Digital games in medical education: Key terms, concepts, and definitions.

Science.gov (United States)

Bigdeli, Shoaleh; Kaufman, David

2017-01-01

Introduction: Game-based education is fast becoming a key instrument in medical education. Method: In this study, papers related to games were filtered and limited to full-text peer-reviewed published in English. Results: To the best of researchers' knowledge, the concepts used in the literature are varied and distinct, and the literature is not conclusive on the definition of educational games for medical education. Conclusion: This paper attempts to classify terms, concepts and definitions common to gamification in medical education.

[Perioperative management of long-term medication].

Science.gov (United States)

Vogel Kahmann, I; Ruppen, W; Lurati Buse, G; Tsakiris, D A; Bruggisser, M

2011-01-01

Anesthesiologists and surgeons are increasingly faced with patients who are under long-term medication. Some of these drugs can interact with anaesthetics or anaesthesia and/or surgical interventions. As a result, patients may experience complications such as bleeding, ischemia, infection or severe circulatory reactions. On the other hand, perioperative discontinuation of medication is often more dangerous. The proportion of outpatient operations has increased dramatically in recent years and will probably continue to increase. Since the implementation of DRGs (pending in Switzerland, introduced in Germany for some time), the patient enters the hospital the day before operation. This means that the referring physician as well as anesthesiologists and surgeons at an early stage must deal with issues of perioperative pharmacotherapy. This review article is about the management of the major drug classes during the perioperative period. In addition to cardiac and centrally acting drugs and drugs that act on hemostasis and the endocrine system, special cases such as immunosuppressants and herbal remedies are mentioned.

The long-term fate of epistaxis patients with exposure to antithrombotic medication.

Science.gov (United States)

Stadler, Rafael R; Kindler, Rahel; Holzmann, David; Soyka, Michael B

2016-09-01

The goal of this study was to evaluate independent risk factors for long-term epistaxis recurrences and their severity. Individual retrospective cohort study-2b level of evidence. The medical information of 603 emergency epistaxis patients was acquired during a former study. This cohort has been contacted 6 years later by conventional mail and asked to answer a specific paper questionnaire. The following parameters were evaluated: recurrent epistaxis episodes, need for a surgical intervention to stop the recurrent bleeding, patient's history for hypertension and diabetes, intake of hemostasis impairing medication now and in the past. One hundred and six (106) patients were included in the study (35.8 % response rate). The mean observation period was 76.58 months. Almost half of the patients (41.5 % = 44/106) reported at least one recurrent epistaxis episode. Patients with exposure to VKA (vitamin K antagonists) showed significantly more frequently a recurrent epistaxis episode. The binary logistic regression confirmed the intake of VKA as an independent and significant risk factor with an odds ratio of 11.6. Every single patient who had to undergo a surgical intervention to stop a recurrent bleeding stated ASA (Acetylsalicylic Acid) intake. We provide evidence that the intake of a vitamin K antagonist is an independent long-term risk factor for recurrent epistaxis episodes. The intake of ASA is a risk factor for the severity of recurrent epistaxis with the increased need for a surgical intervention not only in a short- but also in a long-term perspective. This prognostic investigation, designed as a combined prospective and retrospective cohort study, reaches level 2b level of evidence as it includes retrospective aspects.

Photosensitizing medication use and risk of skin cancer

DEFF Research Database (Denmark)

Kaae, Jeanette; Boyd, Heather A; Hansen, Anne

2010-01-01

Many commonly used medications, including both medications for long-term (daily) use and short-term use (treatment courses of finite duration), have photosensitizing properties. Whether use of these medications affects skin cancer risk, however, is unclear.......Many commonly used medications, including both medications for long-term (daily) use and short-term use (treatment courses of finite duration), have photosensitizing properties. Whether use of these medications affects skin cancer risk, however, is unclear....

Medical students' experiences of their own professional development during three clinical terms: a prospective follow-up study.

Science.gov (United States)

Kalén, Susanne; Lachmann, Hanna; Varttinen, Maria; Möller, Riitta; Bexelius, Tomas S; Ponzer, Sari

2017-02-27

A modern competency-based medical education is well implemented globally, but less is known about how the included learning activities contribute to medical students' professional development. The aim of this study was to explore Swedish medical students' perceptions of the offered learning activities and their experiences of how these activities were connected to their professional development as defined by the CanMEDS framework. A prospective mixed method questionnaire study during three terms (internal medicine, scientific project, and surgery) in which data were collected by using contextual activity sampling system, i.e., the students were sent a questionnaire via their mobile phones every third week. All 136 medical students in the 6th of 11 terms in the autumn of 2012 were invited to participate. Seventy-four students (54%) filled in all of the required questionnaires (4 per term) for inclusion, the total number of questionnaires being 1335. The questionnaires focused on the students' experiences of learning activities, especially in relation to the CanMEDS Roles, collaboration with others and emotions (positive, negative, optimal experiences, i.e., "flow") related to the studies. The quantitative data was analysed statistically and, for the open-ended questions, manifest inductive content analysis was used. Three of the CanMEDs Roles, Medical Expert, Scholar, and Communicator, were most frequently reported while the four others, e.g., the role Health Advocate, were less common. Collaboration with students from other professions was most usual during the 8th term. Positive emotions and experience of "flow" were most often reported during clinical learning activities while the scientific project term was connected with more negative emotions. Our results showed that it is possible, even during clinical courses, to visualise the different areas of professional competence defined in the curriculum and connect these competences to the actual learning activities

Identification of Units and Other Terms in Czech Medical Records

Czech Academy of Sciences Publication Activity Database

Zvára Jr., Karel; Kašpar, Václav

2010-01-01

Roč. 6, č. 1 (2010), s. 78-82 ISSN 1801-5603 R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : natural language processing * healthcare documentation * medical reports * EHR * finite-state machine * regular expression Subject RIV: IN - Informatics, Computer Science http://www.ejbi.org/en/ejbi/article/61-en-identification-of-units-and-other-terms-in-czech-medical-records.html

Enabling online studies of conceptual relationships between medical terms: developing an efficient web platform.

Science.gov (United States)

Albin, Aaron; Ji, Xiaonan; Borlawsky, Tara B; Ye, Zhan; Lin, Simon; Payne, Philip Ro; Huang, Kun; Xiang, Yang

2014-10-07

The Unified Medical Language System (UMLS) contains many important ontologies in which terms are connected by semantic relations. For many studies on the relationships between biomedical concepts, the use of transitively associated information from ontologies and the UMLS has been shown to be effective. Although there are a few tools and methods available for extracting transitive relationships from the UMLS, they usually have major restrictions on the length of transitive relations or on the number of data sources. Our goal was to design an efficient online platform that enables efficient studies on the conceptual relationships between any medical terms. To overcome the restrictions of available methods and to facilitate studies on the conceptual relationships between medical terms, we developed a Web platform, onGrid, that supports efficient transitive queries and conceptual relationship studies using the UMLS. This framework uses the latest technique in converting natural language queries into UMLS concepts, performs efficient transitive queries, and visualizes the result paths. It also dynamically builds a relationship matrix for two sets of input biomedical terms. We are thus able to perform effective studies on conceptual relationships between medical terms based on their relationship matrix. The advantage of onGrid is that it can be applied to study any two sets of biomedical concept relations and the relations within one set of biomedical concepts. We use onGrid to study the disease-disease relationships in the Online Mendelian Inheritance in Man (OMIM). By crossvalidating our results with an external database, the Comparative Toxicogenomics Database (CTD), we demonstrated that onGrid is effective for the study of conceptual relationships between medical terms. onGrid is an efficient tool for querying the UMLS for transitive relations, studying the relationship between medical terms, and generating hypotheses.

Clinical Reasoning Terms Included in Clinical Problem Solving Exercises?

Science.gov (United States)

Musgrove, John L; Morris, Jason; Estrada, Carlos A; Kraemer, Ryan R

2016-05-01

Background Published clinical problem solving exercises have emerged as a common tool to illustrate aspects of the clinical reasoning process. The specific clinical reasoning terms mentioned in such exercises is unknown. Objective We identified which clinical reasoning terms are mentioned in published clinical problem solving exercises and compared them to clinical reasoning terms given high priority by clinician educators. Methods A convenience sample of clinician educators prioritized a list of clinical reasoning terms (whether to include, weight percentage of top 20 terms). The authors then electronically searched the terms in the text of published reports of 4 internal medicine journals between January 2010 and May 2013. Results The top 5 clinical reasoning terms ranked by educators were dual-process thinking (weight percentage = 24%), problem representation (12%), illness scripts (9%), hypothesis generation (7%), and problem categorization (7%). The top clinical reasoning terms mentioned in the text of 79 published reports were context specificity (n = 20, 25%), bias (n = 13, 17%), dual-process thinking (n = 11, 14%), illness scripts (n = 11, 14%), and problem representation (n = 10, 13%). Context specificity and bias were not ranked highly by educators. Conclusions Some core concepts of modern clinical reasoning theory ranked highly by educators are mentioned explicitly in published clinical problem solving exercises. However, some highly ranked terms were not used, and some terms used were not ranked by the clinician educators. Effort to teach clinical reasoning to trainees may benefit from a common nomenclature of clinical reasoning terms.

The long-term psychiatric and medical prognosis of perinatal mental illness.

Science.gov (United States)

Meltzer-Brody, Samantha; Stuebe, Alison

2014-01-01

The perinatal period provides an important window into a woman's long-term health. Perinatal mental illness is a common condition conferring potential serious long-term psychiatric and medical consequences for the mother and family. It is known that childbirth acts as a powerful trigger for depressive episodes in some women, and that women with histories of a mood disorder are particularly vulnerable. Some evidence links perinatal mental illness with obstetrical complications and reduced lactation initiation and duration. Therefore, perinatal mental illness may be a marker for long-term risk, and may contribute directly to subsequent cardiometabolic disease through both neuroendocrine mechanisms and the effects of mental illness on health behaviours. In clinical practice, these associations underscore the importance of screening and treating women with perinatal mental illness to ensure best possible long-term outcomes. Early screening and treatment may both mitigate the primary disease process and reduce the risk of comorbid medical conditions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Introduction of a medical questionnaire concerning long-term sick leave

CERN Multimedia

HR Department

2011-01-01

In order to ensure a closer follow-up of those on long-term sick leave, the Organization will introduce a new medical questionnaire to be sent to employed members of the personnel. This questionnaire consisting of four questions (concerning the diagnosis, pending and future examinations and treatments, the prognostic and the possibility to resume work) will be sent from the Consulting Medical Practitioner to all employed members of the personnel following two consecutive months of sick leave and, thereafter, periodically on a case by case basis. The employed member of the personnel is requested to submit the medical questionnaire to his/her medical practitioner (or the specialist taking care of him/her) in order to complete and return it to the Consulting Medical Practitioner. It should be noted that this questionnaire does not exempt, in any way, the employed member of personnel from providing a medical certificate for all absence due to illness of more than three consecutive calendar days. The procedure to...

Extending FDA guidance to include consumer medication information (CMI) delivery on mobile devices.

Science.gov (United States)

Sage, Adam; Blalock, Susan J; Carpenter, Delesha

This paper describes the current state of consumer-focused mobile health application use and the current U.S. Food and Drug Administration (FDA) guidance on the distribution of consumer medication information (CMI), and discusses recommendations and considerations for the FDA to expand CMI guidance to include CMI in mobile applications. Smartphone-based health interventions have been linked to increased medication adherence and improved health outcomes. Trends in smartphone ownership present opportunities to more effectively communicate and disseminate medication information; however, current FDA guidance for CMI does not outline how to effectively communicate CMI on a mobile platform, particularly in regards to user-centered design and information sourcing. As evidence supporting the potential effectiveness of mobile communication in health care continues to increase, CMI developers, regulating entities, and researchers should take note. Although mobile-based CMI offers an innovative mechanism to deliver medication information, caution should be exercised. Specifically, considerations for developing mobile CMI include consumers' digital literacy, user experience (e.g., usability), and the quality and accuracy of new widely used sources of information (e.g., crowd-sourced reviews and ratings). Recommended changes to FDA guidance for CMI include altering the language about scientific accuracy to address more novel methods of information gathering (e.g., anecdotal experiences and Google Consumer Surveys) and including guidance for usability testing of mobile health applications. Copyright © 2016 Elsevier Inc. All rights reserved.

New trends of short-term humanitarian medical volunteerism: professional and ethical considerations.

Science.gov (United States)

Asgary, Ramin; Junck, Emily

2013-10-01

Short-term humanitarian medical volunteerism has grown significantly among both clinicians and trainees over the past several years. Increasingly, both volunteers and their respective institutions have faced important challenges in regard to medical ethics and professional codes that should not be overlooked. We explore these potential concerns and their risk factors in three categories: ethical responsibilities in patient care, professional responsibility to communities and populations, and institutional responsibilities towards trainees. We discuss factors increasing the risk of harm to patients and communities, including inadequate preparation, the use of advanced technology and the translation of Western medicine, issues with clinical epidemiology and test utility, difficulties with the principles of justice and clinical justice, the lack of population-based medicine, sociopolitical effects of foreign aid, volunteer stress management, and need for sufficient trainee supervision. We review existing resources and offer suggestions for future skill-based training, organisational responsibilities, and ethical preparation.

78 FR 25304 - Siemens Medical Solutions, USA, Inc., Oncology Care Systems (Radiation Oncology), Including On...

Science.gov (United States)

2013-04-30

..., USA, Inc., Oncology Care Systems (Radiation Oncology), Including On-Site Leased Workers From Source... Medical Solutions, USA, Inc., Oncology Care Systems (Radiation Oncology), including on- site leased... of February 2013, Siemens Medical Solutions, USA, Inc., Oncology Care Systems (Radiation Oncology...

Long-term impact of a preclinical endovascular skills course on medical student career choices.

Science.gov (United States)

Lee, Jason T; Son, Ji H; Chandra, Venita; Lilo, Emily; Dalman, Ronald L

2011-10-01

Surging interest in the 0 + 5 integrated vascular surgery (VS) residency and successful recruitment of the top students in medical school requires early exposure to the field. We sought to determine the impact of a high-fidelity simulation-based preclinical endovascular skills course on medical student performance and ultimate career specialty choices. Fifty-two preclinical medical students enrolled in an 8-week VS elective course from 2007 to 2009. Students completed a baseline and postcourse survey and performed a renal angioplasty/stent procedure on an endovascular simulator (pretest). A curriculum consisting of didactic teaching covering peripheral vascular disease and weekly mentored simulator sessions concluded with a final graded procedure (posttest). Long-term follow-up surveys 1 to 3 years after course completion were administered to determine ultimate career paths of participants as well as motivating factors for career choice. Objective and subjective performance measured on the simulator and through structured global assessment scales improved in all students from pre- to posttest, particularly with regard to technical skill and overall procedural competency (P choices including surgical subspecialties (64%), radiology (10%), and cardiology (6%). Most respondents indicated major reasons for continued interest in VS were the ability to practice endovascular procedures on the simulator (92%) and mentorship from VS faculty (70%). Basic endovascular skills can be efficiently introduced through a simulation-based curriculum and lead to improved novice performance. Early exposure of preclinical medical students provides an effective teaching and recruitment tool for procedural-based fields, particularly surgical subspecialties. Mentored exposure to endovascular procedures on the simulator positively impacts long-term medical student attitudes toward vascular surgery and ultimate career choices. Copyright © 2011 Society for Vascular Surgery. Published by

Medical Decision-Making Among Elderly People in Long Term Care.

Science.gov (United States)

Tymchuk, Alexander J.; And Others

1988-01-01

Presented informed consent information on high and low risk medical procedures to elderly persons in long term care facility in standard, simplified, or storybook format. Comprehension was significantly better for simplified and storybook formats. Ratings of decision-making ability approximated comprehension test results. Comprehension test…

Making short-term international medical volunteer placements work: a qualitative study.

Science.gov (United States)

Elnawawy, Omnia; Lee, Andrew C K; Pohl, Gerda

2014-06-01

International medical volunteering has grown in recent decades. It has the potential to benefit and harm the volunteer and host countries; but there is a paucity of literature on the impacts of international medical volunteering and a need to find ways to optimise the benefits of such placements. In this study, one example of international medical volunteering was examined involving British GPs on short-term placements in Nepal. The intention was to explore the expectations and experiences of the local health workers, volunteers, and host organisation to try and understand what makes volunteer placements work. Qualitative study of key informant interviews. Stakeholders of a short-term international medical volunteer (IMV) placement programme in Nepal. Key informant interviews were carried out via face-to-face or telephone/internet interviews with five previous volunteers, three representatives from a non-governmental organisation providing placements, and five local health workers in Nepal who had had contact with the IMVs. Interviews were recorded, transcribed, and analysed using standard thematic framework approaches. All the stakeholders had their own specific motives for participating in the IMV programme. The relationship between volunteers and the Nepalese health workers was complex and characterised by discrepant and occasionally unrealistic expectations. Managing these different expectations was challenging. Contextual issues and cultural differences are important considerations in medical volunteer programmes, and this study highlights the importance of robust preparation pre-placement for the volunteer and host to ensure positive outcomes. © British Journal of General Practice 2014.

Prevalence of inappropriate medication using Beers criteria in Japanese long-term care facilities

Directory of Open Access Journals (Sweden)

Yamada Yukari

2006-01-01

Full Text Available Abstract Background The prevalence and risk factors of potentially inappropriate medication use among the elderly patients have been studied in various countries, but because of the difficulty of obtaining data on patient characteristics and medications they have not been studied in Japan. Methods We conducted a retrospective cross-sectional study in 17 Japanese long-term care (LTC facilities by collecting data from the comprehensive MDS assessment forms for 1669 patients aged 65 years and over who were assessed between January and July of 2002. Potentially inappropriate medications were identified on the basis of the 2003 Beers criteria. Results The patients in the sample were similar in terms of demographic characteristics to those in the national survey. Our study revealed that 356 (21.1% of the patients were treated with potentially inappropriate medication independent of disease or condition. The most commonly inappropriately prescribed medication was ticlopidine, which had been prescribed for 107 patients (6.3%. There were 300 (18.0% patients treated with at least 1 inappropriate medication dependent on the disease or condition. The highest prevalence of inappropriate medication use dependent on the disease or condition was found in patients with chronic constipation. Multiple logistic regression analysis revealed psychotropic drug use (OR = 1.511, medication cost of per day (OR = 1.173, number of medications (OR = 1.140, and age (OR = 0.981 as factors related to inappropriate medication use independent of disease or condition. Neither patient characteristics nor facility characteristics emerged as predictors of inappropriate prescription. Conclusion The prevalence and predictors of inappropriate medication use in Japanese LTC facilities were similar to those in other countries.

Does packaging with a calendar feature improve adherence to self-administered medication for long-term use? A systematic review.

Science.gov (United States)

Zedler, Barbara K; Kakad, Priyanka; Colilla, Susan; Murrelle, Lenn; Shah, Nirav R

2011-01-01

The therapeutic benefit of self-administered medications for long-term use is limited by an average 50% nonadherence rate. Patient forgetfulness is a common factor in unintentional nonadherence. Unit-of-use packaging that incorporates a simple day-and-date feature (calendar packaging) is designed to improve adherence by prompting patients to maintain the prescribed dosing schedule. To review systematically, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, randomized controlled trial evidence of the adherence benefits and harms of calendar blister packaging (CBP) and calendar pill organizers (CPO) for self-administered, long-term medication use. Data sources included the MEDLINE and Web of Science and Cochrane Library databases from their inception to September 2010 and communication with researchers in the field. Key search terms included blister-calendar pack, blister pack, drug packaging, medication adherence, medication compliance, medication compliance devices, medication containers, medication organizers, multicompartment compliance aid, persistence, pill-box organizers, prescription refill, randomized controlled trials, and refill compliance. Selected studies had an English-language title; a randomized controlled design; medication packaged in CBP or CPO; a requirement of solid, oral medication self-administered daily for longer than 1 month in community-dwelling adults; and at least 1 quantitative outcome measure of adherence. Two reviewers extracted data independently on study design, sample size, type of intervention and control, and outcomes. Ten trials with a total of 1045 subjects met the inclusion criteria, and 9 also examined clinical outcomes (seizures, blood pressure, psychiatric symptoms) or health care resource utilization. Substantial heterogeneity among trials precluded meta-analysis. In 3 studies, calendar packaging was part of a multicomponent adherence intervention. Six of 10 trials

Risk of poor neonatal outcome at term after medically assisted reproduction: a propensity score-matched study.

