multiple sclerosis, epilepsy, dystonia, and chronic pain. In inflammatory conditions cannabinoids improve pain in rheumatoid arthritis and:pain and diarrhea in Crohn's disease. Despite their therapeutic potential, cannabinoids are not free of side effects including psychosis, anxiety, paranoia, dependence and abuse. Controlled clinical studies investigating the therapeutic potential of cannabis are few and small, whereas pressure for expanding cannabis use is increasing. Currently, as long as cannabis is classified as an illicit drug and until further controlled studies are performed, the use of medical cannabis should be limited to patients who failed conventional better established treatment.

  19. Frontiers in medical imaging technology

    International Nuclear Information System (INIS)

    Iinuma, Takeshi

    1992-01-01

    At present many medical images are used for diagnostics and treatment. After the advent of X-ray computer tomography (XCT), the violent development of medical images has continued. Medical imaging technology can be defined as the field of technology that deals with the production, processing, display, transmission, evaluation and so on of medical images, and it can be said that the present development of medical imaging diagnostics has been led by medical imaging technology. In this report, the most advanced technology of medical imaging is explained. The principle of XCT is shown. The feature of XCT is that it can image the delicate difference in the X-ray absorption factor of the cross section being measured. The technical development has been advanced to reduce the time for imaging and to heighten the resolution. The technology which brings about a large impact to future imaging diagnostics is computed radiography. Magnetic resonance imaging is the method of imaging the distribution of protons in human bodies. Positron CT is the method of measurement by injecting a positron-emitting RI. These methods are explained. (K.I.)

  20. Continuous downstream processing of biopharmaceuticals.

    Science.gov (United States)

    Jungbauer, Alois

    2013-08-01

    Continuous manufacturing has been applied in many different industries but has been pursued reluctantly in biotechnology where the batchwise process is still the standard. A shift to continuous operation can improve productivity of a process and substantially reduce the footprint. Continuous operation also allows robust purification of labile biomolecules. A full set of unit operations is available to design continuous downstream processing of biopharmaceuticals. Chromatography, the central unit operation, is most advanced in respect to continuous operation. Here, the problem of 'batch' definition has been solved. This has also paved the way for implementation of continuous downstream processing from a regulatory viewpoint. Economic pressure, flexibility, and parametric release considerations will be the driving force to implement continuous manufacturing strategies in future. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. [Humanities in medical education: between reduction and integration].

    Science.gov (United States)

    Han, Taehee

    2015-09-01

    Reductive logic has been a major reasoning style in development of modern biomedical sciences. However, when "medical humanities" is developed by reductive reasoning, integrative and holistic values of humanities tend to be weakened. In that sense, identity and significance of "medical humanities" continue to be controversial despite of its literal clarity. Humanities in medical education should be established by strengthening humanistic and socialistic aspects of regular medical curriculum as well as developing individual "medical humanities" programs.

  2. Medications (for IBS)

    Medline Plus

    Full Text Available ... Agents Antidepressant Medications Newer IBS Medications Probiotics and Antibiotics Pharmacologic, or drug, therapy is best used in ... Agents Antidepressant Medications Newer IBS Medications Probiotics and ... Treatments Understanding Stress Cognitive Behavioral Therapy Relaxation ...

  3. Medications (for IBS)

    Medline Plus

    Full Text Available ... Agents Antidiarrheal Agents Antidepressant Medications Newer IBS Medications Probiotics and Antibiotics Pharmacologic, or drug, therapy is best ... Agents Antidiarrheal Agents Antidepressant Medications Newer IBS Medications ... Psychological Treatments Understanding Stress Cognitive Behavioral ...

  4. The Medical Home

    Science.gov (United States)

    ... Videos for Educators Search English Español The Medical Home KidsHealth / For Parents / The Medical Home What's in ... for your child. What Does the Term "Medical Home" Mean? A medical home isn't a place ...

  5. Medications (for IBS)

    Medline Plus

    Full Text Available ... Agents Antidepressant Medications Newer IBS Medications Probiotics and Antibiotics Pharmacologic, or drug, therapy is best used in ... Agents Antidepressant Medications Newer IBS Medications Probiotics and Antibiotics Psychological Treatments Understanding Stress Cognitive Behavioral Therapy Relaxation ...