Science.gov (United States)

Ensing, Sabine; Abu-Hanna, Ameen; Roseboom, Tessa J; Repping, Sjoerd; van der Veen, Fulco; Mol, Ben Willem J; Ravelli, Anita C J

2015-08-01

To study risk of birth asphyxia and related morbidity among term singletons born after medically assisted reproduction (MAR). Population cohort study. Not applicable. A total of 1,953,932 term singleton pregnancies selected from a national registry for 1999-2011. None. Primary outcome Apgar score score score matching analysis was performed with matching on multiple maternal baseline covariates (maternal age, ethnicity, socioeconomic status, parity, year of birth, and preexistent diseases). Each MAR pregnancy was matched to three SC controls. Relative to SC, the MAR singletons had an increased risk of adverse neonatal outcomes including Apgar score score matching, the risk of an Apgar score Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Improvement of cardiac function persists long term with medical therapy for left ventricular systolic dysfunction.

Science.gov (United States)

Chen, David; Chang, Richard; Umakanthan, Branavan; Stoletniy, Liset N; Heywood, J Thomas

2007-09-01

In certain patients with left ventricular (LV) systolic dysfunction, improvements in cardiac function are seen after initiation of medical therapy; however, the long-term stability of ventricular function in such patients is not well described. We retrospectively analyzed 171 patients who had a baseline ejection fraction of 45% or less, a follow-up echocardiogram at 2 to 12 months after initiation of medical therapy, and a final echocardiogram. We found that 48.5% of the patients demonstrated initial improvements in LV function after initiation of medical therapy, and the improvements appear to be sustained (88% of patients) at 44 +/- 21 months follow-up. A nonischemic etiology and younger age were the only independent predictors of change of LV ejection fraction of 10 or more at a mean 8.4 +/- 3.4 months after optimal medical therapy. Our study revealed a trend toward improved long-term survival in individuals with an early improvement in LV ejection fraction with medical therapy, especially in those with sustained improvement.

Homeopathic medical practice: Long-term results of a cohort study with 3981 patients

Directory of Open Access Journals (Sweden)

Baur Roland

2005-11-01

Full Text Available Abstract Background On the range of diagnoses, course of treatment, and long-term outcome in patients who chose to receive homeopathic medical treatment very little is known. We investigated homeopathic practice in an industrialized country under everyday conditions. Methods In a prospective, multicentre cohort study with 103 primary care practices with additional specialisation in homeopathy in Germany and Switzerland, data from all patients (age >1 year consulting the physician for the first time were observed. The main outcome measures were: Patient and physician assessments (numeric rating scales from 0 to 10 and quality of life at baseline, and after 3, 12, and 24 months. Results A total of 3,981 patients were studied including 2,851 adults (29% men, mean age 42.5 ± 13.1 years; 71% women, 39.9 ± 12.4 years and 1,130 children (52% boys, 6.5 ± 3.9 years; 48% girls, 7.0 ± 4.3 years. Ninety-seven percent of all diagnoses were chronic with an average duration of 8.8 ± 8 years. The most frequent diagnoses were allergic rhinitis in men, headache in women, and atopic dermatitis in children. Disease severity decreased significantly (p Conclusion Disease severity and quality of life demonstrated marked and sustained improvements following homeopathic treatment period. Our findings indicate that homeopathic medical therapy may play a beneficial role in the long-term care of patients with chronic diseases.

Learning curves and long-term outcome of simulation-based thoracentesis training for medical students

Science.gov (United States)

2011-01-01

Background Simulation-based medical education has been widely used in medical skills training; however, the effectiveness and long-term outcome of simulation-based training in thoracentesis requires further investigation. The purpose of this study was to assess the learning curve of simulation-based thoracentesis training, study skills retention and transfer of knowledge to a clinical setting following simulation-based education intervention in thoracentesis procedures. Methods Fifty-two medical students were enrolled in this study. Each participant performed five supervised trials on the simulator. Participant's performance was assessed by performance score (PS), procedure time (PT), and participant's confidence (PC). Learning curves for each variable were generated. Long-term outcome of the training was measured by the retesting and clinical performance evaluation 6 months and 1 year, respectively, after initial training on the simulator. Results Significant improvements in PS, PT, and PC were noted among the first 3 to 4 test trials (p 0.05). Clinical competency in thoracentesis was improved in participants who received simulation training relative to that of first year medical residents without such experience (p simulation-based thoracentesis training can significantly improve an individual's performance. The saturation of learning from the simulator can be achieved after four practice sessions. Simulation-based training can assist in long-term retention of skills and can be partially transferred to clinical practice. PMID:21696584

Electronic Medical Record and Quality Ratings of Long Term Care Facilities Long-Term Care Facility Characteristics and Reasons and Barriers for Adoption of Electronic Medical Record

Science.gov (United States)

Daniels, Cheryl Andrea

2013-01-01

With the growing elderly population, compounded by the retirement of the babyboomers, the need for long-term care (LTC) facilities is expected to grow. An area of great concern for those that are seeking a home for their family member is the quality of care provided by the nursing home to the residents. Electronic medical records (EMR) are often…

MELLO: Medical lifelog ontology for data terms from self-tracking and lifelog devices.

Science.gov (United States)

Kim, Hye Hyeon; Lee, Soo Youn; Baik, Su Youn; Kim, Ju Han

2015-12-01

The increasing use of health self-tracking devices is making the integration of heterogeneous data and shared decision-making more challenging. Computational analysis of lifelog data has been hampered by the lack of semantic and syntactic consistency among lifelog terms and related ontologies. Medical lifelog ontology (MELLO) was developed by identifying lifelog concepts and relationships between concepts, and it provides clear definitions by following ontology development methods. MELLO aims to support the classification and semantic mapping of lifelog data from diverse health self-tracking devices. MELLO was developed using the General Formal Ontology method with a manual iterative process comprising five steps: (1) defining the scope of lifelog data, (2) identifying lifelog concepts, (3) assigning relationships among MELLO concepts, (4) developing MELLO properties (e.g., synonyms, preferred terms, and definitions) for each MELLO concept, and (5) evaluating representative layers of the ontology content. An evaluation was performed by classifying 11 devices into 3 classes by subjects, and performing pairwise comparisons of lifelog terms among 5 devices in each class as measured using the Jaccard similarity index. MELLO represents a comprehensive knowledge base of 1998 lifelog concepts, with 4996 synonyms for 1211 (61%) concepts and 1395 definitions for 926 (46%) concepts. The MELLO Browser and MELLO Mapper provide convenient access and annotating non-standard proprietary terms with MELLO (http://mello.snubi.org/). MELLO covers 88.1% of lifelog terms from 11 health self-tracking devices and uses simple string matching to match semantically similar terms provided by various devices that are not yet integrated. The results from the comparisons of Jaccard similarities between simple string matching and MELLO matching revealed increases of 2.5, 2.2, and 5.7 folds for physical activity,body measure, and sleep classes, respectively. MELLO is the first ontology for

40 years of military medical education: an overview of the Long-Term Career Outcome Study (LTCOS).

Science.gov (United States)

Durning, Steven J; Artino, Anthony R; Dong, Ting; Cruess, David F; Gilliland, William R; DeZee, Kent J; Saguil, Aaron; Waechter, Donna M; McManigle, John E

2012-09-01

In 2005, the Long-Term Career Outcome Study (LTCOS) was established by the Dean, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USU). The original charge to the LTCOS team was to establish an electronic database of current and past students at USU. Since its inception, however, the LTCOS team has broadened its mission and started collecting and analyzing data on a continuous basis for the purposes of program evaluation and, in some cases, research. The purpose of this commentary is to review the history of the LTCOS, including details about USU, a brief review of prior LTCOS work, and progress made since our last essay on LTCOS efforts. This commentary also provides an introduction to the special issue, which is arranged as a series of articles that span the medical education continuum (i.e., before, during, and after medical school). The relative balance of articles in each phase of training represents the LTCOS team's efforts to address the entire continuum of medical education.

Humanities in undergraduate medical education: a literature review.

Science.gov (United States)

Ousager, Jakob; Johannessen, Helle

2010-06-01

Humanities form an integral part of undergraduate medical curricula at numerous medical schools all over the world, and medical journals publish a considerable quantity of articles in this field. The aim of this study was to determine the extent to which the literature on humanities in undergraduate medical education seeks to provide evidence of a long-term impact of this integration of humanities in undergraduate medical education. Medline was searched for publications concerning the humanities in undergraduate medical education appearing from January 2000 to December 2008. All articles were manually sorted by the authors. Two hundred forty-five articles were included in the study. Following a qualitative analysis, the references included were categorized as "pleading the case," "course descriptions and evaluations," "seeking evidence of long-term impact," or "holding the horses." Two hundred twenty-four articles out of 245 either praised the (potential) effects of humanities on medical education or described existing or planned courses without offering substantial evidence of any long-term impact of these curricular activities on medical proficiency. Only 9 articles provided evidence of attempts to document long-term impacts using diverse test tools, and 10 articles presented relatively reserved attitudes toward humanities in undergraduate medical education. Evidence on the positive long-term impacts of integrating humanities into undergraduate medical education is sparse. This may pose a threat to the continued development of humanities-related activities in undergraduate medical education in the context of current demands for evidence to demonstrate educational effectiveness.

On the Performance of Medical Information Retrieval using MeSH Terms – A Survey

Directory of Open Access Journals (Sweden)

Swetha S

2014-09-01

Full Text Available Internet users have increased everywhere. Searching and retrieving documents is a common thing nowadays. Retrieving related documents from the search engines are difficult task. To retrieve correct documents, knowledge about the search topic is essential. Even though separate search engines are there to retrieve medical documents the users are not familiar with MeSH terms (Medical Subject Heading. So, both the search browser and the MeSH terms have to be integrated to make the search effective and efficient. To implement this integration, SimpleMed and MeSHMed were introduced. The MeSH terms have to be ranked to know how frequently it has been used and to know the importance of the MeSH terms. To rank it a semi – automated tool called MeSHy was developed. The terms were extracted, filtered, ranked and displayed to the user. Classifiers have to be constructed to label the documents as health and non – health. Three strategies were used to classify them. The errors that are commonly done by the users have to be found out. It was calculated based on the queries presented by the user to the search browser.

Emergency medical readmission: long-term trends and impact on mortality.

LENUS (Irish Health Repository)

Glynn, Nigel

2011-04-01

There is increasing emphasis on prevention of emergency medical readmissions. The broad pattern of acute medical readmissions was studied over a seven-year period and the impact of any readmission on 30-day mortality was recorded. Significant predictors of outcome, including co-morbidity and illness severity score, were entered into a multivariate regression model, adjusting the univariate estimates of the readmission status on mortality. In total, 23,114 consecutive acute medical patients were admitted between 2002-8; the overall readmission rate was 27%. Readmission independently predicted an increased 30-day mortality; the odds ratio, was 1.12 (95% confidence interval (CI) 1.09 to 1.14). This fell to 1.05 (95% CI 1.02 to 1.08) when adjusted for outcome predictors including acute illness severity. The trend for readmissions was to progressively increase over time; the median times between consecutive admissions formed an exponential time series. Efforts to reduce or avoid readmissions may depend on an ability to modify the underlying chronic disease.

Medical device software: defining key terms.

Science.gov (United States)

Pashkov, Vitalii; Gutorova, Nataliya; Harkusha, Andrii

one of the areas of significant growth in medical devices has been the role of software - as an integral component of a medical device, as a standalone device and more recently as applications on mobile devices. The risk related to a malfunction of the standalone software used within healthcare is in itself not a criterion for its qualification or not as a medical device. It is therefore, necessary to clarify some criteria for the qualification of stand-alone software as medical devices Materials and methods: Ukrainian, European Union, United States of America legislation, Guidelines developed by European Commission and Food and Drug Administration's, recommendations represented by international voluntary group and scientific works. This article is based on dialectical, comparative, analytic, synthetic and comprehensive research methods. the legal regulation of software which is used for medical purpose in Ukraine limited to one definition. In European Union and United States of America were developed and applying special guidelines that help developers, manufactures and end users to difference software on types standing on medical purpose criteria. Software becomes more and more incorporated into medical devices. Developers and manufacturers may not have initially appreciated potential risks to patients and users such situation could have dangerous results for patients or users. It is necessary to develop and adopt the legislation that will intend to define the criteria for the qualification of medical device software and the application of the classification criteria to such software, provide some illustrative examples and step by step recommendations to qualify software as medical device.

Long-term outcome of medically treated epilepsy.

Science.gov (United States)

Sillanpää, M; Schmidt, D

2017-01-01

To review the long-term outcome of epilepsy in population-based studies. Analysis of population-based studies. About two of three patients with new-onset epilepsy will, in the long run, enter five-year terminal remission. Chances for remission are best for those with idiopathic or cryptogenic epilepsy. It is unclear whether the seizure outcome has improved over the last several decades. Social outcome, however, may have become better because of the improved level of knowledge on and public attitudes toward people with epilepsy, and possibly fewer prejudices at home, daycare, school, military and labor market. While we still do not have a cure for epilepsy for all patients, relief of the medical and social consequences is available for many and hope is on the horizon for people with epilepsy. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

[Comments on Nigel Wiseman's A Practical Dictionary of Chinese Medicine: on the use of Western medical terms in English glossary of Chinese medicine].

Science.gov (United States)

Xie, Zhu-fan; Liu, Gan-zhong; Lu, Wei-bo

2005-11-01

Mr. Wiseman believes that Western medical terms chosen as equivalents of Chinese medical terms should be the words known to all speakers and not requiring any specialist knowledge or instrumentation to understand or identify, and strictly technical Western medical terms should be avoided regardless of their conceptual conformity to the Chinese terms. According to such criteria, many inappropriate Western medical terms are selected as English equivalents by the authors of the Dictionary, and on the other hand, many ready-made appropriate Western medical terms are replaced by loan English terms with the Chinese style of word formation. The experience obtained by translating Western medical terms into Chinese when Western medicine was first introduced to China should be helpful for developing English equivalents at present. However, the authors of the Dictionary adhere to their own opinions and reject others' experience. The English terms thus created do not reflect the genuine meaning of the Chinese terms, but make the English glossary in chaos. The so-called true face of traditional Chinese revealed by such terms is merely the Chinese custom of word formation and metaphoric rhetoric. In other words, traditional Chinese medicine is not regarded as a system of medicine but merely some Oriental folklore.

Identifying Meaning Components in the Translation of Medical Terms from English into Indonesian: A Semantic Approach

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I Gusti Agung Sri Rwa Jayantini

2017-10-01

Full Text Available This paper focuses on identifying meaning components in the translation of English medical terms into Indonesian. The data used in this study are the English medical term disorder and its Indonesian equivalent penyakit (disease. The two terms are purposively chosen as the data of the present study, which is a comparative research on the lexical meaning investigation in two different languages. The investigation involving a particular term in one language and its equivalent in the other language is worth doing since the lexicons in every language have their own specific concepts that may be synonymous, yet they are not always interchangeable in all contexts. The analysis into meaning components is called decomposition by means of several semantic theories to analyse the meaning of a lexical item (Löbner 2013. Here, the meaning components of the two compared terms are demonstrated through a semantic approach, particularly Natural Semantic Metalanguage (NSM supported by the investigation on their synonyms and how the terms are used in different contexts. The results show that the meaning components of a particular term in one language like the English term disorder are not always found in the Indonesian term penyakit, or, conversely, some of the meaning components of the Indonesian term do not always exist in the English term.

Workplace Violence and Safety Issues in Long-Term Medical Care Facilities: Nurses' Perspectives

Directory of Open Access Journals (Sweden)

Bankole K. Fasanya

2016-06-01

Conclusion: WPV is an epidemic problem that affects all health-care professionals. The findings of this study could help long-term medical care facilities' management identify the areas to focus on mitigating, controlling, and/or eliminating incidents of WPV.

Projecting long term medical spending growth.

Science.gov (United States)

Borger, Christine; Rutherford, Thomas F; Won, Gregory Y

2008-01-01

We present a dynamic general equilibrium model of the U.S. economy and the medical sector in which the adoption of new medical treatments is endogenous and the demand for medical services is conditional on the state of technology. We use this model to prepare 75-year medical spending forecasts and a projection of the Medicare actuarial balance, and we compare our results to those obtained from a method that has been used by government actuaries. Our baseline forecast predicts slower health spending growth in the long run and a lower Medicare actuarial deficit relative to the previous projection methodology.

Visual Impairment, Including Blindness

Science.gov (United States)

... professionals/13 Need a glossary? |Becoming familiar with medical terminology relating to the visual system may also prove helpful, especially when talking to medical professionals and reading about ... Glossary of Eye Terminology , which lists common terms that eye doctors use ...

Stability and development of psychotic symptoms and the use of antipsychotic medication - long-term follow-up

DEFF Research Database (Denmark)

Gotfredsen, D R; Wils, R S; Hjorthøj, C

2017-01-01

BACKGROUND: Few studies have evaluated the development in the use of antipsychotic medication and psychotic symptoms in patients with first-episode psychosis on a long-term basis. Our objective was to investigate how psychotic symptoms and the use of antipsychotic medication changed over a 10-yea...

Looking good but doing harm? Perceptions of short-term medical missions in Nicaragua.

Science.gov (United States)

Nouvet, Elysée; Chan, Elizabeth; Schwartz, Lisa J

2018-04-01

In this paper, we present findings from a qualitative study that gathered Nicaraguans' perceptions of short-term foreign medical missions, towards deepening the understanding of what Nicaraguans value or find limited in the work of such foreign missions operating in their country. Fifty-two interviews were conducted with patients, relatives of patients, Nicaraguan physicians and nurses who partnered with or observed missions at work, 'beneficiary' community leaders, and individuals who were unable or unwilling to access mission-provided healthcare. Factors underlying participants' positive and more critical accounts of foreign primary and surgical missions are described and analysed. Empirical investigation on how, whether or not, or on what bases short-term medical missions (STMs) have been perceived as beneficial, harmful, or otherwise by those on the receiving end of these efforts is limited. This study aims to contribute to the evidence base for reflecting on the ethical performance of trans-national STMs.

Medical Underwriting In Long-Term Care Insurance: Market Conditions Limit Options For Higher-Risk Consumers.

Science.gov (United States)

Cornell, Portia Y; Grabowski, David C; Cohen, Marc; Shi, Xiaomei; Stevenson, David G

2016-08-01

A key feature of private long-term care insurance is that medical underwriters screen out would-be buyers who have health conditions that portend near-term physical or cognitive disability. We applied common underwriting criteria based on data from two long-term care insurers to a nationally representative sample of individuals in the target age range (50-71 years) for long-term care insurance. The screening criteria put upper bounds on the current proportion of Americans who could gain coverage in the individual market without changes to medical underwriting practice. Specifically, our simulations show that in the target age range, approximately 30 percent of those whose wealth meets minimum industry standards for suitability for long-term care insurance would have their application for such insurance rejected at the underwriting stage. Among the general population-without considering financial suitability-we estimated that 40 percent would have their applications rejected. The predicted rejection rates are substantially higher than the rejection rates of about 20-25 percent of applicants in the actual market. In evaluating reforms for long-term care financing and their potential to increase private insurance rates, as well as to reduce financial pressure on public safety-net programs, policy makers need to consider the role of underwriting in the market for long-term care insurance. Project HOPE—The People-to-People Health Foundation, Inc.