  6. Medical muddle.

    Science.gov (United States)

    Gartrell, Nanette

    2014-01-01

    Nanette Gartrell, MD, is a psychiatrist and researcher whose investigations have documented the mental health and psychological well-being of lesbian, gay, bisexual, and transgender (LGBT) people over the past four decades. Nanette is the principal investigator of an ongoing longitudinal study of lesbian families in which the children were conceived by donor insemination. Now in its 27th year, this project has been cited internationally in the debates over equality in marriage, foster care, and adoption. Previously on the faculty at Harvard Medical School and the University of California, San Francisco, Nanette is currently a Visiting Distinguished Scholar at the Williams Institute, UCLA School of Law. In 2013, Nanette received the Association of Women Psychiatrists Presidential Commendation Award for "selfless and enduring vision, leadership, wisdom, and mentorship in the fields of women's mental health, ethics, and gender research." At the age of 63, Nanette experienced a 3 ½ month period of intractable, incapacitating dizziness for which there was never a clear diagnosis.

  7. MEDICAL PROFESSIONALISH

    Directory of Open Access Journals (Sweden)

    Jože Drinovec

    2002-12-01

    Full Text Available Background. Due to restrictions imposed on a clinical freedom, interest for professionalism in healthcare has been getting bigger not only in medicine literature and various mass media but also in teaching and organisation of healthcare. Professionalism stands not only for a medicine’s contract with society, recognition of a physician status, privilege and monopoly but also for a genuine physician’s commitment to professional responsibilities.Analysis. In 2002 European and American associations approved a document on medical professionalism in the new millenium, so-called Physician Charter. This document includes fundamental principles of professionalism such as altruism, patient autonomy and social justice. In particular, it analyses a physician’s professional competency, honesty with patients, patient confidentiality, appropriate relations with patients, improvements regarding a healthcare quality, healthcare access, just distribution of finite funds, commitment to scientific knowledge, trust maintenance by managing conflicts of interest and a professional responsibility.Conclusions. Physician’s professionalism means philosophycal and sociological analysis of his/her profession and its position in a society. It includes a concern for improvements of his/ her own scientific knowledge, skills, a genuine ethic interest for an individual patient bearing in mind principles of equality and justice in society. Whether performing an organisational and public work or participating in professional health organizations, physician’s interest for a patient must prevail.

  8. Continuous Non-malleable Codes

    DEFF Research Database (Denmark)

    Faust, Sebastian; Mukherjee, Pratyay; Nielsen, Jesper Buus

    2014-01-01

    or modify it to the encoding of a completely unrelated value. This paper introduces an extension of the standard non-malleability security notion - so-called continuous non-malleability - where we allow the adversary to tamper continuously with an encoding. This is in contrast to the standard notion of non...... is necessary to achieve continuous non-malleability in the split-state model. Moreover, we illustrate that none of the existing constructions satisfies our uniqueness property and hence is not secure in the continuous setting. We construct a split-state code satisfying continuous non-malleability. Our scheme...... is based on the inner product function, collision-resistant hashing and non-interactive zero-knowledge proofs of knowledge and requires an untamperable common reference string. We apply continuous non-malleable codes to protect arbitrary cryptographic primitives against tampering attacks. Previous...

  9. The Continued Assessment of Self-Continuity and Identity

    Science.gov (United States)

    Dunkel, Curtis S.; Minor, Leslie; Babineau, Maureen

    2010-01-01

    Studies have found that self-continuity is predictive of a substantial number of important outcome variables. However, a recent series of studies brings into question the traditional method of measuring self-continuity in favor of an alternative (B. M. Baird, K. Le, & R. E. Lucas, 2006). The present study represents a further comparison of…

  10. Beyond Continuous Delivery: An Empirical Investigation of Continuous Deployment Challenges

    DEFF Research Database (Denmark)

    Shahin, Mojtaba; Ali Babar, Muhammad; Zahedi, Mansooreh

    2017-01-01

    Context: A growing number of software organizations have been adopting Continuous DElivery (CDE) and Continuous Deployment (CD) practices. Researchers have started investing significant efforts in studying different aspects of CDE and CD. Many studies refer to CDE (i.e., where an application is p...

  11. Continuous exponential martingales and BMO

    CERN Document Server

    Kazamaki, Norihiko

    1994-01-01

    In three chapters on Exponential Martingales, BMO-martingales, and Exponential of BMO, this book explains in detail the beautiful properties of continuous exponential martingales that play an essential role in various questions concerning the absolute continuity of probability laws of stochastic processes. The second and principal aim is to provide a full report on the exciting results on BMO in the theory of exponential martingales. The reader is assumed to be familiar with the general theory of continuous martingales.

  12. Continuous acoustic emission from aluminium

    International Nuclear Information System (INIS)

    Fenici, P.; Kiesewetter, N.; Schiller, P.