Risk of poor neonatal outcome at term after medically assisted reproduction: a propensity score-matched study

NARCIS (Netherlands)

Ensing, Sabine; Abu-Hanna, Ameen; Roseboom, Tessa J.; Repping, Sjoerd; van der Veen, Fulco; Mol, Ben Willem J.; Ravelli, Anita C. J.

2015-01-01

To study risk of birth asphyxia and related morbidity among term singletons born after medically assisted reproduction (MAR). Population cohort study. Not applicable. A total of 1,953,932 term singleton pregnancies selected from a national registry for 1999-2011. None. Primary outcome Apgar score

Short-term Risk of Serious Fall Injuries in Older Adults Initiating and Intensifying Treatment with Antihypertensive Medication

Science.gov (United States)

Shimbo, Daichi; Bowling, C. Barrett; Levitan, Emily B.; Deng, Luqin; Sim, John J.; Huang, Lei; Reynolds, Kristi; Muntner, Paul

2016-01-01

Background Antihypertensive medication use has been associated with an increased risk of falls in some but not all studies. Few data are available on the short-term risk of falls following antihypertensive medication initiation and intensification. Methods and Results We examined the association between initiating and intensifying antihypertensive medication and serious fall injuries in a case-crossover study of 90,127 Medicare beneficiaries who were ≥65 years old and had a serious fall injury between July 1, 2007 and December 31, 2012, based on emergency department and inpatient claims. Antihypertensive medication initiation was defined by a prescription fill with no fills in the prior year. Intensification was defined by the addition of a new antihypertensive class, and, separately, titration by the addition of a new class or increase in dosage of a current class. Exposures were ascertained for the 15 days before the fall (case period) and six 15-day earlier periods (control periods). Overall, 272, 1508, and 3113 Medicare beneficiaries initiated, added a new class of antihypertensive medication or titrated therapy, respectively, within 15 days of their serious fall injury. The odds for a serious fall injury was increased during the 15 days following antihypertensive medication initiation [odds ratio, OR, 1.36 (95% CI 1.19, 1.55)], adding a new class [OR 1.16 (95% CI 1.10, 1.23)], and titration [OR 1.13 (95% CI 1.08, 1.18)]. These associations were attenuated beyond 15 days. Conclusions Antihypertensive medication initiation and intensification was associated with a short-term, but not long-term, increased risk of serious fall injuries among older adults. PMID:27166208

A systematic review of social, economic and diplomatic aspects of short-term medical missions.

Science.gov (United States)

Caldron, Paul H; Impens, Ann; Pavlova, Milena; Groot, Wim

2015-09-15

Short-term medical missions (STMMs) represent a grass-roots form of aid, transferring medical services rather than funds or equipment. The objective of this paper is to review empirical studies on social, economic and diplomatic aspects of STMMs. A systematic literature review was conducted by searching PubMed and EBSCOhost for articles published from 1947-2014 about medical missions to lower and middle income countries (LMICs). Publications focused on military, disaster and dental service trips were excluded. A data extraction process was used to identify publications relevant to our objective stated above. PubMed and EBSCOhost searches provided 4138 and 3262 articles respectively for review. Most articles that provide useful information have appeared in the current millennium and are found in focused surgical journals. Little attention is paid to aspects of volunteerism, altruism and philanthropy related to STMM activity in the literature reviewed (1 article). Evidence of professionalization remains scarce, although elements including guidelines and tactical instructions have been emerging (27 articles). Information on costs (10 articles) and commentary on the relevance of market forces (1 article) are limited. Analyses of spill-over effects, i.e., changing attitudes of physicians or their communities towards aid, and characterizations of STMMs as meaningful foreign aid or strategic diplomacy are few (4 articles). The literature on key social, economic and diplomatic aspects of STMMs and their consequences is sparse. Guidelines, tactical instructions and attempts at outcome measures are emerging that may better professionalize the otherwise unregulated activity. A broader discussion of these key aspects may lead to improved accountability and intercultural professionalism to accompany medical professionalism in STMM activity.

Medications (for IBS)

Medline Plus

Full Text Available ... be taken on a more long-term basis. These include low dose antidepressant agents or the relatively ... IBS in multi-center, high quality clinical trials. These are prescription medications intended for specific use under ...

Long-term outcomes for women versus men with unstable angina/non-ST-segment elevation myocardial infarction managed medically without revascularization

DEFF Research Database (Denmark)

Clemmensen, Peter; Roe, Matthew T.; Hochman, Judith S.

2015-01-01

BACKGROUND: Women with acute coronary syndromes (ACS) are less likely to undergo invasive revascularization than men, but sex-specific differences in long-term outcomes and platelet reactivity among medically managed ACS patients remain uncertain. We examined sex-specific differences in long......-term ischemic and bleeding outcomes and platelet reactivity for medically managed ACS patients randomized to prasugrel versus clopidogrel plus aspirin. METHODS: Data from 9,326 patients enrolled in TRILOGY ACS were analyzed to determine differences in long-term ischemic and bleeding outcomes between women (n....... There were no sex-specific, treatment-related differences in 30-day platelet reactivity. CONCLUSIONS: Long-term ischemic and bleeding outcomes in medically managed ACS patients were similar for women versus men, as was treatment-related platelet reactivity. Women had a higher baseline risk profile and, after...

Computerised clinical decision support systems to improve medication safety in long-term care homes: a systematic review.

Science.gov (United States)

Marasinghe, Keshini Madara

2015-05-12

Computerised clinical decision support systems (CCDSS) are used to improve the quality of care in various healthcare settings. This systematic review evaluated the impact of CCDSS on improving medication safety in long-term care homes (LTC). Medication safety in older populations is an important health concern as inappropriate medication use can elevate the risk of potentially severe outcomes (ie, adverse drug reactions, ADR). With an increasing ageing population, greater use of LTC by the growing ageing population and increasing number of medication-related health issues in LTC, strategies to improve medication safety are essential. Databases searched included MEDLINE, EMBASE, Scopus and Cochrane Library. Three groups of keywords were combined: those relating to LTC, medication safety and CCDSS. One reviewer undertook screening and quality assessment. Overall findings suggest that CCDSS in LTC improved the quality of prescribing decisions (ie, appropriate medication orders), detected ADR, triggered warning messages (ie, related to central nervous system side effects, drug-associated constipation, renal insufficiency) and reduced injury risk among older adults. CCDSS have received little attention in LTC, as attested by the limited published literature. With an increasing ageing population, greater use of LTC by the ageing population and increased workload for health professionals, merely relying on physicians' judgement on medication safety would not be sufficient. CCDSS to improve medication safety and enhance the quality of prescribing decisions are essential. Analysis of review findings indicates that CCDSS are beneficial, effective and have potential to improve medication safety in LTC; however, the use of CCDSS in LTC is scarce. Careful assessment on the impact of CCDSS on medication safety and further modifications to existing CCDSS are recommended for wider acceptance. Due to scant evidence in the current literature, further research on implementation and

Weaving together peer assessment, audios and medical vignettes in teaching medical terms

Science.gov (United States)

Khan, Lateef M.

2015-01-01

Objectives The current study aims at exploring the possibility of aligning peer assessment, audiovisuals, and medical case-report extracts (vignettes) in medical terminology teaching. In addition, the study wishes to highlight the effectiveness of audio materials and medical history vignettes in preventing medical students' comprehension, listening, writing, and pronunciation errors. The study also aims at reflecting the medical students' attitudes towards the teaching and learning process. Methods The study involved 161 medical students who received an intensive medical terminology course through audio and medical history extracts. Peer assessment and formative assessment platforms were applied through fake quizzes in a pre- and post-test manner. An 18-item survey was distributed amongst students to investigate their attitudes and feedback towards the teaching and learning process. Quantitative and qualitative data were analysed using the SPSS software. Results The students did better in the posttests than on the pretests for both the quizzes of audios and medical vignettes showing a t-test of -12.09 and -13.60 respectively. Moreover, out of the 133 students, 120 students (90.22%) responded to the survey questions. The students gave positive attitudes towards the application of audios and vignettes in the teaching and learning of medical terminology and towards the learning process. Conclusions The current study revealed that the teaching and learning of medical terminology have more room for the application of advanced technologies, effective assessment platforms, and active learning strategies in higher education. It also highlights that students are capable of carrying more responsibilities of assessment, feedback, and e-learning. PMID:26637986

Capillary refill time is a predictor of short-term mortality for adult patients admitted to a medical department

DEFF Research Database (Denmark)

Mrgan, Monija; Rytter, Dorte; Brabrand, Mikkel

2014-01-01

the relationship between CRT (using two existing definitions and as a continuous variable) and short-term mortality. METHODS: We included all acutely admitted adult patients to a medical admission unit. We measured CRT, blood pressure, pulse, temperature and peripheral oxygen saturation. We presented the data...... mortality with all definitions of CRT. Performing multivariable analysis, controlling for age, sex, mean blood pressure, pulse, temperature and peripheral oxygen saturation, we found increasing CRT as a continuous variable and according to the Schriger and Baraff definition to be associated with increased...... mortality. Both the Trauma score and Schriger and Baraff definitions had high negative predictive values. The calculations on the Schriger and Baraff defition were based on limited power. CONCLUSIONS: We found a significant association between CRT measured as a continuous variable and short-term mortality...

Issues of medical necessity: a medical director's guide to good faith adjudication.

Science.gov (United States)

Quinn, C

1997-06-01

The term medical necessity is difficult to define, a problem for insurers who need to clearly describe what is and is not covered in their contracts with subscribers. An unclear, vague definition of medical necessity leaves insurers vulnerable to litigation by subscribers denied care deemed medically unnecessary. To avoid lawsuits, insurers must make every effort to educate their subscribers about their medical coverage, going beyond merely providing a lengthy subscriber handbook. In decisions on medical necessity, medical directors at insurance companies play a key role. They can bolster the insurer's position in denial-of-care cases in numerous ways, including keeping meticulous records, eliminating unreasonable financial incentives, maintaining a claims denial database, and consulting with other insurers to achieve a consensus on medical necessity.

Should Pharmacies Be Included in Medication Reconciliation? A Report of Recurrent Valproic Acid Toxicity

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B. Tate Cutshall

2017-03-01

Full Text Available Including outpatient pharmacies in the medication reconciliation process upon hospital discharge is not commonly performed. This case highlights the consequences of a patient refilling a discontinued prescription for valproic acid (VPA. We present a 32-year old male found unresponsive after ingesting delayed release divalproex sodium. Cerebral edema was visualized on magnetic resonance imaging. Hemodialysis and levo-carnitine treatment led to improved mental status, and VPA was discontinued. The same patient presented with VPA overdose eight months later after he continued to fill an outdated prescription. This case highlights consequences of VPA toxicity; it also demonstrates an opportunity to improve patient safety and high-value care by collaborating with outpatient pharmacies in the medication reconciliation process upon hospital discharge.

Prevalence of pain medication prescriptions in France, Germany, and the UK - a cross-sectional study including 4,270,142 patients.

Science.gov (United States)

Jacob, Louis; Kostev, Karel

2018-01-01

The goal of the present study was to analyze the prevalence of pain medication prescriptions in general practices in France, Germany, and the UK. This study included all patients aged ≥18 years followed in 2016 in general practitioner practices in France, Germany and the UK. The primary outcome was the prevalence of patients receiving prescriptions for pain medications in France, Germany, and the UK in 2016. The following drugs were included in the analysis: anti-inflammatory and antirheumatic products, non-steroids and analgesics including opioids, antimigraine preparations, and other analgesics and antipyretics. Demographic variables included age and gender. This study included 4,270,142 patients. The prevalences of pain medication prescriptions were 57.3% in France, 29.6% in Germany, and 21.7% in the UK. Although this prevalence generally remained consistent between age groups in France (54.3%-60.3%), it increased with age in Germany (18-30 years: 23.8%; >70 years: 35.8%) and in the UK (18-30 years: 9.3%; >70 years: 43.8%). Finally, the prevalence of pain medication prescriptions was higher in women than in men in all three countries. Paracetamol was prescribed to 82.3% and 60.1% of patients receiving pain medication in France and the UK, respectively, whereas ibuprofen was prescribed to 46.5% of individuals in Germany. The prevalence of pain medication prescriptions was higher in France than in Germany and the UK. Further research is needed to gain a better understanding of the differences in the prescription patterns between these three European countries.

ContextD: an algorithm to identify contextual properties of medical terms in a Dutch clinical corpus.

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Afzal, Zubair; Pons, Ewoud; Kang, Ning; Sturkenboom, Miriam C J M; Schuemie, Martijn J; Kors, Jan A

2014-11-29

In order to extract meaningful information from electronic medical records, such as signs and symptoms, diagnoses, and treatments, it is important to take into account the contextual properties of the identified information: negation, temporality, and experiencer. Most work on automatic identification of these contextual properties has been done on English clinical text. This study presents ContextD, an adaptation of the English ConText algorithm to the Dutch language, and a Dutch clinical corpus. We created a Dutch clinical corpus containing four types of anonymized clinical documents: entries from general practitioners, specialists' letters, radiology reports, and discharge letters. Using a Dutch list of medical terms extracted from the Unified Medical Language System, we identified medical terms in the corpus with exact matching. The identified terms were annotated for negation, temporality, and experiencer properties. To adapt the ConText algorithm, we translated English trigger terms to Dutch and added several general and document specific enhancements, such as negation rules for general practitioners' entries and a regular expression based temporality module. The ContextD algorithm utilized 41 unique triggers to identify the contextual properties in the clinical corpus. For the negation property, the algorithm obtained an F-score from 87% to 93% for the different document types. For the experiencer property, the F-score was 99% to 100%. For the historical and hypothetical values of the temporality property, F-scores ranged from 26% to 54% and from 13% to 44%, respectively. The ContextD showed good performance in identifying negation and experiencer property values across all Dutch clinical document types. Accurate identification of the temporality property proved to be difficult and requires further work. The anonymized and annotated Dutch clinical corpus can serve as a useful resource for further algorithm development.

Medical tourism in India.

Science.gov (United States)

Gupta, Vijay; Das, Poonam

2012-06-01

The term 'medical tourism' is under debate because health care is a serious business and rarely do patients combine the two. India is uniquely placed by virtue of its skilled manpower, common language, diverse medical conditions that doctors deal with, the volume of patients, and a large nonresident Indian population overseas. Medical tourism requires dedicated services to alleviate the anxiety of foreign patients. These include translation, currency conversion, travel, visa, posttreatment care system,and accommodation of patient relatives during and after treatment.

Ranking Medical Terms to Support Expansion of Lay Language Resources for Patient Comprehension of Electronic Health Record Notes: Adapted Distant Supervision Approach.

Science.gov (United States)

Chen, Jinying; Jagannatha, Abhyuday N; Fodeh, Samah J; Yu, Hong

2017-10-31

Medical terms are a major obstacle for patients to comprehend their electronic health record (EHR) notes. Clinical natural language processing (NLP) systems that link EHR terms to lay terms or definitions allow patients to easily access helpful information when reading through their EHR notes, and have shown to improve patient EHR comprehension. However, high-quality lay language resources for EHR terms are very limited in the public domain. Because expanding and curating such a resource is a costly process, it is beneficial and even necessary to identify terms important for patient EHR comprehension first. We aimed to develop an NLP system, called adapted distant supervision (ADS), to rank candidate terms mined from EHR corpora. We will give EHR terms ranked as high by ADS a higher priority for lay language annotation-that is, creating lay definitions for these terms. Adapted distant supervision uses distant supervision from consumer health vocabulary and transfer learning to adapt itself to solve the problem of ranking EHR terms in the target domain. We investigated 2 state-of-the-art transfer learning algorithms (ie, feature space augmentation and supervised distant supervision) and designed 5 types of learning features, including distributed word representations learned from large EHR data for ADS. For evaluating ADS, we asked domain experts to annotate 6038 candidate terms as important or nonimportant for EHR comprehension. We then randomly divided these data into the target-domain training data (1000 examples) and the evaluation data (5038 examples). We compared ADS with 2 strong baselines, including standard supervised learning, on the evaluation data. The ADS system using feature space augmentation achieved the best average precision, 0.850, on the evaluation set when using 1000 target-domain training examples. The ADS system using supervised distant supervision achieved the best average precision, 0.819, on the evaluation set when using only 100 target

Short- and long-term subjective medical treatment outcome of trauma surgery patients: the importance of physician empathy

Directory of Open Access Journals (Sweden)

Steinhausen S

2014-09-01

Full Text Available Simone Steinhausen,1 Oliver Ommen,2 Sunya-Lee Antoine,1 Thorsten Koehler,3 Holger Pfaff,4 Edmund Neugebauer11Institute for Research in Operative Medicine (IFOM, Witten/Herdecke University, Campus Cologne-Merheim, Germany; 2Federal Centre for Health Education (BZgA, Cologne, Germany; 3Institute for Applied Social Sciences (infas, Bonn, Germany; 4Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR, Faculty of Human Science and Faculty of Medicine, University of Cologne, Germany Purpose: To investigate accident casualties’ long-term subjective evaluation of treatment outcome 6 weeks and 12 months after discharge and its relation to the experienced surgeon’s empathy during hospital treatment after trauma in consideration of patient-, injury-, and health-related factors. The long-term results are compared to the 6-week follow-up outcomes.Patients and methods: Two hundred and seventeen surgery patients were surveyed at 6 weeks, and 206 patients at 12 months after discharge from the trauma surgical general ward. The subjective evaluation of medical treatment outcome was measured 6 weeks and 12 months after discharge with the respective scale from the Cologne Patient Questionnaire. Physician Empathy was assessed with the Consultation and Relational Empathy Measure. The correlation between physician empathy and control variables with the subjective evaluation of medical treatment outcome 12 months after discharge was identified by means of logistic regression analysis under control of sociodemographic and injury-related factors.Results: One hundred and thirty-six patients were included within the logistic regression analysis at the 12-month follow-up. Compared to the 6-week follow-up, the level of subjective evaluation of medical treatment outcome was slightly lower and the association with physician empathy was weaker. Compared to patients who rated the empathy of their surgeon lower than 31 points, patients

OLTENIA NORTHERN MEDICAL TOURISM AND DEVELOPMENT IN TERMS OF THE POSSIBILITY OF REGIONAL SUSTAINABILITY

Directory of Open Access Journals (Sweden)

Constanta Enea

2013-06-01

Full Text Available Health tourism in Romania is at the beginning - it exists, develops in some areas, shy, we do not boast of many tourists who come to us for such services, however, the data provided by NATA, now a year or two there were over 60,000 people who came to our country for health tourism. Of course, data are incomplete because not all tourists coming to say. But it seems that 250 million would have entered this area. Potential exists, and curiosity and demand for Romania there. But there is enough interest for the development of such tourism. Medical tourism (also called medical travel, health tourism or global healthcare is a term initially coined by travel agencies and the media to rapidly growing phenomenon of crossing international borders to obtain health care services. The paper tries to highlight the chances for Romania, more specifically, Northern Oltenia become a specific area of medical tourism or medical tourism practiced in other countries, to local patient survival chance.

Can medical insurance coverage reduce disparities of income in elderly patients requiring long-term care? The case of the People's Republic of China.

Science.gov (United States)

Zhang, Zhenyu; Wang, Jianbing; Jin, Mingjuan; Li, Mei; Zhou, Litao; Jing, Fangyuan; Chen, Kun

2014-01-01

The People's Republic of China's population is aging rapidly, partly because of the impact of the one-child policy and improvements in the health care system. Caring for bedridden seniors can be a challenge for many families in the People's Republic of China. To identify the inequality of income among different age groups and social statuses, and evaluate the medical burden and health insurance compensation in the People's Republic of China. We measured income inequality and insurance compensation levels among bedridden patients in Zhejiang province, People's Republic of China. Factor analysis and Gini coefficients were used to evaluate degree of income inequality and insurance compensation level. We found distinct regional disparities in Zhejiang province, including the aspects of income, expenses, and time. Gini coefficients of older adults with long-term care needs in urban and rural areas were 0.335 and 0.602, respectively. In all age groups, Gini coefficients increased after adjustment for medical expenditures, and the inequality persisted after insurance reimbursement was taken into consideration. A significant income disparity between rural and urban areas was observed. Inequality increased with age, and medical expenditure is a huge burden for older people with long-term care needs. Health insurance does not play an important role in reducing inequalities among patients who need long-term care services.

Translating medical documents into plain language enhances communication skills in medical students--A pilot study.

Science.gov (United States)

Bittner, Anja; Jonietz, Ansgar; Bittner, Johannes; Beickert, Luise; Harendza, Sigrid

2015-09-01

To train and assess undergraduate medical students' written communication skills by exercises in translating medical reports into plain language for real patients. 27 medical students participated in a newly developed communication course. They attended a 3-h seminar including a briefing on patient-centered communication and an introduction to working with the internet platform http://washabich.de. In the following ten weeks, participants "translated" one medical report every fortnight on this platform receiving feedback by a near-peer supervisor. A pre- and post-course assignment consisted of a self-assessment questionnaire on communication skills, analysis of a medical text with respect to medical jargon, and the translation of a medical report into plain language. In the self-assessment, students rated themselves in most aspects of patient-centered communication significantly higher after attending the course. After the course they marked significantly more medical jargon terms correctly than before (pcommunicative aspects (pcommunication skills and medical knowledge in undergraduate medical students. To include translation exercises in the undergraduate medical curriculum. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Long-term control medication use and asthma control status among children and adults with asthma.

Science.gov (United States)

Zahran, Hatice S; Bailey, Cathy M; Qin, Xiaoting; Johnson, Carol

2017-12-01

Uncontrolled asthma decreases quality of life and increases health care use. Most people with asthma need daily use of long-term control (LTC) medications for asthma symptoms and to prevent asthma attacks. Ongoing assessment of a person's level of asthma control and medication use is important in determining the effectiveness of current treatment to decrease the frequency and intensity of symptoms and functional limitations. To assess the use of LTC medication among children and adults with current asthma and identify contributing factors for LTC medication use. We used the 2006-2010 Behavioral Risk Factor Surveillance System (BRFSS) child and adult Asthma Call-back Survey (ACBS) data to assess the level of asthma control and LTC medication use. Asthma control was classified as well controlled and uncontrolled using guideline-based measures. We used multivariable logistic regression models to identify contributing factors for LTC medication use and having uncontrolled asthma. Among persons with current asthma, 46.0% of children and 41.5% of adults were taking LTC medications and 38.4% of children and 50.0% of adults had uncontrolled asthma. Among children who had uncontrolled asthma (38.4%), 24.1% were taking LTC medications and 14.3% were not taking LTC medications. Among adults who had uncontrolled asthma (50.0%), 26.7% were taking LTC medications and 23.3% were not taking LTC medications. Using BRFSS ACBS data to assess the level of asthma control and LTC medication use can identify subpopulations of persons with asthma who receive suboptimal treatment, for which better asthma-related medical treatment and management are needed.

Medical Tourism and the Libyan National Health Services

OpenAIRE

Taguri, Adel El

2007-01-01

Medical tourism is a term that is used frequently by the media and travel agencies as a catchall phrase to describe a process where people travel to other countries to obtain medical, dental, and/or surgical care [1,2]. Leisure aspects of traveling are usually included on such a medical travel trip [1]. The term is also used to describe a situation where doctors travel to other places to deliver services to endogenous populations [3].Many factors have led to the recent increase in popularity ...

Long-term causes of death in patients with infective endocarditis who undergo medical therapy only or surgical treatment

DEFF Research Database (Denmark)

Østergaard, Lauge; Oestergaard, Louise Bruun; Lauridsen, Trine Kiilerich

2018-01-01

OBJECTIVES: It is known that patients surviving infective endocarditis have a poor long-term prognosis; however, few studies have addressed the long-term causes of death in patients surviving the initial hospitalization. METHODS: Using Danish administrative registries, we identified patients...... admitted to a hospital with 1st time infective endocarditis in the period from January 1996 to December 2014, who were alive at the time of discharge. The study population was categorized into (i) patients undergoing medical therapy only and (ii) patients undergoing surgical and medical treatment. We...... examined the cardiovascular and non-cardiovascular causes of death. Using the Cox analysis, we investigated the associated risk of dying from a specific prespecified cause of death (heart failure, infective endocarditis and stroke) within the surgery group when compared with the medically treated group...

Analysis of scientific papers in the field of radiology and medical imaging included in Science Citation Index expanded and published by Turkish authors.

Science.gov (United States)

Akpinar, Erhan; Karçaaltincaba, Muşturay

2010-09-01

We aimed to analyze scientific papers published by Turkish authors in "radiology, nuclear medicine and medical imaging" journals included in the Science Citation Index Expanded and compared the number of published scientific papers from Turkey and other countries. We retrospectively searched all papers published by Turkish authors between 1945 and 2008 by using Web of Science software. We performed the analysis by typing "Turkey" in the address section and all radiology and medical imaging journals in the source title section using the general search function of the software. We further analyzed these results by using "analyze" function of the software according to the number of publications per year, journals, institution and type of papers. We also calculated total number of citations to published scientific papers using citation report function. We analyzed the rank of Turkey among other countries in terms of the number of published papers. Overall, 4,532 papers were published between 1945 and 2008. The first paper was published in 1976. Number of publications increased dramatically from 1976 (n = 1) to 2008 (n = 383). The top 5 journals publishing papers from Turkish authors were European Journal of Nuclear Medicine and Molecular Imaging (n = 328), Clinical Nuclear Medicine (n = 296), European Journal of Radiology (n = 289), European Radiology (n = 207) and Journal of Clinical Ultrasound (n = 186). All published papers received 18,419 citations and citation to paper ratio was 4.06. The rank of Turkey among other countries in terms of published papers improved during the last 25 years. Number of papers from Turkey published in radiology and medical imaging journals has increased at the start of the new millennium. Currently, Turkey is among the top 12 countries when the number of scientific papers published in radiology journals is taken into consideration.

Teaching Medical Ethics in Graduate and Undergraduate Medical Education: A Systematic Review of Effectiveness.

Science.gov (United States)

de la Garza, Santiago; Phuoc, Vania; Throneberry, Steven; Blumenthal-Barby, Jennifer; McCullough, Laurence; Coverdale, John

2017-08-01

One objective was to identify and review studies on teaching medical ethics to psychiatry residents. In order to gain insights from other disciplines that have published research in this area, a second objective was to identify and review studies on teaching medical ethics to residents across all other specialties of training and on teaching medical students. PubMed, EMBASE, and PsycINFO were searched for controlled trials on teaching medical ethics with quantitative outcomes. Search terms included ethics, bioethics, medical ethics, medical students, residents/registrars, teaching, education, outcomes, and controlled trials. Nine studies were found that met inclusion criteria, including five randomized controlled trails and four controlled non-randomized trials. Subjects included medical students (5 studies), surgical residents (2 studies), internal medicine house officers (1 study), and family medicine preceptors and their medical students (1 study). Teaching methods, course content, and outcome measures varied considerably across studies. Common methodological issues included a lack of concealment of allocation, a lack of blinding, and generally low numbers of subjects as learners. One randomized controlled trial which taught surgical residents using a standardized patient was judged to be especially methodologically rigorous. None of the trials incorporated psychiatry residents. Ethics educators should undertake additional rigorously controlled trials in order to secure a strong evidence base for the design of medical ethics curricula. Psychiatry ethics educators can also benefit from the findings of trials in other disciplines and in undergraduate medical education.

Medication Refusal: Resident Rights, Administration Dilemma.

Science.gov (United States)

Haskins, Danielle R; Wick, Jeannette Y

2017-12-01

Occasionally, residents actively or passively refuse to take medications. Residents may refuse medication for a number of reasons, including religious beliefs, dietary restrictions, misunderstandings, cognitive impairment, desire to self-harm, or simple inconvenience. This action creates a unique situation for pharmacists and long-term facility staff, especially if patients have dementia. Residents have the legal right to refuse medications, and long-term care facilities need to employ a process to resolve disagreement between the health care team that recommends the medication and the resident who refuses it. In some cases, simple interventions like selecting a different medication or scheduling medications in a different time can address and resolve the resident's objection. If the medical team and the resident cannot resolve their disagreement, often an ethics consultation is helpful. Documenting the resident's refusal to take any or all medications, the health care team's actions and any other outcomes are important. Residents' beliefs may change over time, and the health care team needs to be prepared to revisit the issue as necessary.

Intercoder Reliability of Mapping Between Pharmaceutical Dose Forms in the German Medication Plan and EDQM Standard Terms.

Science.gov (United States)

Sass, Julian; Becker, Kim; Ludmann, Dominik; Pantazoglou, Elisabeth; Dewenter, Heike; Thun, Sylvia

2018-01-01

A nationally uniform medication plan has recently been part of German legislation. The specification for the German medication plan was developed in cooperation between various stakeholders of the healthcare system. Its' goal is to enhance usability and interoperability while also providing patients and physicians with the necessary information they require for a safe and high-quality therapy. Within the research and development project named Medication Plan PLUS, the specification of the medication plan was tested and reviewed for semantic interoperability in particular. In this study, the list of pharmaceutical dose forms provided in the specification was mapped to the standard terms of the European Directorate for the Quality of Medicines & HealthCare by different coders. The level of agreement between coders was calculated using Cohen's Kappa (κ). Results show that less than half of the dose forms could be coded with EDQM standard terms. In addition to that Kappa was found to be moderate, which means rather unconvincing agreement among coders. In conclusion, there is still vast room for improvement in utilization of standardized international vocabulary and unused potential considering cross-border eHealth implementations in the future.

International student exchange and the medical curriculum: evaluation of a medical sciences translational physiology course in Brazil.

Science.gov (United States)

Morris, Mariana; Jones, T David; Rocha, Maria Jose Alves; Fazan, Rubens; Chapleau, Mark W; Salgado, Helio C; Johnson, Alan Kim; Irigoyen, Maria Claudia; Michelini, Lisete C; Goldstein, David L

2006-09-01

The objective of the present study was to conduct a short-term international course on translational physiology for medical students from Wright State University and the University of Iowa. The goals were to 1) provide students with an exposure to the academic, cultural, and medical environments in Brazil; 2) promote awareness of the global medical community; and 3) provide an academic course focused on translational physiology. An evaluation of the students was conducted to determine whether such a short-term course might be useful in the medical curriculum. The 2-wk course was held in the summer of 2005 at the University of São Paulo School of Medicine in Ribeirão Preto, Brazil, for 23 American students. The program included presentations of basic and clinical topics, meetings with medical students, and clinical presentations. The program finished with student attendance at a scientific meeting sponsored by the Brazilian Society of Hypertension. Student surveys evaluated issues related to perceived treatment, Brazilian medical school environment, culture and personal attributes, and career aspirations. The international Medical Sciences Translational Physiology course for medical students provided a brief, but intense, experience. It gave students a picture of the medical environment in Brazil and an appreciation for the differences and similarities in cultures. Most students reported that it was a positive experience that would be beneficial to their careers. In conclusion, a short-term international course provides an efficient means for medical students to experience aspects of global medical science.

Can medical insurance coverage reduce disparities of income in elderly patients requiring long-term care? The case of the People’s Republic of China

Science.gov (United States)

Zhang, Zhenyu; Wang, Jianbing; Jin, Mingjuan; Li, Mei; Zhou, Litao; Jing, Fangyuan; Chen, Kun

2014-01-01

Background The People’s Republic of China’s population is aging rapidly, partly because of the impact of the one-child policy and improvements in the health care system. Caring for bedridden seniors can be a challenge for many families in the People’s Republic of China. Objective To identify the inequality of income among different age groups and social statuses, and evaluate the medical burden and health insurance compensation in the People’s Republic of China. Methods We measured income inequality and insurance compensation levels among bedridden patients in Zhejiang province, People’s Republic of China. Factor analysis and Gini coefficients were used to evaluate degree of income inequality and insurance compensation level. Results We found distinct regional disparities in Zhejiang province, including the aspects of income, expenses, and time. Gini coefficients of older adults with long-term care needs in urban and rural areas were 0.335 and 0.602, respectively. In all age groups, Gini coefficients increased after adjustment for medical expenditures, and the inequality persisted after insurance reimbursement was taken into consideration. Conclusion A significant income disparity between rural and urban areas was observed. Inequality increased with age, and medical expenditure is a huge burden for older people with long-term care needs. Health insurance does not play an important role in reducing inequalities among patients who need long-term care services. PMID:24855346

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

Science.gov (United States)

Sillanpaa, Matti; Schmidt, Dieter

2009-01-01

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

Medical response to effects of ionising radiation

International Nuclear Information System (INIS)

Crosbie, W.A.; Gittus, J.H.

1989-01-01

The proceedings of a conference on 'Medical Response to Effects of Ionising Radiation' in 1989 in the form of nineteen papers published as a book. Topics discussed include radiation accidents at nuclear facilities, the medical management of radiation casualties, the responsibilities, plans and resources for coping with a nuclear accident and finally the long term effects of radiation, including leukaemia epidemiology studies. All papers were selected and indexed separately. (UK)

Distinguishing patterns in the dynamics of long-term medication use by Markov analysis: beyond persistence

Directory of Open Access Journals (Sweden)

Lammers Jan-Willem J

2007-07-01

Full Text Available Abstract Background In order to accurately distinguish gaps of varying length in drug treatment for chronic conditions from discontinuation without resuming therapy, short-term observation does not suffice. Thus, the use of inhalation corticosteroids (ICS in the long-term, during a ten-year period is investigated. To describe medication use as a continuum, taking into account the timeliness and consistency of refilling, a Markov model is proposed. Methods Patients, that filled at least one prescription in 1993, were selected from the PHARMO medical record linkage system (RLS containing >95% prescription dispensings per patient originating from community pharmacy records of 6 medium-sized cities in the Netherlands. The probabilities of continuous use, the refilling of at least one ICS prescription in each year of follow-up, and medication free periods were assessed by Markov analysis. Stratified analysis according to new use was performed. Results The transition probabilities of the refilling of at least one ICS prescription in the subsequent year of follow-up, were assessed for each year of follow-up and for the total study period. The change of transition probabilities in time was evaluated, e.g. the probability of continuing ICS use of starters in the first two years (51% of follow-up increased to more than 70% in the following years. The probabilities of different patterns of medication use were assessed: continuous use (7.7%, cumulative medication gaps (1–8 years 69.1% and discontinuing (23.2% during ten-year follow-up for new users. New users had lower probability of continuous use (7.7% and more variability in ICS refill patterns than previous users (56%. Conclusion In addition to well-established methods in epidemiology to ascertain compliance and persistence, a Markov model could be useful to further specify the variety of possible patterns of medication use within the continuum of adherence. This Markov model describes variation in

Medical terminology: Its size and typology.

Science.gov (United States)

Kucharz, Eugeniusz Józef

2015-01-01

Medical terminology is one of the largest specialized terminologies and is estimated to contain over 250,000 items. Classification of medical terminology into six categories is proposed. The categories are as the following: (A) medical terms that are a part of general basic lexicon of average native speaker (0.02-0.03 % of all terms), (B) specialized medical terms known by average physician (about 45 % of all terms), (C) highly-specialized terms of subspecialties (about 15 % of all terms) (D) medical terms that primarily belong to other terminologies (e.g. biological, chemical, physical, statistical) (about 20 % of all terms), (E) medical slang (0.04-0.05 % of all terms), and (F) pharmaceutical terminology (about 20 % of all terms).

ADHD medication use and long-term consequences

NARCIS (Netherlands)

van den Ban, E.F.

2014-01-01

There is ample evidence of the increasing use of ADHD medication, both in children and in adults. We found that the in The Netherlands, the overall incidence of ADHD medication use increased 6.5 fold in both males and females between 2001 and 2006. The major proportion of all treated patients

Medical students are afraid to include abortion in their future practices: in-depth interviews in Maharastra, India.

Science.gov (United States)

Sjöström, Susanne; Essén, Birgitta; Gemzell-Danielsson, Kristina; Klingberg-Allvin, Marie

2016-01-12

Unsafe abortions are estimated to cause eight per-cent of maternal mortality in India. Lack of providers, especially in rural areas, is one reason unsafe abortions take place despite decades of legal abortion. Education and training in reproductive health services has been shown to influence attitudes and increase chances that medical students will provide abortion care services in their future practice. To further explore previous findings about poor attitudes toward abortion among medical students in Maharastra, India, we conducted in-depth interviews with medical students in their final year of education. We used a qualitative design conducting in-depth interviews with twenty-three medical students in Maharastra applying a topic guide. Data was organized using thematic analysis with an inductive approach. The participants described a fear to provide abortion in their future practice. They lacked understanding of the law and confused the legal regulation of abortion with the law governing gender biased sex selection, and concluded that abortion is illegal in Maharastra. The interviewed medical students' attitudes were supported by their experiences and perceptions from the clinical setting as well as traditions and norms in society. Medical abortion using mifepristone and misoprostol was believed to be unsafe and prohibited in Maharastra. The students perceived that nurse-midwives were knowledgeable in Sexual and Reproductive Health and many found that they could be trained to perform abortions in the future. To increase chances that medical students in Maharastra will perform abortion care services in their future practice, it is important to strengthen their confidence and knowledge through improved medical education including value clarification and clinical training.

Simulation-based medical education training improves short and long-term competency in, and knowledge of central venous catheter insertion: A before and after intervention study.

Science.gov (United States)

Cartier, Vanessa; Inan, Cigdem; Zingg, Walter; Delhumeau, Cecile; Walder, Bernard; Savoldelli, Georges L

2016-08-01

Multimodal educational interventions have been shown to improve short-term competency in, and knowledge of central venous catheter (CVC) insertion. To evaluate the effectiveness of simulation-based medical education training in improving short and long-term competency in, and knowledge of CVC insertion. Before and after intervention study. University Geneva Hospital, Geneva, Switzerland, between May 2008 and January 2012. Residents in anaesthesiology aware of the Seldinger technique for vascular puncture. Participants attended a half-day course on CVC insertion. Learning objectives included work organization, aseptic technique and prevention of CVC complications. CVC insertion competency was tested pretraining, posttraining and then more than 2 years after training (sustainability phase). The primary study outcome was competency as measured by a global rating scale of technical skills, a hand hygiene compliance score and a checklist compliance score. Secondary outcome was knowledge as measured by a standardised pretraining and posttraining multiple-choice questionnaire. Statistical analyses were performed using paired Student's t test or Wilcoxon signed-rank test. Thirty-seven residents were included; 18 were tested in the sustainability phase (on average 34 months after training). The average global rating of skills was 23.4 points (±SD 4.08) before training, 32.2 (±4.51) after training (P Simulation-based medical education training was effective in improving short and long-term competency in, and knowledge of CVC insertion.