    1976-01-01

    Continuous acoustic emission of aluminum single crystals and polycrystals during tensile tests at constant cross-head speed and at room temperature is measured with a Root Mean Square Level recorder. By means of the Kaiser effect it is shown that the continuous emission is related to the plastic deformation. The plot of continuous emission against strain takes different shapes for pure single crystals, pure polycrystals and impure polycrystals. The measured voltages have about the same value for pure single and polycrystals and are considerably greater than that for impure polycrystals. A method is developed to distinguish between continuous emission and burst

  13. Education in Medical Biochemistry in Serbia.

    Science.gov (United States)

    Majkic-Sing, Nada

    2010-06-01

    Medical biochemistry is the usual name for clinical biochemistry or clinical chemistry in Serbia. Medical biochemistry laboratories and medical biochemists as a profession are part of Health Care System and are regulated through: the Health Care Law and rules issued by the Chamber of Medical Biochemists of Serbia. The first continuous and organized education for Medical Biochemists in Serbia dates from 1945, when Department of Medical Biochemistry was established at Pharmaceutical Faculty in Belgrade. In 1987 at the same Faculty a five years undergraduate branch was established, educating Medical Biochemists under a special program. Since 2006 the new five year undergraduate (according to Bologna Declaration) and postgraduate program of four-year specialization according to EC4 European Syllabus for Post-Graduate Training in Clinical Chemistry and Laboratory Medicine has been established. The Ministry of Education and Ministry of Public Health accredits the programs. There are four requirements for practicing medical biochemistry in the Health Care System: University Diploma of the Faculty of Pharmacy (Medical Biochemistry), successful completion of the profession exam at the Ministry of Health after completion of one additional year of obligatory practical training in medical laboratories, membership in the Serbian Chamber of Medical Biochemists and licence for skilled work issued by Serbian Chamber of Medical Biochemists.

  14. Teaching Medical Students Clinical Anesthesia.

    Science.gov (United States)

    Curry, Saundra E

    2018-05-01

    There are many reasons for evaluating our approach and improving our teaching of America's future doctors, whether they become anesthesiologists (recruitment) or participate in patient management in the perioperative period (general patient care). Teaching medical students the seminal aspects of any medical specialty is a continual challenge. Although no definitive curricula or single clinical approach has been defined, certain key features can be ascertained from clinical experience and the literature. A survey was conducted among US anesthesiology teaching programs regarding the teaching content and approaches currently used to teach US medical students clinical anesthesia. Using the Accreditation Council for Graduate Medical Education website that lists 133 accredited anesthesiology programs, residency directors were contacted via e-mail. Based on those responses and follow-up phone calls, teaching representatives from 125 anesthesiology departments were identified and asked via e-mail to complete a survey. The survey was returned by 85 programs, yielding a response rate of 68% of individuals contacted and 63% of all departments. Ninety-one percent of the responding departments teach medical students, most in the final 2 years of medical school. Medical student exposure to clinical anesthesia occurred as elective only at 42% of the institutions, was requirement only at 16% of responding institutions, and the remainder had both elective and required courses. Anesthesiology faculty at 43% of the responding institutions reported teaching in the preclinical years of medical school, primarily in the departments of pharmacology and physiology. Forty-five percent of programs reported interdisciplinary teaching with other departments teaching classes such as gross anatomy. There is little exposure of anesthesiology faculty to medical students in other general courses. Teaching in the operating room is the primary teaching method in the clinical years. Students are

  15. Future Directions in Medical Physics

    Science.gov (United States)

    Jeraj, Robert

    Medical Physics is a highly interdisciplinary field at the intersection between physics and medicine and biology. Medical Physics is aiming at development of novel applications of physical processes and techniques in various areas of medicine and biology. Medical Physics had and continues to have profound impact by developing improved imaging and treatment technologies, and helping to advance our understanding of the complexity of the disease. The general trend in medicine towards personalized therapy, and emphasis on accelerated translational research is having a profound impact on medical physics as well. In the traditional stronghold for medical physicists - radiation therapy - the new reality is shaping in the form of biologically conformal and combination therapies, as well as advanced particle therapy approaches, such as proton and ion therapies. Rapid increase in faster and more informative multi-modality medical imaging is bringing a wealth of information that is being complemented with data obtained from genomic profiling and other biomarkers. Novel data analysis and data mining approaches are proving grounds for employment of various artificial intelligence methods that will help further improving clinical decision making for optimization of various therapies as well as better understanding of the disease properties and disease evolution, ultimately leading to improved clinical outcomes.

  16. Cognitive Medical Multiagent Systems

    OpenAIRE

    Barna Iantovics

    2010-01-01

    The development of efficient and flexible agent-based medical diagnosis systems represents a recent research direction. Medical multiagent systems may improve the efficiency of traditionally developed medical computational systems, like the medical expert systems. In our previous researches, a novel cooperative medical diagnosis multiagent system called CMDS (Contract Net Based Medical Diagnosis System) was proposed. CMDS system can solve flexibly a large variety of medical diagnosis problems...