Long-term patterns of adherence to medication therapy among patients with type 2 diabetes mellitus in Denmark

DEFF Research Database (Denmark)

Jensen, Majken Linnemann; Jørgensen, Marit Eika; Hansen, Ebba Holme

2017-01-01

: Adherence to six medicine groups (metformin, sulfonylureas, acetylsalicylic acid, thiazide diuretics, renin angiotensin system inhibitors, and statins) were analysed among 5,232 patients with type 2 diabetes at a tertiary referral hospital during 1998-2009. Rate-ratios of initiation of treatment, recurrent......AIMS: Poor adherence to medication therapy among type 2 diabetes patients is a clinical challenge. We aimed to determine which factors are associated with the three phases of long-term adherence to medication: initiation, implementation and discontinuation in a register-based study. METHODS...... gaps in supply of medication, and discontinuation of treatment were analysed using Poisson regression. RESULTS: Poor initiation rather than poor implementation or discontinuation was the main contributor to medication nonadherence. Polypharmacy was a risk factor for slower initiation of treatment...

Term Familiarity to indicate Perceived and Actual Difficulty of Text in Medical Digital Libraries.

Science.gov (United States)

Leroy, Gondy; Endicott, James E

2011-10-01

With increasing text digitization, digital libraries can personalize materials for individuals with different education levels and language skills. To this end, documents need meta-information describing their difficulty level. Previous attempts at such labeling used readability formulas but the formulas have not been validated with modern texts and their outcome is seldom associated with actual difficulty. We focus on medical texts and are developing new, evidence-based meta-tags that are associated with perceived and actual text difficulty. This work describes a first tag, term familiarity , which is based on term frequency in the Google corpus. We evaluated its feasibility to serve as a tag by looking at a document corpus (N=1,073) and found that terms in blogs or journal articles displayed unexpected but significantly different scores. Term familiarity was then applied to texts and results from a previous user study (N=86) and could better explain differences for perceived and actual difficulty.

American Association for Emergency Psychiatry Task Force on Medical Clearance of Adult Psychiatric Patients. Part II: Controversies over Medical Assessment, and Consensus Recommendations.

Science.gov (United States)

Wilson, Michael P; Nordstrom, Kimberly; Anderson, Eric L; Ng, Anthony T; Zun, Leslie S; Peltzer-Jones, Jennifer M; Allen, Michael H

2017-06-01

The emergency medical evaluation of psychiatric patients presenting to United States emergency departments (ED), usually termed "medical clearance," often varies between EDs. A task force of the American Association for Emergency Psychiatry (AAEP), consisting of physicians from emergency medicine, physicians from psychiatry and a psychologist, was convened to form consensus recommendations for the medical evaluation of psychiatric patients presenting to U.S.EDs. The task force reviewed existing literature on the topic of medical evaluation of psychiatric patients in the ED and then combined this with expert consensus. Consensus was achieved by group discussion as well as iterative revisions of the written document. The document was reviewed and approved by the AAEP Board of Directors. Eight recommendations were formulated. These recommendations cover various topics in emergency medical examination of psychiatric patients, including goals of medical screening in the ED, the identification of patients at low risk for co-existing medical disease, key elements in the ED evaluation of psychiatric patients including those with cognitive disorders, specific language replacing the term "medical clearance," and the need for better science in this area. The evidence indicates that a thorough history and physical examination, including vital signs and mental status examination, are the minimum necessary elements in the evaluation of psychiatric patients. With respect to laboratory testing, the picture is less clear and much more controversial.

Gender matters in medical education.

Science.gov (United States)

Bleakley, Alan

2013-01-01

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

Association of Bariatric Surgery vs Medical Obesity Treatment With Long-term Medical Complications and Obesity-Related Comorbidities.

Science.gov (United States)

Jakobsen, Gunn Signe; Småstuen, Milada Cvancarova; Sandbu, Rune; Nordstrand, Njord; Hofsø, Dag; Lindberg, Morten; Hertel, Jens Kristoffer; Hjelmesæth, Jøran

2018-01-16

The association of bariatric surgery and specialized medical obesity treatment with beneficial and detrimental outcomes remains uncertain. To compare changes in obesity-related comorbidities in patients with severe obesity (body mass index ≥40 or ≥35 and at least 1 comorbidity) undergoing bariatric surgery or specialized medical treatment. Cohort study with baseline data of exposures from November 2005 through July 2010 and follow-up data from 2006 until death or through December 2015 at a tertiary care outpatient center, Vestfold Hospital Trust, Norway. Consecutive treatment-seeking adult patients (n = 2109) with severe obesity assessed (221 patients excluded and 1888 patients included). Bariatric surgery (n = 932, 92% gastric bypass) or specialized medical treatment (n = 956) including individual or group-based lifestyle intervention programs. Primary outcomes included remission and new onset of hypertension based on drugs dispensed according to the Norwegian Prescription Database. Prespecified secondary outcomes included changes in comorbidities. Adverse events included complications retrieved from the Norwegian Patient Registry and a local laboratory database. Among 1888 patients included in the study, the mean (SD) age was 43.5 (12.3) years (1249 women [66%]; mean [SD] baseline BMI, 44.2 [6.1]; 100% completed follow-up at a median of 6.5 years [range, 0.2-10.1]). Surgically treated patients had a greater likelihood of remission and lesser likelihood for new onset of hypertension (remission: absolute risk [AR], 31.9% vs 12.4%); risk difference [RD], 19.5% [95% CI, 15.8%-23.2%], relative risk [RR], 2.1 [95% CI, 2.0-2.2]; new onset: AR, 3.5% vs 12.2%, RD, 8.7% [95% CI, 6.7%-10.7%], RR, 0.4 [95% CI, 0.3-0.5]; greater likelihood of diabetes remission: AR, 57.5% vs 14.8%; RD, 42.7% [95% CI, 35.8%-49.7%], RR, 3.9 [95% CI, 2.8-5.4]; greater risk of new-onset depression: AR, 8.9% vs 6.5%; RD, 2.4% [95% CI, 1.3%-3.5%], RR, 1.5 [95% CI, 1.4-1.7]; and

Workplace Violence and Safety Issues in Long-Term Medical Care Facilities: Nurses' Perspectives

OpenAIRE

Bankole K. Fasanya; Emmanuel A. Dada

2016-01-01

Background: Workplace violence (WPV) is becoming an issue that needs immediate attention in the United States, especially during this period as more states are adopting the “stand your ground laws to promote worker protection.” This study was conducted to investigate how WPV has contributed to an unsafe environment for nurses and nursing assistants who work in long-term medical care facilities. Methods: A structure questionnaire was used to collect data for the study. Three facilities were...

Medical humanities: lineage, excursionary sketch and rationale.

Science.gov (United States)

Hurwitz, Brian

2013-11-01

Medical Humanities the journal started life in 2000 as a special edition of the JME. However, the intellectual taproots of the medical humanities as a field of enquiry can be traced to two developments: calls made in the 1920s for the development of multidisciplinary perspectives on the sciences that shed historical light on their assumptions, methods and practices; refusals to assimilate all medical phenomena to a biomedical worldview. Medical humanities the term stems from a desire to situate the significance of medicine as a product of culture. But despite growing usage over half a century the term defies a unifying encapsulation and continues to conjure up a multitude of discourse communities, including scholars working at the interfaces of health and humanities, arts and health, and medical education and bioethics. The field is intellectually capacious and polymorphous, forming and reforming around critical new research questions and teaching tasks spanning disciplines.

Information and communication technology in medical education: an experience from a developing country.

Science.gov (United States)

Houshyari, Asefeh Badiey; Bahadorani, Mahnaz; Tootoonchi, Mina; Gardiner, John Jacob Zucker; Peña, Roberto A; Adibi, Peyman

2012-03-01

This literature review was conducted using PubMed-Medline, PubMed-Central and ERIC databases, 1979- 2010, for research studies and pertinent theoretical publications including journals and texts. Key search words included general terms such as: "medical education," "information and communication technology in medical education," "medical students' computer skills" and "ICT use among medical students". Theoretical approaches were included to place the review within an educational and social context, and selected studies to demonstrate use of ICT in medical education through time and in different countries.

Expansion of the relativistic Fokker-Planck equation including non-linear terms and a non-Maxwellian background

International Nuclear Information System (INIS)

Shkarofsky, I.P.

1997-01-01

The relativistic Fokker-Planck collision term in Braams and Karney [Phys. Fluids B 1, 1355 (1989)] is expanded using Cartesian tensors (equivalent to associated Legendre spherical harmonics) retaining all non-linear terms and an arbitrary zeroth order distribution background. Expressions are given for collision terms between all harmonics and the background distribution in terms of the j and y functions in Braams and Karney. The results reduce to Braams and Karney for the first order harmonic term with a Maxwellian background and to those given by Shkarofsky [Can. J. Phys. 41, 1753 (1963)] in the non-relativistic limit. Expressions for the energy and momentum transfer associated with relativistic Coulomb collisions are given. The fast two dimensional Fokker-Planck solver in Shoucri and Shkarofsky [Comput. Phys. Commun. 82, 287 (1994)] has been extended to include the second order harmonic term. copyright 1997 American Institute of Physics

78 FR 76507 - Revised Medical Criteria for Evaluating Cancer (Malignant Neoplastic Diseases)

Science.gov (United States)

2013-12-17

... include updating the medical terminology in the listings. For example, we would replace the term ``Hodgkin... Revised Medical Criteria for Evaluating Cancer (Malignant Neoplastic Diseases); Proposed Rule #0;#0...

Long-term health and medical cost impact of smoking prevention in adolescence.

Science.gov (United States)

Wang, Li Yan; Michael, Shannon L

2015-02-01

To estimate smoking progression probabilities from adolescence to young adulthood and to estimate long-term health and medical cost impacts of preventing smoking in today's adolescents. Using data from the National Longitudinal Study of Adolescent Health (Add Health), we first estimated smoking progression probabilities from adolescence to young adulthood. Then, using the predicted probabilities, we estimated the number of adolescents who were prevented from becoming adult daily smokers as a result of a hypothetical 1 percentage point reduction in the prevalence of ever smoking in today's adolescents. We further estimated lifetime medical costs saved and quality-adjusted life years (QALYs) gained as a result of preventing adolescents from becoming adult daily smokers. All costs were in 2010 dollars. Compared with never smokers, those who had tried smoking at baseline had higher probabilities of becoming current or former daily smokers at follow-up regardless of baseline grade or sex. A hypothetical 1 percentage point reduction in the prevalence of ever smoking in 24.5 million students in 7th-12th grades today could prevent 35,962 individuals from becoming a former daily smoker and 44,318 individuals from becoming a current daily smoker at ages 24-32 years. As a result, lifetime medical care costs are estimated to decrease by $1.2 billion and lifetime QALYs is estimated to increase by 98,590. Effective smoking prevention programs for adolescents go beyond reducing smoking prevalence in adolescence; they also reduce daily smokers in young adulthood, increase QALYs, and reduce medical costs substantially in later life. This finding indicates the importance of continued investment in effective youth smoking prevention programs. Published by Elsevier Inc.

Effect of short-term research training programs on medical students' attitudes toward aging.

Science.gov (United States)

Jeste, Dilip V; Avanzino, Julie; Depp, Colin A; Gawronska, Maja; Tu, Xin; Sewell, Daniel D; Huege, Steven F

2018-01-01

Strategies to build a larger workforce of physicians dedicated to research on aging are needed. One method to address this shortage of physician scientists in geriatrics is short-term training in aging research for early-stage medical students. The authors examined the effects of two summer research training programs, funded by the National Institutes of Health, on medical students' attitudes toward aging, using the Carolina Opinions on Care of Older Adults (COCOA). The programs combined mentored research, didactics, and some clinical exposure. In a sample of 134 participants, COCOA scores improved significantly after completion of the research training program. There was a significant interaction of gender, such that female students had higher baseline scores than males, but this gender difference in COCOA scores was attenuated following the program. Four of the six COCOA subscales showed significant improvement from baseline: early interest in geriatrics, empathy/compassion, attitudes toward geriatrics careers, and ageism.

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

Science.gov (United States)

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

2017-01-01

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

American Association for Emergency Psychiatry Task Force on Medical Clearance of Adult Psychiatric Patients. Part II: Controversies over Medical Assessment, and Consensus Recommendations

Directory of Open Access Journals (Sweden)

Michael P. Wilson

2017-05-01

Full Text Available Introduction: The emergency medical evaluation of psychiatric patients presenting to United States emergency departments (ED, usually termed “medical clearance,” often varies between EDs. A task force of the American Association for Emergency Psychiatry (AAEP, consisting of physicians from emergency medicine, physicians from psychiatry and a psychologist, was convened to form consensus recommendations for the medical evaluation of psychiatric patients presenting to U.S.EDs. Methods: The task force reviewed existing literature on the topic of medical evaluation of psychiatric patients in the ED and then combined this with expert consensus. Consensus was achieved by group discussion as well as iterative revisions of the written document. The document was reviewed and approved by the AAEP Board of Directors. Results: Eight recommendations were formulated. These recommendations cover various topics in emergency medical examination of psychiatric patients, including goals of medical screening in the ED, the identification of patients at low risk for co-existing medical disease, key elements in the ED evaluation of psychiatric patients including those with cognitive disorders, specific language replacing the term “medical clearance,” and the need for better science in this area. Conclusion: The evidence indicates that a thorough history and physical examination, including vital signs and mental status examination, are the minimum necessary elements in the evaluation of psychiatric patients. With respect to laboratory testing, the picture is less clear and much more controversial.

Can medical insurance coverage reduce disparities of income in elderly patients requiring long-term care? The case of the People’s Republic of China

Directory of Open Access Journals (Sweden)

Zhang ZY

2014-05-01

Full Text Available Zhenyu Zhang,1 Jianbing Wang,1 Mingjuan Jin,1 Mei Li,1 Litao Zhou,2 Fangyuan Jing,1 Kun Chen1 1Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People’s Republic of China; 2Quality Control Department, Zhejiang Hospital, Zhejiang, People’s Republic of China Background: The People’s Republic of China’s population is aging rapidly, partly because of the impact of the one-child policy and improvements in the health care system. Caring for bedridden seniors can be a challenge for many families in the People’s Republic of China.Objective: To identify the inequality of income among different age groups and social statuses, and evaluate the medical burden and health insurance compensation in the People’s Republic of China.Methods: We measured income inequality and insurance compensation levels among bedridden patients in Zhejiang province, People’s Republic of China. Factor analysis and Gini coefficients were used to evaluate degree of income inequality and insurance compensation level.Results: We found distinct regional disparities in Zhejiang province, including the aspects of income, expenses, and time. Gini coefficients of older adults with long-term care needs in urban and rural areas were 0.335 and 0.602, respectively. In all age groups, Gini coefficients increased after adjustment for medical expenditures, and the inequality persisted after insurance reimbursement was taken into consideration.Conclusion: A significant income disparity between rural and urban areas was observed. Inequality increased with age, and medical expenditure is a huge burden for older people with long-term care needs. Health insurance does not play an important role in reducing inequalities among patients who need long-term care services. Keywords: Gini coefficient, bedridden, long-term care, insurance

Economic impact of medication error: a systematic review.

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Walsh, Elaine K; Hansen, Christina Raae; Sahm, Laura J; Kearney, Patricia M; Doherty, Edel; Bradley, Colin P

2017-05-01

Medication error is a significant source of morbidity and mortality among patients. Clinical and cost-effectiveness evidence are required for the implementation of quality of care interventions. Reduction of error-related cost is a key potential benefit of interventions addressing medication error. The aim of this review was to describe and quantify the economic burden associated with medication error. PubMed, Cochrane, Embase, CINAHL, EconLit, ABI/INFORM, Business Source Complete were searched. Studies published 2004-2016 assessing the economic impact of medication error were included. Cost values were expressed in Euro 2015. A narrative synthesis was performed. A total of 4572 articles were identified from database searching, and 16 were included in the review. One study met all applicable quality criteria. Fifteen studies expressed economic impact in monetary terms. Mean cost per error per study ranged from €2.58 to €111 727.08. Healthcare costs were used to measure economic impact in 15 of the included studies with one study measuring litigation costs. Four studies included costs incurred in primary care with the remaining 12 measuring hospital costs. Five studies looked at general medication error in a general population with 11 studies reporting the economic impact of an individual type of medication error or error within a specific patient population. Considerable variability existed between studies in terms of financial cost, patients, settings and errors included. Many were of poor quality. Assessment of economic impact was conducted predominantly in the hospital setting with little assessment of primary care impact. Limited parameters were used to establish economic impact. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Long-term outcomes of patent foramen ovale closure or medical therapy after cryptogenic stroke: A meta-analysis of randomized trials.

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Abdelaziz, Hesham K; Saad, Marwan; Abuomara, Hossamaldin Z; Nairooz, Ramez; Pothineni, Naga Venkata K; Madmani, Mohamed E; Roberts, David H; Mahmud, Ehtisham

2018-05-04

To examine long-term clinical outcomes with transcatheter patent foramen ovale (PFO) closure versus medical therapy alone in patients with cryptogenic stroke. A long-standing debate regarding the optimal approach for the management of patients with PFO after a cryptogenic stroke exists. An electronic search was performed for randomized clinical trials (RCTs) reporting clinical outcomes with PFO closure vs. medical therapy alone after stroke. Random effects DerSimonian-Laird risk ratios (RR) were calculated. The main outcome was recurrence of stroke. Other outcomes included transient ischemic attack (TIA), new-onset atrial fibrillation/flutter (AF/AFL), major bleeding, serious adverse events, and device-related complications. All-cause mortality was also examined. Five RCTs with a total of 3,440 patients were included. At a mean follow-up of 4.02 ± 1.57 years, PFO closure was associated with less recurrence of stroke (RR = 0.43; 95% CI 0.19-0.91; P = .027) compared with medical therapy alone. No difference was observed between both strategies for TIA (P = .21), major bleeding (P = .69), serious adverse events (P = .35), and all-cause death (P = .48). However, PFO closure, was associated with increased new-onset AF/AFL (P < .001), risk of pulmonary embolism (P = .04), and device-related complications (P < .001). On a subgroup analysis, stroke recurrence rate remained lower in PFO closure arm regardless of the type of closure device used (P interaction  = .50), or the presence of substantial shunt in the majority of study population (P interaction  = .13). Transcatheter PFO closure reduces the recurrence of stroke compared with medical therapy alone, with no significant safety concerns. Close follow-up of patients after PFO closure is recommended to detect new-onset atrial arrhythmias. © 2018 Wiley Periodicals, Inc.

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

Science.gov (United States)

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

2017-01-01

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

Long-term medical outcomes in survivors of extra-ocular retinoblastoma: the Memorial Sloan-Kettering Cancer Center (MSKCC) experience.

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Friedman, Danielle Novetsky; Sklar, Charles A; Oeffinger, Kevin C; Kernan, Nancy A; Khakoo, Yasmin; Marr, Brian P; Wolden, Suzanne L; Abramson, David H; Dunkel, Ira J

2013-04-01

Data on long-term outcomes of survivors of extra-ocular retinoblastoma are lacking. The authors sought to provide the first report characterizing long-term outcomes among survivors of extra-ocular retinoblastoma. Retrospective analysis of long-term medical outcomes in 19 survivors of extra-ocular retinoblastoma treated between 1992 and 2009. Severity of outcomes was graded using Common Terminology Criteria for Adverse Events. All patients received intensive multimodality therapy for their extra-ocular disease after management of their primary intra-ocular disease, including conventional chemotherapy (n = 19, 100%), radiotherapy (n = 15, 69%), and/or high-dose chemotherapy with autologous stem cell transplant (n = 17, 89%). The median follow-up was 7.8 years from diagnosis of extra-ocular retinoblastoma (range 2-17.8 years). The most common long-term non-visual outcomes were hearing loss (n = 15, 79%), short stature (n = 7, 37%), and secondary malignancies [SMN] (n = 6, 31%). Sixty-eight percent of survivors exhibited ≥2 non-visual long-term outcomes of any grade. Except short stature, which was not graded for severity, Grade 3-4 outcomes were limited to: ototoxicity (n = 8; n = 4 require hearing aids), SMNs (n = 6), and unequal limb length (n = 1). Five patients who developed SMNs carried a known RB1 mutation. SMNs developed at a median of 11.1 years after initial diagnosis; two patients died of their SMN. Long-term cardiac, pulmonary, hepatobiliary, or renal conditions were not identified in any survivors. Long-term outcomes are commonly seen in extra-ocular retinoblastoma survivors but the majority are mild-moderate in their severity. Longer comprehensive follow-up is needed to fully assess treatment-related outcomes but the information collected to date may affect management decisions for children with extra-ocular disease. Copyright © 2012 Wiley Periodicals, Inc.

Assessment of the rates and characteristics of the short-term supply of medication (Tider from an integrated healthcare delivery system in the United States

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Delate T

2017-06-01

Full Text Available Objectives: The purpose of this study was to describe the rate of medication short-term supply dispensings (tider, patient and medication characteristics associated with a tider, and costs for tider dispensings in an integrated healthcare delivery system in Colorado, United States. Methods: This was a retrospective study conducted in an integrated healthcare delivery system’s outpatient clinics. All patients who had a prescription dispensed for a study medication at any of the system’s 28 outpatient pharmacies during the first quarter of 2016 were included. A tider was identified as a 3-day supply of a prescription medication that was dispensed at no charge to a patient. The quarterly tider rate and the per member per month (PMPM cost of tiders were estimated. Patient and medication characteristics associated with a tider were assessed. Results: A total of 444,225 study medications were dispensed for 135,907 patients during the study period. There were 3,430 (0.77%, 95%CI 0.75%:0.80% medications dispensed as a tider. The PMPM cost of tider medications and their dispensing fees was USD 0.03. There were 1,092 (0.8% and 134,815 (99.2% patients who did and did not, respectively, have at least one tider dispensed during the study period. Patient characteristics strongly associated with having had a tider dispensed included being older, male, and a Medicare beneficiary. Cardiovascular and neuromuscular medications had the highest rates of tider dispensing. Conclusions: The rate of tider dispensing was relatively low; however, approximately one out of 125 patients had at least one tider. Patients who had a tider were more likely to be older, female, a Medicare beneficiary, and having had a previous tider dispensing and a higher burden of chronic disease. The tider medication was more likely to be a cardiovascular or neuromuscular medication class and more likely to be dispensed on a weekend. The total cost of dispensing a tider appears reasonable

Glossary of technical terms for the medical technology professionals.

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Rafael Felipe García Rodríguez

2014-03-01

Full Text Available The current work is a glossary of technical terms in English language for Medical Health Professionals, has been prepared due to the lack of technical lexicon the students have during and after their university studies, that is, the students have a deficit of technical words which limits their professional competence and accountability. This shortage limits them and makes it a great laboring challenge if they have to work overseas in English-speaking countries. The glossary comprises the main and necessary words which are needed for this type of professional in their field of action. These graduates have a solid knowledge and comprehension of biological, biochemical and biophysical fundamentals in their mother tongue but they do not have the necessary elements in the target language to operate properly. It is a need that they can work appropriately in the spheres of prevention, promotion and health recovery to support a diagnosis, a treatment and a management not only in their mother tongue but in English for their future work.

Tonsillectomy efficacy in children with PFAPA syndrome is comparable to the standard medical treatment: a long-term observational study.

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Vigo, Giulia; Martini, Giorgia; Zoppi, Silvia; Vittadello, Fabio; Zulian, Francesco

2014-01-01

Tonsillectomy has recently been suggested as an effective treatment for PFAPA syndrome but little is known about its long-term efficacy. We compared the clinical features and the long-term outcome of a large cohort of patients with PFAPA syndrome treated with tonsillectomy or with standard medical treatment. We conducted a retrospective study on patients with PFAPA syndrome followed at a tertiary care centre from January 1993 to August 2010. Clinical characteristics and laboratory parameters were evaluated at onset and during the follow-up. Disease outcomes of patients who underwent tonsillectomy and of those treated with medical therapy (NSAIDs, prednisone) were compared. Clinical remission on medication (CRM) was considered the persistence of fever attacks which were well controlled by medical therapy, clinical remission (CR) was defined as the absence of fever attacks, without any treatment, for more than 12 months. 275 patients with PFAPA syndrome, 59.6% males, aged 27.9 months at onset and followed for mean 54.5 months, entered the study. CR was reported in 59.6% of the patients and was significantly less frequent in those with positive family history for PFAPA (46.4% vs. 66.1%, p=0.003). 27/41 patients (65.9%), responded to tonsillectomy and this result was comparable with that observed in those treated with medical therapy (59.1%, p=0.51). Disease duration, age at remission or presence of associated symptoms were not significantly different in both groups. No predictors of tonsillectomy failure were found. In a large cohort of patients with PFAPA syndrome, tonsillectomy efficacy was comparable to the standard medical treatment.

Ethical precepts for medical volunteerism: including local voices and values to guide RHD surgery in Rwanda.

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Coors, Marilyn E; Matthew, Thomas L; Matthew, Dayna B

2015-10-01

At the invitation of the Rwandan Government, Team Heart, a team of American healthcare professionals, performs volunteer rheumatic heart disease (RHD) surgery in Rwanda every year, and confronts ethical concerns that call for cultural sensitivity. This article describes how five standard bioethical precepts are applied in practice in medical volunteerism related to RHD surgery in Rwanda. The content for the applied precepts stems from semiscripted, transcribed conversations with the authors, two Rwandan cardiologists, a Rwandan nurse and a Rwandan premedical student. The conversations revealed that the criteria for RHD surgical selection in Rwanda are analogous to the patient-selection process involving material scarcity in the USA. Rwandan notions of benefit and harm focus more attention on structural issues, such as shared benefit, national reputation and expansion of expertise, than traditional Western notions. Harm caused by inadequate patient follow-up remains a critical concern. Gender disparities regarding biological and social implications of surgical valve choices impact considerations of justice. Individual agency remains important, but not central to Rwandan concepts of justice, transparency and respect, particularly regarding women. The Rwandan understanding of standard bioethical precepts is substantively similar to the traditionally recognised interpretation with important contextual differences. The communal importance of improving the health of a small number of individuals may be underestimated in previous literature. Moreover, openness and the incorporation of Rwandan stakeholders in difficult ethical choices and long-term contributions to indigenous medical capacity appear to be valued by Rwandans. These descriptions of applied precepts are applicable to different medical missions in other emerging nations following a similar process of inclusion. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted

Medications and impaired driving.

Science.gov (United States)

Hetland, Amanda; Carr, David B

2014-04-01

To describe the association of specific medication classes with driving outcomes and provide clinical recommendations. The MEDLINE and EMBASE databases were searched for articles published from January 1973 to June 2013 on classes of medications associated with driving impairment. The search included outcome terms such as automobile driving, motor vehicle crash, driving simulator, and road tests. Only English-language articles that contained findings from observational or interventional designs with ≥ 10 participants were included in this review. Cross-sectional studies, case series, and case reports were excluded. Driving is an important task and activity for the majority of adults. Some commonly prescribed medications have been associated with driving impairment measured by road performance, driving simulation, and/or motor vehicle crashes. This review of 30 studies identified findings with barbiturates, benzodiazepines, hypnotics, antidepressants, opioid and nonsteroidal analgesics, anticonvulsants, antipsychotics, antiparkinsonian agents, skeletal muscle relaxants, antihistamines, anticholinergic medications, and hypoglycemic agents. Additional studies of medication impact on sedation, sleep latency, and psychomotor function, as well as the role of alcohol, are also discussed. Psychotropic agents and those with central nervous system side effects were associated with measures of impaired driving performance. It is difficult to determine if such associations are actually a result of medication use or the medical diagnosis itself. Regardless, clinicians should be aware of the increased risk of impaired driving with specific classes of medications, educate their patients, and/or consider safer alternatives.

Using Probablilistic Risk Assessment to Model Medication System Failures in Long-Term Care Facilities

National Research Council Canada - National Science Library

Comden, Sharon C; Marx, David; Murphy-Carley, Margaret; Hale, Misti

2005-01-01

.... Discussion: The models provide contextual maps of the errors and behaviors that lead to medication delivery system failures, including unanticipated risks associated with regulatory practices and common...

Laparoscopic fundoplication surgery versus medical management for gastro-oesophageal reflux disease (GORD) in adults.

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Garg, Sushil K; Gurusamy, Kurinchi Selvan

2015-11-05

Gastro-oesophageal reflux disease (GORD) is a common condition with 3% to 33% of people from different parts of the world suffering from GORD. There is considerable uncertainty about whether people with GORD should receive an operation or medical treatment for controlling the condition. To assess the benefits and harms of laparoscopic fundoplication versus medical treatment for people with gastro-oesophageal reflux disease. We searched the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group (UGPD) Trials Register (June 2015), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 6, 2015), Ovid MEDLINE (1966 to June 2015), and EMBASE (1980 to June 2015) to identify randomised controlled trials. We also searched the references of included trials to identify further trials. We considered only randomised controlled trials (RCT) comparing laparoscopic fundoplication with medical treatment in people with GORD irrespective of language, blinding, or publication status for inclusion in the review. Two review authors independently identified trials and independently extracted data. We calculated the risk ratio (RR) or standardised mean difference (SMD) with 95% confidence intervals (CI) using both fixed-effect and random-effects models with RevMan 5 based on available case analysis. Four studies met the inclusion criteria for the review, and provided information on one or more outcomes for the review. A total of 1160 participants in the four RCTs were either randomly assigned to laparoscopic fundoplication (589 participants) or medical treatment with proton pump inhibitors (571 participants). All the trials included participants who had had reflux symptoms for at least six months and had received long-term acid suppressive therapy. All the trials included only participants who could undergo surgery if randomised to the surgery arm. All of the trials were at high risk of bias. The overall quality of evidence was low or very low. None

Effects of the medication nursing assistant role on nurse job satisfaction and stress in long-term care.

Science.gov (United States)

Walker, Margaret J

2008-01-01

Long-term care nurses continue to struggle with increasing workloads, fulfilling regulatory requirements and limited staffing resources. One method of impacting the workload is the introduction of the new medication nursing assistant (MNA) role to alleviate the nurse from prolonged time intervals spent administering medications. An early step in MNA role implementation is to evaluate its impact by comparing agencies using the MNA and those not using the role. This article presents findings from a mixed method study examining the efficacy of the MNA role in relationship to job satisfaction and the degree of perceived stress experienced by long-term care nurses. Ninety-one nurses employed at 2 large New Hampshire facilities responded. Findings offer empirical evidence supporting the use of the MNA to reduce job stress and increase satisfaction for licensed nurses. The MNA role is accepted by nurse leaders and viewed as a benefit. Findings also support a correlation between empowerment and decision making in the nursing environment with levels of nurse satisfaction.

The Medical Home

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... 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 ...

Medication use in pregnancy: a cross-sectional, multinational web-based study.

Science.gov (United States)

Lupattelli, A; Spigset, O; Twigg, M J; Zagorodnikova, K; Mårdby, A C; Moretti, M E; Drozd, M; Panchaud, A; Hämeen-Anttila, K; Rieutord, A; Gjergja Juraski, R; Odalovic, M; Kennedy, D; Rudolf, G; Juch, H; Passier, A; Björnsdóttir, I; Nordeng, H

2014-02-17

Intercountry comparability between studies on medication use in pregnancy is difficult due to dissimilarities in study design and methodology. This study aimed to examine patterns and factors associated with medications use in pregnancy from a multinational perspective, with emphasis on type of medication utilised and indication for use. Cross-sectional, web-based study performed within the period from 1 October 2011 to 29 February 2012. Uniform collection of drug utilisation data was performed via an anonymous online questionnaire. Multinational study in Europe (Western, Northern and Eastern), North and South America and Australia. Pregnant women and new mothers with children less than 1 year of age. Prevalence of and factors associated with medication use for acute/short-term illnesses, chronic/long-term disorders and over-the-counter (OTC) medication use. The study population included 9459 women, of which 81.2% reported use of at least one medication (prescribed or OTC) during pregnancy. Overall, OTC medication use occurred in 66.9% of the pregnancies, whereas 68.4% and 17% of women reported use of at least one medication for treatment of acute/short-term illnesses and chronic/long-term disorders, respectively. The extent of self-reported medicated illnesses and types of medication used by indication varied across regions, especially in relation to urinary tract infections, depression or OTC nasal sprays. Women with higher age or lower educational level, housewives or women with an unplanned pregnancy were those most often reporting use of medication for chronic/long-term disorders. Immigrant women in Western (adjusted OR (aOR): 0.55, 95% CI 0.34 to 0.87) and Northern Europe (aOR: 0.50, 95% CI 0.31 to 0.83) were less likely to report use of medication for chronic/long-term disorders during pregnancy than non-immigrants. In this study, the majority of women in Europe, North America, South America and Australia used at least one medication during pregnancy. There

Workplace Violence and Safety Issues in Long-Term Medical Care Facilities: Nurses' Perspectives.

Science.gov (United States)

Fasanya, Bankole K; Dada, Emmanuel A

2016-06-01

Workplace violence (WPV) is becoming an issue that needs immediate attention in the United States, especially during this period as more states are adopting the "stand your ground laws to promote worker protection." This study was conducted to investigate how WPV has contributed to an unsafe environment for nurses and nursing assistants who work in long-term medical care facilities. A structure questionnaire was used to collect data for the study. Three facilities were sampled and 80 nurses and certified nursing assistants participated in the study. Ninety-two percent (n = 74) were female and 8% (n = 6) were male. Approximately 62% were black or African American, approximately 33% were Caucasians, and only 2% were from other ethnicities. We found that 65% of the participants had experienced WPV while 41% believed that management shows little or no concern for their safety. Approximately 23% of respondents believed that reporting supervisor's WPV act is an unsafe action. In addition, 22% of those who reported that they have experienced WPV believed that the work environment is not safe to perform their duties. This significant difference in perception of workplace safety between those who had experienced WPV and those who had not was significant (t = 3.95, df = 158, p < 0.0001). WPV is an epidemic problem that affects all health-care professionals. The findings of this study could help long-term medical care facilities' management identify the areas to focus on mitigating, controlling, and/or eliminating incidents of WPV.

Survey of Australians using cannabis for medical purposes

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Dillon Paul

2005-10-01

Full Text Available Abstract Background The New South Wales State Government recently proposed a trial of the medical use of cannabis. Australians who currently use cannabis medicinally do so illegally and without assurances of quality control. Given the dearth of local information on this issue, this study explored the experiences of medical cannabis users. Methods Australian adults who had used cannabis for medical purposes were recruited using media stories. A total of 147 respondents were screened by phone and anonymous questionnaires were mailed, to be returned by postage paid envelope. Results Data were available for 128 participants. Long term and regular medical cannabis use was frequently reported for multiple medical conditions including chronic pain (57%, depression (56%, arthritis (35%, persistent nausea (27% and weight loss (26%. Cannabis was perceived to provide "great relief" overall (86%, and substantial relief of specific symptoms such as pain, nausea and insomnia. It was also typically perceived as superior to other medications in terms of undesirable effects, and the extent of relief provided. However, nearly one half (41% experienced conditions or symptoms that were not helped by its use. The most prevalent concerns related to its illegality. Participants reported strong support for their use from clinicians and family. There was almost universal interest (89% in participating in a clinical trial of medical cannabis, and strong support (79% for investigating alternative delivery methods. Conclusion Australian medical cannabis users are risking legal ramifications, but consistent with users elsewhere, claim moderate to substantial benefits from its use in the management of their medical condition. In addition to strong public support, medical cannabis users show strong interest in clinical cannabis research, including the investigation of alternative delivery methods.

System Dynamics in Medical Education: A Tool for Life

Science.gov (United States)

Rubin, David M.; Richards, Christopher L.; Keene, Penelope A. C.; Paiker, Janice E.; Gray, A. Rosemary T.; Herron, Robyn F. R.; Russell, Megan J.; Wigdorowitz, Brian

2012-01-01

A course in system dynamics has been included in the first year of our university's six-year medical curriculum. System Dynamics is a discipline that facilitates the modelling, simulation and analysis of a wide range of problems in terms of two fundamental concepts viz. rates and levels. Many topics encountered in the medical school curriculum,…

Biological risks of medical irradiations: Medical physics monograph 5

International Nuclear Information System (INIS)

Fullerton, G.D.; Kopp, D.T.; Waggener, R.G.; Webster, E.W.

1980-01-01

This book is the fifth in a series of monographs by the American Association of Physicists in Medicine (AAPM) and is a compendium of papers presented at an AAPM regional symposium conducted in San Antonio in July 1980. The book is divided into three sections: (1) biological fundamentals of ionizing radiation, (2) risk evaluation and reduction in three principle radiologic subspecialties (diagnostic radiology, nuclear medicine and radiation therapy), and (3) medical-legal implications. The first section includes a historical review of radiation biology, including a discussion of somatic and genetic effects and statistical approaches to risk estimates. The section on risk evaluation and reduction includes a good review of the units of exposure and activity including the international (SI) system employing the gray, becquerel, and seivert that respectively replace the rad, Curie, and rem. The unavoidable problem of legal responsibility and liability is the subject of the third, and last, section of the monograph. A chapter summarizing the legal history of medical irradiation also includes a glossary of pertinent legal terms. Recent court decisions that impact upon the clinical use of radiation are presented and discussed as well as proposed changes in federal guidelines that could have a large impact on the practice of medicine in general and radiology in particular

Military Medical Care: Questions and Answers

Science.gov (United States)

2009-05-14

Tricare Latin America and Canada Area covering Central and South America, the Caribbean Basin, Canada, Puerto Rico and the Virgin Islands. • Tricare...program is designed to fill long-term prescriptions to treat conditions such as high blood pressure, asthma, or diabetes ; it does not include medications

Postgraduation retention of medical students from Otago and Auckland medical programmes.

Science.gov (United States)

Shelker, William; Poole, Phillippa; Bagg, Warwick; Wood, Ian; Glue, Paul

2014-01-24

Auckland and Otago medical programmes have different methods for selecting students. This study compared postgraduate retention in New Zealand (NZ) of medical graduates from the two medical programmes, to assess whether different selection methods influenced retention. Other variables assessed included entrance category and age at graduation. Anonymised databases were created of all graduates from the Otago Faculty of Medicine (1999-2011) and the Auckland medical programme (2000-2012). Demographic and entry category data were recorded. Retention was defined as presence on the NZ Medical Register in December 2012. Risk differences (RD) were calculated to compare retention between the two medical programmes using the Mantel-Haenszel method. The influence of medical programme entrance category on retention was also tested. The influence of covariates on retaining graduates on the register was evaluated using a multiple logistic regression model. The postgraduate retention of graduates of the two medical programmes over 13 years was identical (Auckland 74.9%, Otago 73.6%, P=0.48). Retention of graduate and non-graduate entry students from both medical programmes was similar by 6 years after graduation. Age during medical school did not affect retention. University of attendance had no effect on postgraduation retention of students on the NZ Medical Register, suggesting that retention is not influenced by the different student selection methods at each programme. The data presented shows that New Zealand graduates regardless of programme completed show a similar profile in terms of retention.

High prevalence of self-medication practices among medical and pharmacy students: a study from Jordan.