  17. Continuous supersonic plasma wind tunnel

    DEFF Research Database (Denmark)

    Andersen, S.A.; Jensen, Vagn Orla; Nielsen, P.

    1968-01-01

    The B field configuration of a Q-device has been modified into a magnetic Laval nozzle. Continuous supersonic plasma flow is observed with M≈3......The B field configuration of a Q-device has been modified into a magnetic Laval nozzle. Continuous supersonic plasma flow is observed with M≈3...

  18. Perspectives: The Continuous Improvement Trap

    Science.gov (United States)

    Arnold, David L.

    2011-01-01

    Accrediting agencies, legislators, pundits, and even higher educational professionals have become enamored with applying the language of continuous improvement to learning outcomes. The Southern Association of Colleges and Schools Commission on Colleges specifically uses the term "continuing improvement" in Core Standard 2.5, one of its…

  19. Continual integral in perturbation theory

    International Nuclear Information System (INIS)

    Slavnov, A.A.

    1975-01-01

    It is shown that all results obtained by means of continual integration within the framework of perturbation theory are completely equivalent to those obtained by the usual diagram technique and are therfore just as rigorous. A rigorous justification is given for the rules for operating with continual integrals in perturbation theory. (author)

  20. Teaching communication skills and medical ethics to undergraduate medical student

    Directory of Open Access Journals (Sweden)

    SADIA AHSIN

    2013-07-01

    Full Text Available Introduction: The purpose of this study was to improve communication skills and knowledge of bioethics of last year medical students doing clerkship and to evaluate the effectiveness of using workshops for this purpose from students’ point of view, in order to continue such programs in future. Methods: After Ethical approval for the study a two-day workshop on teaching effective communication skills and principles of medical ethics was planned and conducted by the department of Medical Education through multidisciplinary faculty of Foundation University Medical College, Pakistan. A total of 102 last year medical students participated in this workshop. The students were divided into 8 groups each containing 12 students. A team of pre trained facilitators for each group conducted the group activities. Teaching strategies including interactive discussions on basic principles of doctor-patient relationship, power point presentations, day to day case scenarios, video clips and presentations involving students in role plays were used. Pre and post workshop self evaluation proformas about knowledge and skills of communication and medical ethics were rated (0=none, 1=below average, 2=average, 3=above average, 4=very good, 5=excellent by the students. Results: 89 out of 102 participants returned the proformas. A significant percentage of students (%82 showed improvement in their knowledge and skills of appreciating bioethical issues like valid informed consent, patient confidentiality, end of life issues and breaking bad news by rating as “very good” after participation in the workshop. More than %70 students recommended this activity for other students. Conclusion: Teaching through interactive workshops was found to be an effective method as reflected by students’ feedback. Therefore, the program will be continued in future.

  1. Introducing quality assurance and medical audit into the UCSF medical center curriculum.

    Science.gov (United States)

    Barbaccia, J C

    1976-05-01

    The experience gained by a medical school faculty in developing and piloting a course for undergraduate medical students in medical care evaluation led to a similar effort for house staff. It is recognized that if the profession is to fulfill the demand by society for social accountability in the use of resources for health care, medical care assessment and quality assurance mechanisms must become an intimate part of the clinical experience of medical students and house officers. Teaching these subjects requires a theoretical framework; introduction of content and skills appropriate to the level of the student and continuation of progressively more advanced training throughout medical education; use of assessment and quality assurance techniques by clinician-teachers themselves to provide models for the student; and continued evolution of pedagogic approach and course content based on developments in the area.

  2. Medical professionalism from a socio-cultural perspective: evaluating medical residents communicative attitudes during the medical encounter in malaysia.

    Science.gov (United States)

    Ganasegeran, K; Al-Dubai, S A R

    2014-01-01

    The practice of medicine requires good communication skills to foster excellent rapport in doctor patient relationship. Reports on communication skills learning attitude among medical professionals are key essentials toward improving patient safety and quality of care. We aimed to determine factors affecting communication skills learning attitudes among medical residents in Malaysia. Cross-sectional survey, in a Malaysian public health hospital. A total of 191 medical residents across medical and surgical based rotations were included. We assessed the validated communication skills attitude scale among medical residents from different rotations. Statistical Package of Social Sciences (SPSS®) (version 16.0, IBM, Armonk, NY) was used. Cronbach's alpha was used to test the internal consistency of the scale. Descriptive analysis was conducted for all variables. Bivariate analysis was employed across the socio-demographic variables. Majority of the residents believed that communication skills training should be made compulsory in Malaysia (78.5%). Medical residents agreed that acquiring good communication skills is essential to be a good doctor. However, the majority cited time pressures for not being able to learn communication skills. Significant differences in communication skills learning attitude scores were found between Malays and Chinese. The majority of medical residents had a positive attitude toward communication skills learning. Socio-demographic factors influenced communication skills learning attitude among medical residents. Incorporating communicative skills modules during hospital Continuous Medical Education for medical residents is essential to cultivate communicative skills attitudes for effective doctor-patient relationship during the routine medical encounters.