Science.gov (United States)

Alkhatatbeh, Mohammad J; Alefan, Qais; Alqudah, Mohammad A Y

2016-05-01

To assess self-medication practices and to evaluate the impact of obtaining medical knowledge on self-medication among medical and pharmacy students at Jordan University of Science and Technology. This was a cross-sectional study. A well-validated questionnaire that included 3 sections about self-medication was administered to the subjects after introducing the term "self-medication" verbally. 1,317 students had participated in the study and were subgrouped according to their academic level into seniors and juniors. Compared to the general population rate of 42.5%, self-medication practice was reported by (1,034, 78.5%) of the students and most common amongst pharmacy students (n = 369, 82.9%) compared to Pharm.D. (n = 357, 77.9%) and medical students (n = 308, 74.4%) (p = 0.009). There was no significant difference between juniors and seniors (557, 79.1% vs. 477, 77.8%, p = 0.59, respectively). Headache (71.2%) and common cold (56.5%) were frequent ailments that provoked self-medication. Analgesics (79.9%) and antibiotics (59.8%) were frequently used to self-treat these aliments. Reasons for self-medication included previous disease experience (55.7%); minor aliments (55.3%); and having enough medical knowledge (32.1%). Medicines were used according to instructions obtained mainly from the leaflet (28.8%); pharmacist (20.7%); and university courses (19.7%). Senior students were more aware of the risk of self-medication than junior students. The majority of students frequently advise other people about self-medication (83.6%). Self-medication was common among students irrespective to their level of medical knowledge. Obtaining medical knowledge increased the students' awareness of the risk of self-medication which may result in practicing responsible self-medication. However, medical teaching institutions need to educate students about the proper use of medicines as a therapeutic tool.

Altruism: Should it be Included as an Attribute of Medical Professionalism?

Directory of Open Access Journals (Sweden)

Joanne Harris

2018-03-01

Next steps: For many, the future of the medical profession lies in abandoning altruism as part of its defining qualities and adopting a new ethical definition of professionalism that fits with the complexities of modern society

Long-Term Follow-Up Study of Young Adults Treated for Unilateral Complete Cleft Lip, Alveolus, and Palate by a Treatment Protocol Including Two-Stage Palatoplasty: Speech Outcomes.

Science.gov (United States)

Kappen, Isabelle Francisca Petronella Maria; Bittermann, Dirk; Janssen, Laura; Bittermann, Gerhard Koendert Pieter; Boonacker, Chantal; Haverkamp, Sarah; de Wilde, Hester; Van Der Heul, Marise; Specken, Tom Fjmc; Koole, Ron; Kon, Moshe; Breugem, Corstiaan Cornelis; Mink van der Molen, Aebele Barber

2017-05-01

No consensus exists on the optimal treatment protocol for orofacial clefts or the optimal timing of cleft palate closure. This study investigated factors influencing speech outcomes after two-stage palate repair in adults with a non-syndromal complete unilateral cleft lip and palate (UCLP). This was a retrospective analysis of adult patients with a UCLP who underwent two-stage palate closure and were treated at our tertiary cleft centre. Patients ≥17 years of age were invited for a final speech assessment. Their medical history was obtained from their medical files, and speech outcomes were assessed by a speech pathologist during the follow-up consultation. Forty-eight patients were included in the analysis, with a mean age of 21 years (standard deviation, 3.4 years). Their mean age at the time of hard and soft palate closure was 3 years and 8.0 months, respectively. In 40% of the patients, a pharyngoplasty was performed. On a 5-point intelligibility scale, 84.4% received a score of 1 or 2; meaning that their speech was intelligible. We observed a significant correlation between intelligibility scores and the incidence of articulation errors (Pspeech assessment, and 11%-17% of the patients exhibited increased nasalance scores, assessed through nasometry. The present study describes long-term speech outcomes after two-stage palatoplasty with hard palate closure at a mean age of 3 years old. We observed moderate long-term intelligibility scores, a relatively high incidence of persistent hypernasality, and a high pharyngoplasty incidence.

Graves' disease in children: long-term outcomes of medical therapy.

Science.gov (United States)

Rabon, Shona; Burton, Amy M; White, Perrin C

2016-10-01

Management options are limited for the treatment of Graves' disease, and there is controversy regarding optimal treatment. We describe the demographic and biochemical characteristics of children with Graves' disease and the outcomes of its management. This is a retrospective study reviewing medical records from 2001 to 2011 at a tertiary-care paediatric hospital. Diagnostic criteria included elevated free T4 and total T3, suppressed TSH, and either positive thyroid-stimulating immunoglobulin or thyroid receptor antibodies or clinical signs suggestive of Graves' disease, for example exophthalmos. Patients were treated with antithyroid drugs (ATD), radioactive iodine, or thyroidectomy. The main outcome measures were remission after medical therapy for at least 6 months and subsequent relapse. A total of 291 children met diagnostic criteria. A total of 62 were male (21%); 117 (40%) were Hispanic, 90 (31%) Caucasian, and 59 (20%) African American. Mean age (±standard deviation) at diagnosis was 12·3 ± 3·8 (range 3-18·5) years. At diagnosis, 268 patients were started on an antithyroid drug and 23 underwent thyroid ablation or thyroidectomy. Fifty-seven (21%) children achieved remission and 16 (28%) of these patients relapsed, almost all within 16 months. Gender and ethnicity did not affect rates of remission or relapse. Of 251 patients treated with methimazole, 53 (21%) had an adverse reaction, including rash, arthralgias, elevated transaminases, or neutropenia. Most children with Graves' disease treated with ATD do not experience remission, but most remissions do not end in relapse. Adverse reactions to methimazole are common but generally mild. © 2016 John Wiley & Sons Ltd.

Substance abuse: medical and slang terminology.

Science.gov (United States)

Hamid, Humera; El-Mallakh, Rif S; Vandeveir, Keith

2005-03-01

Substance abuse is among one of the major problems plaguing our society. It has come to the attention of several healthcare professionals that a communication gap exists between themselves and substance abusers. Most of the time the substance abusers are only familiar with the slang terms of abused substances, a terminology that medical professionals are usually unaware of. This paper is an attempt to close that communication gap, allowing health care professionals to understand the slang terminology that their patients use, thus enabling them to make appropriate treatment decisions. In addition, the article presents some key features (including active ingredient, pharmacological classification, medical use, abuse form, usage method, combinations used, effects sought, long-term possible effects, and detectability in urine) of the most commonly abused substances.

Why do they care? Narratives of physician volunteers on motivations for participation in short-term medical missions abroad.

Science.gov (United States)

Caldron, Paul H; Impens, Ann; Pavlova, Milena; Groot, Wim

2018-01-01

Short-term medical missions (STMMs) refer to the provision of direct pro bono medical services in lower and middle income countries for periods ranging from days to a few weeks by physicians from rich countries. Survey data have provided limited information on demographic and professional profiles of physicians as well as monetary and manpower inputs. Understanding why physicians participate, however, remains incomplete. The study's objective was to elicit physicians' motivations directly. Semi-structured interviews of physicians identified through snowball recruiting were conducted to explore motivational themes and then analyzed using narrative software employing directed content analysis methodology. Twenty physicians from varying backgrounds and specialties were interviewed. Responses identified aspects of the decision to participate and the relative influence of economic, diplomatic, value-related, and emotive constructs. Personality traits may be more influential to participation than demographic, professional, or socioeconomic determinants. Word-of-mouth recruitment appears to underlie the increase in STMM activity, facilitated by information technology. Reported key motivators for physician participation in STMMs tend to parallel schools of thought regarding philanthropy and volunteering and include satisfaction from helping in challenging conditions of limited resources, learning experiences, appreciation from patients, sense of renewal, and the legacy effect of teaching. Copyright © 2017 John Wiley & Sons, Ltd.

EMITEL: E-Encyclopaedia and E-Dictionary of Medical Imaging Technologies

International Nuclear Information System (INIS)

Medvedec, M.; Kovacevic, N.; Magjarevic, R.

2011-01-01

EMITEL (European Medical Imaging Technology e-Encyclopaedia for Lifelong Learning) is an electronic encyclopaedia and multilingual dictionary related to medical imaging technologies. It is a result of the multi-annual international project which involved more than 250 contributors from 35 countries, aiming to foster development of medical physics and biomedical/clinical engineering by a lifelong e-learning web tool for all interested individuals or groups. Currently, the encyclopaedia is equivalent to about 2100 hard copy pages and includes about 3300 terms with an explanatory article for each term. The dictionary provides bidirectional cross-translation of terms between any two among 28 languages from its current database. Dictionary entries are divided into seven groups: diagnostic radiology, nuclear medicine, radiotherapy, magnetic resonance imaging, ultrasound imaging, radiation protection and general terms. Croatian language was implemented in EMITEL dictionary in April 2010. There were 17 Croatian translators and reviewers from 8 institutions and 3 cities, ranging from medical physics experts to linguist. The basic terminological principles of translation were final intelligibility of terms, desirable Croatian origin and linguistic appropriateness. Croatian contribution in the actual phase of EMITEL project attempted to improve the quality and efficiency of the specific professional, scientific and teaching terminology. A sort of novel, consistent and verified pool of terms of emerging medical imaging technologies was built up, as a one small part of the process of developing information technologies and socio-cultural transition from the industrial society into the society of knowledge. (author)

Frontal sinus revision rate after nasal polyposis surgery including frontal recess clearance and middle turbinectomy: A long-term analysis.

Science.gov (United States)

Benkhatar, Hakim; Khettab, Idir; Sultanik, Philippe; Laccourreye, Ollivier; Bonfils, Pierre

2018-08-01

To determine the frontal sinus revision rate after nasal polyposis (NP) surgery including frontal recess clearance (FRC) and middle turbinectomy (MT), to search for predictive factors and to analyse surgical management. Longitudinal analysis of 153 patients who consecutively underwent bilateral sphenoethmoidectomy with FRC and MT for NP with a minimum follow-up of 7 years. Decision of revision surgery was made in case of medically refractory chronic frontal sinusitis or frontal mucocele. Univariate and multivariate analysis incorporating clinical and radiological variables were performed. The frontal sinus revision rate was 6.5% (10/153). The mean time between the initial procedure and revision surgery was 3 years, 10 months. Osteitis around the frontal sinus outflow tract (FSOT) was associated with a higher risk of frontal sinus revision surgery (p=0.01). Asthma and aspirin intolerance did not increase the risk, as well as frontal sinus ostium diameter or residual frontoethmoid cells. Among revised patients, 60% required multiple procedures and 70% required frontal sinus ostium enlargement. Our long-term study reports that NP surgery including FRC and MT is associated with a low frontal sinus revision rate (6.5%). Patients developing osteitis around the FSOT have a higher risk of frontal sinus revision surgery. As mucosal damage can lead to osteitis, FSOT mucosa should be preserved during initial NP surgery. However, as multiple procedures are common among NP patients requiring frontal sinus revision, frontal sinus ostium enlargement should be considered during first revision in the hope of reducing the need of further revisions. Copyright © 2018 Elsevier B.V. All rights reserved.

Comparative Effectiveness of Homoeopathic vs. Conventional Therapy in Usual Care of Atopic Eczema in Children: Long-Term Medical and Economic Outcomes

Science.gov (United States)

Roll, Stephanie; Reinhold, Thomas; Pach, Daniel; Brinkhaus, Benno; Icke, Katja; Staab, Doris; Jäckel, Tanja; Wegscheider, Karl; Willich, Stefan N.; Witt, Claudia M.

2013-01-01

Background One in five children visiting a homeopathic physician suffers from atopic eczema. Objectives We aimed to examine the long-term effectiveness, safety and costs of homoeopathic vs. conventional treatment in usual medical care of children with atopic eczema. Methods In this prospective multi-centre comparative observational non-randomized rater-blinded study, 135 children (48 homoeopathy, 87 conventional) with mild to moderate atopic eczema were included by their respective physicians. Depending on the specialisation of the physician, the primary treatment was either standard conventional treatment or individualized homeopathy as delivered in routine medical care. The main outcome was the SCORAD (SCORing Atopic Dermatitis) at 36 months by a blinded rater. Further outcomes included quality of life, conventional medicine consumption, safety and disease related costs at six, 12 and 36 months after baseline. A multilevel ANCOVA was used, with physician as random effect and the following fixed effects: age, gender, baseline value, severity score, social class and parents’ expectation. Results The adjusted mean SCORAD showed no significant differences between the groups at 36 months (13.7 95% CI [7.9–19.5] vs. 14.9 [10.4–19.4], p = 0.741). The SCORAD response rates at 36 months were similar in both groups (33% response: homoeopathic 63.9% vs. conventional 64.5%, p = 0.94; 50% response: 52.0% vs. 52.3%, p = 0.974). Total costs were higher in the homoeopathic versus the conventional group (months 31–36 200.54 Euro [132.33–268.76] vs. 68.86 Euro [9.13–128.58], p = 0.005). Conclusions Taking patient preferences into account, while being unable to rule out residual confounding, in this long-term observational study, the effects of homoeopathic treatment were not superior to conventional treatment for children with mild to moderate atopic eczema, but involved higher costs. PMID:23383019

Semantic equivalences in Romanian medical terminology

Directory of Open Access Journals (Sweden)

Corina Lungu

2014-12-01

Full Text Available The present paper aims to underline some aspects concerning the presence of synonymy semantic relationship in specialized medical terminology, having as object of study Romanian medical terms. For this study we use a descriptive, conceptual and lexical semantic research method to provide the understanding of different couples, groups or synonymic series where medical terms have several variations: specialized/common terms, syntagms and patronyms of French or different origin. We propose a classification scheme of synonyms of medical lexicon, terms or synonymic syntagms, total and partial, in order to meet the accessibility needs in scientific communication.

The sunshine act and medical publications: Guidance from professional medical associations.

Science.gov (United States)

Toroser, Dikran; DeTora, Lisa; Cairns, Angela; Juneja, Renu; Georgieva, Anna; Weigel, Al; Pepitone, Kim

2015-01-01

To review guidance from professional medical associations to physicians on the Sunshine Act, with a focus on industry support for medical publications. Using 'Sunshine Act' as a search term, we searched PubMed (dates February 2013 to November 2014) and the 'grey literature' using Google and Google Scholar. Online information was extracted from websites of pre-identified professional medical associations. Some professional medical associations have published peer-reviewed recommendations, position statements or general advice on their websites and in journals around the Sunshine Act. Associations also provided broad online educational resources for physicians. There was universal agreement between peer-reviewed publications, including guidelines, for the need for full transparency and disclosure of industry support. Surveys by some professional associations showed variance in opinion on the forecasted impact of the Sunshine Act on physician-industry relationships. There was scarce information specifically related to reporting requirements for industry-supported medical publications. There is a shortage of information for physicians from professional associations regarding the Sunshine Act and support for medical publications. Due to the lack of clear guidance regarding support for publications, there are presently varying interpretations of the Sunshine Act. The literature debates the potential impact of the Sunshine Act and expresses some concerns that physician-enabled innovation in drug development may be hindered.

Association of learning styles with research self-efficacy: study of short-term research training program for medical students.

Science.gov (United States)

Dumbauld, Jill; Black, Michelle; Depp, Colin A; Daly, Rebecca; Curran, Maureen A; Winegarden, Babbi; Jeste, Dilip V

2014-12-01

With a growing need for developing future physician scientists, identifying characteristics of medical students who are likely to benefit from research training programs is important. This study assessed if specific learning styles of medical students, participating in federally funded short-term research training programs, were associated with research self-efficacy, a potential predictor of research career success. Seventy-five first-year medical students from 28 medical schools, selected to participate in two competitive NIH-supported summer programs for research training in aging, completed rating scales to evaluate learning styles at baseline, and research self-efficacy before and after training. We examined associations of individual learning styles (visual-verbal, sequential-global, sensing-intuitive, and active-reflective) with students' gender, ranking of medical school, and research self-efficacy. Research self-efficacy improved significantly following the training programs. Students with a verbal learning style reported significantly greater research self-efficacy at baseline, while visual, sequential, and intuitive learners demonstrated significantly greater increases in research self-efficacy from baseline to posttraining. No significant relationships were found between learning styles and students' gender or ranking of their medical school. Assessments of learning styles may provide useful information to guide future training endeavors aimed at developing the next generation of physician-scientists. © 2014 Wiley Periodicals, Inc.

The European source-term evaluation code ASTEC: status and applications, including CANDU plant applications

International Nuclear Information System (INIS)

Van Dorsselaere, J.P.; Giordano, P.; Kissane, M.P.; Montanelli, T.; Schwinges, B.; Ganju, S.; Dickson, L.

2004-01-01

Research on light-water reactor severe accidents (SA) is still required in a limited number of areas in order to confirm accident-management plans. Thus, 49 European organizations have linked their SA research in a durable way through SARNET (Severe Accident Research and management NETwork), part of the European 6th Framework Programme. One goal of SARNET is to consolidate the integral code ASTEC (Accident Source Term Evaluation Code, developed by IRSN and GRS) as the European reference tool for safety studies; SARNET efforts include extending the application scope to reactor types other than PWR (including VVER) such as BWR and CANDU. ASTEC is used in IRSN's Probabilistic Safety Analysis level 2 of 900 MWe French PWRs. An earlier version of ASTEC's SOPHAEROS module, including improvements by AECL, is being validated as the Canadian Industry Standard Toolset code for FP-transport analysis in the CANDU Heat Transport System. Work with ASTEC has also been performed by Bhabha Atomic Research Centre, Mumbai, on IPHWR containment thermal hydraulics. (author)

Long-term survival benefit of revascularization compared with medical therapy in patients with coronary chronic total occlusion and well-developed collateral circulation.

Science.gov (United States)

Jang, Woo Jin; Yang, Jeong Hoon; Choi, Seung-Hyuk; Song, Young Bin; Hahn, Joo-Yong; Choi, Jin-Ho; Kim, Wook Sung; Lee, Young Tak; Gwon, Hyeon-Cheol

2015-02-01

The purpose of this study was to compare the long-term clinical outcomes of patients with chronic total occlusion (CTO) and well-developed collateral circulation treated with revascularization versus medical therapy. Little is known about the clinical outcomes and optimal treatment strategies of CTO with well-developed collateral circulation. We screened 2,024 consecutive patients with at least 1 CTO detected on coronary angiogram. Of these, we analyzed data from 738 patients with Rentrop 3 grade collateral circulation who were treated with medical therapy alone (n = 236), coronary artery bypass grafting (n = 170) or percutaneous coronary intervention (n = 332; 80.1% successful). Patients who underwent revascularization and medical therapy (revascularization group, n = 502) were compared with those who underwent medical therapy alone (medication group, n = 236) in terms of cardiac death and major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction, and repeat revascularization. During a median follow-up duration of 42 months, multivariate analysis revealed a significantly lower incidence of cardiac death (hazard ratio [HR]: 0.29; 95% confidence interval [CI]: 0.15 to 0.58; p collateral circulation, aggressive revascularization may reduce the risk of cardiac mortality and MACE. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

PASTE: patient-centered SMS text tagging in a medication management system.

Science.gov (United States)

Stenner, Shane P; Johnson, Kevin B; Denny, Joshua C

2012-01-01

To evaluate the performance of a system that extracts medication information and administration-related actions from patient short message service (SMS) messages. Mobile technologies provide a platform for electronic patient-centered medication management. MyMediHealth (MMH) is a medication management system that includes a medication scheduler, a medication administration record, and a reminder engine that sends text messages to cell phones. The object of this work was to extend MMH to allow two-way interaction using mobile phone-based SMS technology. Unprompted text-message communication with patients using natural language could engage patients in their healthcare, but presents unique natural language processing challenges. The authors developed a new functional component of MMH, the Patient-centered Automated SMS Tagging Engine (PASTE). The PASTE web service uses natural language processing methods, custom lexicons, and existing knowledge sources to extract and tag medication information from patient text messages. A pilot evaluation of PASTE was completed using 130 medication messages anonymously submitted by 16 volunteers via a website. System output was compared with manually tagged messages. Verified medication names, medication terms, and action terms reached high F-measures of 91.3%, 94.7%, and 90.4%, respectively. The overall medication name F-measure was 79.8%, and the medication action term F-measure was 90%. Other studies have demonstrated systems that successfully extract medication information from clinical documents using semantic tagging, regular expression-based approaches, or a combination of both approaches. This evaluation demonstrates the feasibility of extracting medication information from patient-generated medication messages.