  3. Chronic kidney disease – the silent epidemic | Davids | Continuing ...

    African Journals Online (AJOL)

    Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 25, No 8 (2007) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should ...

  4. 42 CFR 456.233 - Initial continued stay review date.

    Science.gov (United States)

    2010-10-01

    ... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals... must provide that— (a) When a recipient is admitted to the mental hospital under admission review... will be reviewed; (b) If an individual applies for Medicaid while in the mental hospital, the committee...

  5. 42 CFR 456.128 - Initial continued stay review date.

    Science.gov (United States)

    2010-10-01

    ... norms to assign the initial continued stay review date, the number of days between the individual's... and criteria required to be described under § 456.129; (2) The individual's condition; and (3) The individual's projected discharge date; (c)(1) The committee uses any available appropriate regional medical...

  6. What Drives Nurses' Blended e-Learning Continuance Intention?

    Science.gov (United States)

    Cheng, Yung-Ming

    2014-01-01

    This study's purpose was to synthesize the user network (including subjective norm and network externality), task-technology fit (TTF), and expectation-confirmation model (ECM) to explain nurses' intention to continue using the blended electronic learning (e-learning) system within medical institutions. A total of 450 questionnaires were…

  7. Feedback after continuous assessment: An essential element of ...

    African Journals Online (AJOL)

    Feedback after continuous assessment: An essential element of students' learning in medical education. Sir,. Regarding the philosophy and goals at all levels of education in Nigeria, section 1, paragraph 9(g) of the. National Policy on Education (revised 2004) stated that,. “educational assessment and evaluation shall be ...

  8. 46 CFR 154.1435 - Medical first aid guide.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 5 2010-10-01 2010-10-01 false Medical first aid guide. 154.1435 Section 154.1435 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES SAFETY... Equipment § 154.1435 Medical first aid guide. Each vessel must have a copy of the IMO Medical First Aid...

  9. 21 CFR 880.5300 - Medical absorbent fiber.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Medical absorbent fiber. 880.5300 Section 880.5300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... Devices § 880.5300 Medical absorbent fiber. (a) Identification. A medical absorbent fiber is a device...

  10. Development of Colonial Medical and Health Services in Ibadan ...

    African Journals Online (AJOL)

    Journal of History and Diplomatic Studies ... There is no doubt that medicine is important in the history of any society. ... This limitation of colonial medical intervention coupled with age old medical ideas in Ibadan consequently occasioned the continuity of indigenous medical culture and adaptation of Western medicine in ...

  11. 21 CFR 880.6060 - Medical disposable bedding.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Medical disposable bedding. 880.6060 Section 880.6060 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... Devices § 880.6060 Medical disposable bedding. (a) Identification. Medical disposable bedding is a device...

  12. Energy functionals for medical image segmentation: choices and consequences

    OpenAIRE

    McIntosh, Christopher

    2011-01-01

    Medical imaging continues to permeate the practice of medicine, but automated yet accurate segmentation and labeling of anatomical structures continues to be a major obstacle to computerized medical image analysis. Though there exists numerous approaches for medical image segmentation, one in particular has gained increasing popularity: energy minimization-based techniques, and the large set of methods encompassed therein. With these techniques an energy function must be chosen, segmentations...

  13. Protein design using continuous rotamers.

    Directory of Open Access Journals (Sweden)

    Pablo Gainza

    2012-01-01

    Full Text Available Optimizing amino acid conformation and identity is a central problem in computational protein design. Protein design algorithms must allow realistic protein flexibility to occur during this optimization, or they may fail to find the best sequence with the lowest energy. Most design algorithms implement side-chain flexibility by allowing the side chains to move between a small set of discrete, low-energy states, which we call rigid rotamers. In this work we show that allowing continuous side-chain flexibility (which we call continuous rotamers greatly improves protein flexibility modeling. We present a large-scale study that compares the sequences and best energy conformations in 69 protein-core redesigns using a rigid-rotamer model versus a continuous-rotamer model. We show that in nearly all of our redesigns the sequence found by the continuous-rotamer model is different and has a lower energy than the one found by the rigid-rotamer model. Moreover, the sequences found by the continuous-rotamer model are more similar to the native sequences. We then show that the seemingly easy solution of sampling more rigid rotamers within the continuous region is not a practical alternative to a continuous-rotamer model: at computationally feasible resolutions, using more rigid rotamers was never better than a continuous-rotamer model and almost always resulted in higher energies. Finally, we present a new protein design algorithm based on the dead-end elimination (DEE algorithm, which we call iMinDEE, that makes the use of continuous rotamers feasible in larger systems. iMinDEE guarantees finding the optimal answer while pruning the search space with close to the same efficiency of DEE.Software is available under the Lesser GNU Public License v3. Contact the authors for source code.

  14. Account-based retiree medical plans: what's good for your pension plan may be good for your retiree medical plan.

    Science.gov (United States)

    Ruschau, W J

    2001-09-01

    Many of the same forces that caused employers to gravitate toward account-based pension plans are beginning to spark similar changes in retiree medical plans. As medical costs continue to escalate, account-based retiree medical plans offer a new way to manage company outlays, while preserving an important benefit for retirees.

  15. Continuous culture apparatus and methodology

    International Nuclear Information System (INIS)

    Conway, H.L.

    1975-01-01

    At present, we are investigating the sorption of potentially toxic trace elements by phytoplankton under controlled laboratory conditions. Continuous culture techniques were used to study the mechanism of the sorption of the trace elements by unialgal diatom populations and the factors influencing this sorption. Continuous culture methodology has been used extensively to study bacterial kinetics. It is an excellent technique for obtaining a known physiological state of phytoplankton populations. An automated method for the synthesis of continuous culture medium for use in these experiments is described

  16. Manipulating continuous variable photonic entanglement

    International Nuclear Information System (INIS)

    Plenio, M.B.

    2005-01-01

    I will review our work on photonic entanglement in the continuous variable regime including both Gaussian and non-Gaussian states. The feasibility and efficiency of various entanglement purification protocols are discussed this context. (author)

  17. Continuing education and professional development

    International Nuclear Information System (INIS)

    Adams, Edwina

    2002-01-01

    The success of a profession will be determined upon its education and training. A profession is required to encompass: a core body of knowledge; a set of ethical codes of practice; and have practitioners with humanistic qualities. In order to maintain the success of a profession it is necessary to have continuing education, which enhances professional development. Continuing professional education includes a form of self-regulation, which ensures the maintenance of a minimum standard of practice in this ever-changing workplace, and by regulating this standard, the discipline becomes more accountable to the client and the profession as a whole. In Australia, the Nuclear Medicine society's continuing education programs and Universities offering postgraduate programs promote continuing education. If technologists are to successfully keep up with developments in instrumentation, protocols and changing health care requirements, we must ensure that the education of practitioners does not cease at certification of entry to the workplace (Au)

  18. Rapid Continuous Multimaterial Extrusion Bioprinting

    NARCIS (Netherlands)

    Liu, Wanjun; Zhang, Yu Shrike; Heinrich, Marcel A.; De Ferrari, F; Jang, HL; Bakht, SM; Alvarez, MM; Yang, J; Li, YC; Trujillo-de Stantiago, G; Miri, AK; Zhu, K; Khoshakhlagh, P; Prakash, G; Cheng, H; Guan, X; Zhong, Z; Ju, J; Zhu, GH; Jin, X; Ryon Shin, Su; Dokmeci, M.R.; Khademhosseini, Ali

    The development of a multimaterial extrusion bioprinting platform is reported. This platform is capable of depositing multiple coded bioinks in a continuous manner with fast and smooth switching among different reservoirs for rapid fabrication of complex constructs, through digitally controlled

  19. Continuation of superpave projects monitoring.

    Science.gov (United States)

    2011-07-01

    This study involved the continuous monitoring of material properties and field performance of twelve Superpave project sections in Florida for the establishment of reasonable and effective mixture design guidelines and criteria, the identification an...

  20. Continuous Delivery and Quality Monitoring

    CERN Multimedia

    CERN. Geneva

    2016-01-01

    After introducing Continuous Delivery, I will switch the topic and try to answer the question how much should we invest in quality and how to do it efficiently. My observations reveal that software quality is often considered as the slo...

  1. Stratigraphy -- The Fall of Continuity.

    Science.gov (United States)

    Byers, Charles W.

    1982-01-01

    Reviews advances in stratigraphy as illustrated in the current geological literature, discussing discontinuity and how the recognition of discontinuity in the stratigraphic record is changing views of Superposition and Original Lateral Continuity. (Author/JN)

  2. Qubit Complexity of Continuous Problems

    National Research Council Canada - National Science Library

    Papageorgiou, A; Traub, J. F

    2005-01-01

    .... The authors show how to obtain the classical query complexity for continuous problems. They then establish a simple formula for a lower bound on the qubit complexity in terms of the classical query complexity...

  3. Competitive Strategy in Continuing Education.

    Science.gov (United States)

    Baden, Clifford

    1987-01-01

    Reviews strategic variables available to those planning continuing education marketing programs. Discusses generic competitive strategies: (1) overall cost leadership, (2) differentiation, and (3) specialization. Mentions several potential problems. (CH)

  4. Implantable Medical Devices

    Science.gov (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More Implantable Medical Devices Updated:Sep 16,2016 For Rhythm Control ... a Heart Attack Introduction Medications Surgical Procedures Implantable Medical Devices • Life After a Heart Attack • Heart Attack ...

  5. Medical alert bracelet (image)

    Science.gov (United States)

    People with diabetes should always wear a medical alert bracelet or necklace that emergency medical workers will be able to find. Medical identification products can help ensure proper treatment in an ...

  6. Asthma Medications and Pregnancy

    Science.gov (United States)

    ... Asthma Associated Conditions Asthma & Pregnancy Asthma & Pregnancy: Medications Asthma & Pregnancy: Medications Make an Appointment Refer a Patient ... make sure you are using it correctly. Other Asthma Related Medication Treatment Annual influenza vaccine (flu shot) ...

  7. Medications (for IBS)

    Medline Plus

    Full Text Available ... Agents Antidiarrheal Agents Antidepressant Medications Newer IBS Medications Probiotics and Antibiotics Pharmacologic, or drug, therapy is best ... Agents Antidiarrheal Agents Antidepressant Medications Newer IBS ... Antibiotics Psychological Treatments Understanding Stress Cognitive Behavioral ...

  8. Medication/Drug Allergy

    Science.gov (United States)

    ... Training Home Conditions Medication/Drug Allergy Medication/Drug Allergy Make an Appointment Find a Doctor Ask a ... risk for adverse reactions to medications. Facts about Allergies The tendency to develop allergies may be inherited. ...

  9. Continuous-Energy Data Checks

    Energy Technology Data Exchange (ETDEWEB)

    Haeck, Wim [Radioprotection and Nuclear Safety Institute, Fontenay-aux-Roses (France); Conlin, Jeremy Lloyd [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); McCartney, Austin Paul [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Parsons, Donald Kent [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-05-25

    The purpose of this report is to provide an overview of all Quality Assurance tests that have to be performed on a nuclear data set to be transformed into an ACE formatted nuclear data file. The ACE file is capable of containing different types of data such as continuous energy neutron data, thermal scattering data, etc. Within this report, we will limit ourselves to continuous energy neutron data.

  10. Atypical work and employment continuity

    OpenAIRE

    Addison, John T.; Surfield, Christopher J.

    2009-01-01

    Atypical employment arrangements such as agency temporary work and contracting have long been criticized as offering more precarious and unstable work than regular employment. Using data from two datasets – the CAEAS and the NLSY79 – we determine whether workers who take such jobs rather than regular employment, or the alternative of continued job search, subsequently experience greater or lesser employment continuity. Observed differences between the various working arrangements are starkest...

  11. Continuous Disintegrations of Gaussian Processes

    OpenAIRE

    LaGatta, Tom

    2010-01-01

    The goal of this paper is to understand the conditional law of a stochastic process once it has been observed over an interval. To make this precise, we introduce the notion of a continuous disintegration: a regular conditional probability measure which varies continuously in the conditioned parameter. The conditioning is infinite-dimensional in character, which leads us to consider the general case of probability measures in Banach spaces. Our main result is that for a certain quantity $M$ b...

  12. Adding Group Psychotherapy to Medication Treatment in Dysthymia

    Science.gov (United States)

    Hellerstein, David J.; Little, Suzanne A. S.; Samstag, Lisa Wallner; Batchelder, Sarai; Muran, J. Christopher; Fedak, Michael; Kreditor, David; Rosenthal, Richard N.; Winston, Arnold

    2001-01-01

    Patients with dysthymia have been shown to respond to treatment with antidepressant medications, and to some degree to psychotherapy. Even patients successfully treated with medication often have residual symptoms and impaired psychosocial functioning. The authors describe a prospective randomized 36-week study of dysthymic patients, comparing continued treatment with antidepressant medication (fluoxetine) alone and medication with the addition of group therapy treatment. After an 8-week trial of fluoxetine, medication-responsive subjects were randomly assigned to receive either continued medication only or medication plus 16 sessions of manualized group psychotherapy. Results provide preliminary evidence that group therapy may provide additional benefit to medication-responding dysthymic patients, particularly in interpersonal and psychosocial functioning. PMID:11264333

  13. [Medical ethics in residency training].

    Science.gov (United States)

    Civaner, Murat; Sarikaya, Ozlem; Balcioğlu, Harun

    2009-04-01

    Medical ethics education in residency training is one of the hot topics of continuous medical education debates. Its importance and necessity is constantly stressed in declarations and statements on national and international level. Parallel to the major structural changes in the organization and the finance model of health care system, patient-physician relationship, identity of physicianship, social perception and status of profession are changing. Besides, scientific developments and technological advancements create possibilities that never exists before, and bring new ethical dilemmas along with. To be able to transplant human organs has created two major problems for instance; procurement of organs in sufficient numbers, and allocating them to the patients in need by using some prioritizing criteria. All those new and challenging questions force the health care workers to find authentic and justifiable solutions while keeping the basic professional values. In that sense, proper medical ethics education in undergraduate and postgraduate term that would make physician-to-be's and student-physicians acquire the core professional values and skill to notice, analyze and develop justifiable solutions to ethical problems is paramount. This article aims to express the importance of medical ethics education in residency training, and to propose major topics and educational methods to be implemented into. To this aim, first, undergraduate medical education, physician's working conditions, the exam of selection for residency training, and educational environment were revised, and then, some topics and educational methods, which are oriented to educate physicians regarding the professional values that they should have, were proposed.

  14. Medications (for IBS)

    Medline Plus

    Full Text Available ... Antidepressant Medications Newer IBS Medications Probiotics and Antibiotics Psychological Treatments Understanding Stress Cognitive Behavioral Therapy Relaxation Techniques for IBS Take Part in Online ...

  15. Medications (for IBS)

    Medline Plus

    Full Text Available ... Agents Antidepressant Medications Newer IBS Medications Probiotics and Antibiotics Psychological Treatments Understanding Stress Cognitive Behavioral Therapy Relaxation Techniques for ...

  16. Cognitive Medical Multiagent Systems

    Directory of Open Access Journals (Sweden)

    Barna Iantovics

    2010-01-01

    Full Text Available The development of efficient and flexible agent-based medical diagnosis systems represents a recent research direction. Medical multiagent systems may improve the efficiency of traditionally developed medical computational systems, like the medical expert systems. In our previous researches, a novel cooperative medical diagnosis multiagent system called CMDS (Contract Net Based Medical Diagnosis System was proposed. CMDS system can solve flexibly a large variety of medical diagnosis problems. This paper analyses the increased intelligence of the CMDS system, which motivates its use for different medical problem’s solving.

  17. Medications (for IBS)

    Medline Plus

    Full Text Available ... Anthony J. Lembo, MD, Instructor of Medicine, Harvard Medical School; Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA. Last modified on February 23, ...

  18. Business continuity 2014: From traditional to integrated Business Continuity Management.

    Science.gov (United States)

    Ee, Henry

    As global change continues to generate new challenges and potential threats to businesses, traditional business continuity management (BCM) slowly reveals its limitations and weak points to ensuring 'business resiliency' today. Consequently, BCM professionals also face the challenge of re-evaluating traditional concepts and introducing new strategies and industry best practices. This paper points to why traditional BCM is no longer sufficient in terms of enabling businesses to survive in today's high-risk environment. It also looks into some of the misconceptions about BCM and other stumbling blocks to establishing effective BCM today. Most importantly, however, this paper provides tips based on the Business Continuity Institute's (BCI) Good Practices Guideline (GPG) and the latest international BCM standard ISO 22301 on how to overcome the issues and challenges presented.

  19. Eliminating US hospital medical errors.

    Science.gov (United States)

    Kumar, Sameer; Steinebach, Marc

    2008-01-01

    Healthcare costs in the USA have continued to rise steadily since the 1980s. Medical errors are one of the major causes of deaths and injuries of thousands of patients every year, contributing to soaring healthcare costs. The purpose of this study is to examine what has been done to deal with the medical-error problem in the last two decades and present a closed-loop mistake-proof operation system for surgery processes that would likely eliminate preventable medical errors. The design method used is a combination of creating a service blueprint, implementing the six sigma DMAIC cycle, developing cause-and-effect diagrams as well as devising poka-yokes in order to develop a robust surgery operation process for a typical US hospital. In the improve phase of the six sigma DMAIC cycle, a number of poka-yoke techniques are introduced to prevent typical medical errors (identified through cause-and-effect diagrams) that may occur in surgery operation processes in US hospitals. It is the authors' assertion that implementing the new service blueprint along with the poka-yokes, will likely result in the current medical error rate to significantly improve to the six-sigma level. Additionally, designing as many redundancies as possible in the delivery of care will help reduce medical errors. Primary healthcare providers should strongly consider investing in adequate doctor and nurse staffing, and improving their education related to the quality of service delivery to minimize clinical errors. This will lead to an increase in higher fixed costs, especially in the shorter time frame. This paper focuses additional attention needed to make a sound technical and business case for implementing six sigma tools to eliminate medical errors that will enable hospital managers to increase their hospital's profitability in the long run and also ensure patient safety.

  20. 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