Medical marijuana patient counseling points for health care professionals based on trends in the medical uses, efficacy, and adverse effects of cannabis-based pharmaceutical drugs.

Science.gov (United States)

Parmar, Jayesh R; Forrest, Benjamin D; Freeman, Robert A

2016-01-01

The purpose of this report is to present a review of the medical uses, efficacy, and adverse effects of the three approved cannabis-based medications and ingested marijuana. A literature review was conducted utilizing key search terms: dronabinol, nabilone, nabiximols, cannabis, marijuana, smoke, efficacy, toxicity, cancer, multiple sclerosis, nausea, vomiting, appetite, pain, glaucoma, and side effects. Abstracts of the included literature were reviewed, analyzed, and organized to identify the strength of evidence in medical use, efficacy, and adverse effects of the approved cannabis-based medications and medical marijuana. A total of 68 abstracts were included for review. Dronabinol's (Marinol) most common medical uses include weight gain, chemotherapy-induced nausea and vomiting (CINV), and neuropathic pain. Nabiximol's (Sativex) most common medical uses include spasticity in multiple sclerosis (MS) and neuropathic pain. Nabilone's (Cesamet) most common medical uses include CINV and neuropathic pain. Smoked marijuana's most common medical uses include neuropathic pain and glaucoma. Orally ingested marijuana's most common medical uses include improving sleep, reducing neuropathic pain, and seizure control in MS. In general, all of these agents share similar medical uses. The reported adverse effects of the three cannabis-based medications and marijuana show a major trend in central nervous system (CNS)-related adverse effects along with cardiovascular and respiratory related adverse effects. Marijuana shares similar medical uses with the approved cannabis-based medications dronabinol (Marinol), nabiximols (Sativex), and nabilone (Cesamet), but the efficacy of marijuana for these medical uses has not been fully determined due to limited and conflicting literature. Medical marijuana also has similar adverse effects as the FDA-approved cannabis-based medications mainly consisting of CNS related adverse effects but also including cardiovascular and respiratory

Medication-related dental erosion: a review.

Science.gov (United States)

Thomas, Manuel S; Vivekananda Pai, A R; Yadav, Amit

2015-10-01

Dental erosion has become a major problem that affects the long-term health of the dentition. Among the various potential causes for erosive tooth wear, the different drugs prescribed for patients may be overlooked. Several therapeutic medications can directly or indirectly be associated with dental erosion. It is the responsibility of oral health providers to make both patients and colleagues aware of drugs that may contribute to this condition. Therefore, the purpose of this discussion is to provide an overview of the various therapeutic medications that can be related to tooth erosion. The authors also include precautionary measures-summarized as The 9 Rs-to avoid or at least reduce medication-induced erosion.

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

OpenAIRE

Monteith, Teshamae S.; Oshinsky, Michael L.

2009-01-01

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

RxTerms

Data.gov (United States)

U.S. Department of Health & Human Services — RxTerms is a drug interface terminology derived from RxNorm for prescription writing or medication history recording (e.g. in e-prescribing systems, PHRs). RxTerms...

Medical uses of accelerators

International Nuclear Information System (INIS)

Bradbury, J.N.

1981-01-01

A variety of particle accelerators have either potential or already demonstrated uses in connection with medically-related research, diagnosis, and treatment. For cancer radiotherapy, nuclear particles including protons, neutrons, heavy ions, and negative pi mesons have advantages compared to conventional radiations in terms of dose localization and/or biological effectiveness. Clinical evaluations of these particles are underway at a number of institutions. Accelerator-produced radionuclides are in widespread use for research and routine diagnostic purposes. Elemental analysis techniques with charged particles and neutrons are being applied to bone, blood, and other tissues. Finally, low-dose medical imaging can be accomplished with accelerated protons and heavy ions. The status and future of these programs are discussed

Using Rituals to Strengthen Your Medical Practice Team.

Science.gov (United States)

Hills, Laura

2015-01-01

Rituals can cement the identity of and strengthen the bonds between any people, including the members of the medical practice team. This article presents the idea that the medical practice manager is in the ideal position to create and use rituals for team building. It defines the term ritual, and explores how rituals differ from customs or traditions. As well, it describes six benefits of rituals and the hallmarks of the most effective team rituals; describes seven creative and interesting corporate rituals that medical practice managers can study for inspiration; suggests 20 excellent opportunities within the medical practice calendar year for medical practice team rituals; and identifies six kinds of rituals that are used in organizations. Finally, this article provides a four-step action plan for ritualizing your medical practice team's morning huddles.

A critical look at medical nutrition terminology and definitions,

NARCIS (Netherlands)

Claassen, E.; Weenen, T.C.; Commandeur, H

2014-01-01

A plethora of terms and definitions for medical nutrition has resulted in an ambiguity in the way "medical nutrition" is termed and defined across various societal levels. The terms medical nutrition, clinical nutrition, enteral nutrition, parenteral nutrition, oral nutritional supplements, medical

MEDICAL TOURISM : Demand for Cuban Medical Tourism by Russian Consumers

OpenAIRE

Ulanova, Anastasia

2015-01-01

Medical tourism, often addressed as health tourism, is a new concept in terms of tourism industry in general, and it is also one of the rapidly developing and growing ones. This thesis gives information on the medical tourism in general and its history. It also revises the development stages of the medical tourism in the world. Cuban medical tourism is analyzed on its own, as well as Russian medical tourism and the demand for it. Medical tourism is rather popular among Russians due to various...

Impact of long-term antihypertensive and antidiabetic medications on the prognosis of post-surgical colorectal cancer: the Fujian prospective investigation of cancer (FIESTA) study.

Science.gov (United States)

Peng, Feng; Hu, Dan; Lin, Xiandong; Liang, Binying; Chen, Ying; Zhang, Hejun; Xia, Yan; Lin, Jinxiu; Zheng, Xiongwei; Niu, Wenquan

2018-05-24

Hypertension and diabetes mellitus are common comorbidities of colorectal cancer. We designed a prospective cohort study aiming to investigate the impact of long-term antihypertensive and antidiabetic medications on colorectal cancer-specific survival and recurrence among 713 post-surgical patients. All participants received radical resection for colorectal cancer during 2000-08, and they were followed up until July 2017. Colorectal cancer patients without hypertension had better survival than those with hypertension (median survival time [MST]: 190.3 months versus 99.0 months, p colorectal cancer survival was statistically significant, that is, patients receiving antidiabetic medications had longer survival time than untreated diabetic patients (MST: 135.8 months versus 80.2 months, p : 0.007), whereas the prognosis was greatly improved in colorectal cancer patients without diabetes mellitus ( p colorectal cancer relative to those without medications, respectively. Our data indicate that long-term antidiabetic medications can significantly prolong the survival and improve the prognosis of post-surgical colorectal cancer.

Medication use in children with asthma: not a child size problem.

Science.gov (United States)

Grover, Charu; Armour, Carol; Asperen, Peter Paul Van; Moles, Rebekah; Saini, Bandana

2011-12-01

The global burden of pediatric asthma is high. Governments and health-care systems are affected by the increasing costs of childhood asthma--in terms of direct health-care costs and indirect costs due to loss of parental productivity, missed school days, and hospitalizations. Despite the availability of effective treatment, the current use of medications in children with asthma is suboptimal. The purpose of this review is to scope the empirical literature to identify the problems associated with the use of pediatric asthma medications. The findings will help to design interventions aiming to improve the use of asthma medications among children. A literature search using electronic search engines (i.e., Medline, International Pharmaceutical Abstracts (IPA), PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)) and the search terms "asthma," "children," and "medicines" (and derivatives of these keywords) was conducted. The search terms were expanded to include emergent themes arising out of search findings. Content themes relating to parents, children themselves, health-care professionals, organizational systems, and specific medications and devices were found. Within these themes, key issues included a lack of parental knowledge about asthma and asthma medications, lack of information provided to parents, parental beliefs and fears, parental behavioral problems, the high costs of medications and devices, the child's self-image, the need for more child responsibility, physician nonadherence to prescribing guidelines, "off-label" prescribing, poor understanding of teachers, lack of access to educational resources, and specific medications. These key issues should be taken into account when modifying the development of educational tools. These tools should focus on targeting the children themselves, the parent/carers, the health-care professionals, and various organizational systems.

The role of medical staff in providing patients rights.

Science.gov (United States)

Masic, Izet; Izetbegovic, Sebija

2014-01-01

Among the priority basic human rights, without a doubt, are the right to life and health-social protection. The process of implementation of human rights in the everyday life of an ordinary citizen in the post-war recovery of Bosnia and Herzegovina faces huge objective and subjective difficulties. Citizens need to be affordable adequate healthcare facilities that will be open to all on equal terms. The term hospital activity implies a set of measures, activities and procedures that are undertaken for the purpose of treatment, diagnosis and medical rehabilitation of patients in the respective health institutions. Principles of hospital care should include: Comprehensiveness (Hospital care is available to all citizens equally); Continuity (Provided is continuous medical care to all users); Availability (Provided approximately equal protection of rights for all citizens). Education of health professionals: The usual threats to patient safety include medical errors, infections occurred in the hospital, unnecessary exposure to high doses of radiation and the use of the wrong drug. Everyday continuing education in the profession of a doctor is lifelong.

Obesity educational interventions in U.S. medical schools: a systematic review and identified gaps.

Science.gov (United States)

Vitolins, Mara Z; Crandall, Sonia; Miller, David; Ip, Eddie; Marion, Gail; Spangler, John G

2012-01-01

Obesity is the second leading cause of preventable death in the United States. However, physicians feel poorly trained to address the obesity epidemic. This article examines effective training methods for overweight and obesity intervention in undergraduate medical education. Using indexing terms related to overweight, obesity, and medical student education, we conducted a literature searched PubMed PsycINFO, Cochrane, and ERIC for relevant articles in English. References from articles identified were also reviewed to located additional articles. We included all studies that incorporated process or outcome evaluations of obesity educational interventions for U.S. medical students. Of an initial 168 citations, 40 abstracts were retrieved; 11 studies were found to be pertinent to medical student obesity education, but only 5 included intervention and evaluation elements. Quality criteria for inclusion consisted of explicit evaluation of the educational methods used. Data extraction identified participants (e.g., year of medical students), interventions, evaluations, and results. These 5 studies successfully used a variety of teaching methods including hands on training, didactic lectures, role-playing, and standardized patient interaction to increase medical students' knowledge, attitudes, and skills regarding overweight and obesity intervention. Two studies addressed medical student bias toward overweight and obese patients. No studies addressed health disparities in the epidemiology and bias of obesity. Despite the commonly cited "obesity epidemic," there are very few published studies that report the effectiveness of medical school obesity educational programs. Gaps still exist within undergraduate medical education including specific training that addresses obesity and long-term studies showing that such training is retained.

Glossary of terms recommended for use in radiation control legislation and associated codes of practice

International Nuclear Information System (INIS)

Swindon, T.; Kennedy, K.N.; Elliott, G.

1983-06-01

A glossary of terms associated with radiological health is presented. It includes basic physics terms, quantities and units, radiological physics terms and radiation protection terms. The National Health and Medical Research Council has recommended that the glossary be used by organizations producing official documents and by appropriate regulatory authorities

Part 3. Assessment of adaptation reactions in the participants of the long-term medical & ecological investigations during the experiment Mars-500

Directory of Open Access Journals (Sweden)

Roman M. Baevsky

2013-05-01

Full Text Available The paper presents the results of the long-term medical & ecological investigations conducted during the experiment Mars-500. Methodology of conducting the long-term medical & ecological investigations and the applied methods are considered. The results are presented in the materials of the research conducted in Russian Federation and Republic of Belarus (Moscow, Syktyvkar, Yekaterinburg, Izhevsk, Magadan and Minsk. For comparative evaluation of the functional state of different reference groups the notion of “ecological stress” was introduced. It depends upon the degree of dominance of the activity of the sympathetic member of the regulatory system over the parasympathetic member. Application of probabilistic approach to the assessment of the functional state and adaptation level with the FR (functional reserve and the DT (the degree of tension of the regulatory mechanisms proved the detected peculiarities of the heart rhythm vegetative regulation. Clear dependency of the functional state of the volunteers on geographic location of regions and climatic parameters is observed. Almost every HRV indicator is characterized by seasonal dynamics. Seasonal dynamics data is exemplified by the research conducted in Yekaterinburg and Syktyvkar. During the earth-bound experiment Mars-500 flight conditions to Mars were simulated. Results of the long-term medical & ecological investigations conducted simultaneously with the experiment Mars-500 showed that health changes in practically healthy people do not usually exceed the limits of the prenosological state.

Using the jigsaw cooperative learning method to teach medical students about long-term and postacute care.

Science.gov (United States)

Buhr, Gwendolen T; Heflin, Mitchell T; White, Heidi K; Pinheiro, Sandro O

2014-06-01

Since many of the frailest and most vulnerable Americans reside in nursing homes, medical students need focused education and training pertaining to this setting. A unique cooperative learning experience utilizing the jigsaw method was developed to engage and expose students to the institutional long-term and postacute care (LTPAC) setting and the roles of personnel there. To accomplish these goals, small groups of medical students interviewed LTPAC personnel about their role, generally, and in relation to a specific patient case. These groups were then rearranged into new groups containing 1 student from each of the original groups plus a faculty facilitator. Each student in the new groups taught about the role of the LTPAC professional they interviewed. To assess the effectiveness of this learning experience, students and LTPAC personnel provided written feedback and rated the activity using a 5-point Likert scale (1 = worst; 5 = best). Students also took a knowledge test. The activity received ratings from students of 3.65 to 4.12 (mean = 3.91). The knowledge test results indicated that students understood the roles of the LTPAC personnel. In general, the jigsaw exercise was well-received by participants and provided an effective means of introducing medical students to the nursing home environment. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Reduction of medication costs after detoxification for medication-overuse headache.

Science.gov (United States)

Shah, Asif M; Bendtsen, Lars; Zeeberg, Peter; Jensen, Rigmor H

2013-04-01

To examine whether detoxifying patients with medication-overuse headache can reduce long-term medication costs. Direct costs of medications in medication-overuse headache have been reported to be very high but have never been calculated on the basis of exact register data. Long-term economic savings obtained by detoxification have never been investigated. We conducted a registry-based observational retrospective follow-up study on 336 medication-overuse headache patients treated and discharged from the Danish Headache Center over a 2-year period. By means of the Danish Register of Medicinal Product Statistics, we collected information on the costs and use of prescription-only medication 1 year before admission and 1 year after discharge from Danish Headache Center. The average medication costs per patient per year decreased with 24%, from US$971 before treatment to US$737 after (P = .001), and the average medication use decreased with 14.4% (P = .02). Savings were most pronounced for patients overusing triptans. In this group, the average medication costs per patient per year decreased with 43% (P headache at a tertiary headache center has a long-lasting effect on the medication costs and use, in particular among patients overusing triptans. The results may not be generalizable to all countries and may be sensitive to the costs of triptans. © 2012 American Headache Society.

The medical dictionary for regulatory activities (MedDRA).

Science.gov (United States)

Brown, E G; Wood, L; Wood, S

1999-02-01

The International Conference on Harmonisation has agreed upon the structure and content of the Medical Dictionary for Regulatory Activities (MedDRA) version 2.0 which should become available in the early part of 1999. This medical terminology is intended for use in the pre- and postmarketing phases of the medicines regulatory process, covering diagnoses, symptoms and signs, adverse drug reactions and therapeutic indications, the names and qualitative results of investigations, surgical and medical procedures, and medical/social history. It can be used for recording adverse events and medical history in clinical trials, in the analysis and tabulations of data from these trials and in the expedited submission of safety data to government regulatory authorities, as well as in constructing standard product information and documentation for applications for marketing authorisation. After licensing of a medicine, it may be used in pharmacovigilance and is expected to be the preferred terminology for international electronic regulatory communication. MedDRA is a hierarchical terminology with 5 levels and is multiaxial: terms may exist in more than 1 vertical axis, providing specificity of terms for data entry and flexibility in data retrieval. Terms in MedDRA were derived from several sources including the WHO's adverse reaction terminology (WHO-ART), Coding Symbols for a Thesaurus of Adverse Reaction Terms (COSTART), International Classification of Diseases (ICD) 9 and ICD9-CM. It will be maintained, further developed and distributed by a Maintenance Support Services Organisation (MSSO). It is anticipated that using MedDRA will improve the quality of data captured on databases, support effective analysis by providing clinically relevant groupings of terms and facilitate electronic communication of data, although as a new tool, users will need to invest time in gaining expertise in its use.

An academic medical center under prolonged rocket attack--organizational, medical, and financial considerations.

Science.gov (United States)

Bar-El, Yaron; Michaelson, Moshe; Hyames, Gila; Skorecki, Karl; Reisner, Shimon A; Beyar, Rafael

2009-09-01

The Rambam Medical Center, the major academic health center in northern Israel, serving a population of two million and providing specialized tertiary care, was exposed to an unprecedented experience during the Second Lebanon War in the summer of 2006. For more than one month, it was subjected to continuous rocket attacks, but it continued to provide emergency and routine medical services to the civilian population and also served the military personnel who were evacuated from the battlefront. To accomplish the goals of serving the population while itself being under fire, the Rambam Medical Center had to undertake major organizational decisions, which included maximizing safety within the hospital by shifting patients and departments, ensuring that the hospital was properly fortified, managing the health professional teams' work schedules, and providing needed services for the families of employees. The Rambam Medical Center's Level I trauma center expertise included multidisciplinary teams and extensive collaborations; modern imaging modalities usually reserved for peacetime medical practice were frequently used. The function of the hospital teams during the war was efficient and smooth, based on the long-term actions taken to prepare for disasters and wartime conditions. Routine hospital services continued, although at 60% of normal occupancy. Financial losses incurred were primarily due to the decrease in revenue-generating activity. The two most important components of managing the hospital under these conditions are (1) the ability to arrive at prompt and meaningful decisions with respect to the organizational and medical hospital operations and (2) the leadership and management of the professional staff and teams.

An approach for estimating measurement uncertainty in medical laboratories using data from long-term quality control and external quality assessment schemes.

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Padoan, Andrea; Antonelli, Giorgia; Aita, Ada; Sciacovelli, Laura; Plebani, Mario

2017-10-26

The present study was prompted by the ISO 15189 requirements that medical laboratories should estimate measurement uncertainty (MU). The method used to estimate MU included the: a) identification of quantitative tests, b) classification of tests in relation to their clinical purpose, and c) identification of criteria to estimate the different MU components. Imprecision was estimated using long-term internal quality control (IQC) results of the year 2016, while external quality assessment schemes (EQAs) results obtained in the period 2015-2016 were used to estimate bias and bias uncertainty. A total of 263 measurement procedures (MPs) were analyzed. On the basis of test purpose, in 51 MPs imprecision only was used to estimate MU; in the remaining MPs, the bias component was not estimable for 22 MPs because EQAs results did not provide reliable statistics. For a total of 28 MPs, two or more MU values were calculated on the basis of analyte concentration levels. Overall, results showed that uncertainty of bias is a minor factor contributing to MU, the bias component being the most relevant contributor to all the studied sample matrices. The model chosen for MU estimation allowed us to derive a standardized approach for bias calculation, with respect to the fitness-for-purpose of test results. Measurement uncertainty estimation could readily be implemented in medical laboratories as a useful tool in monitoring the analytical quality of test results since they are calculated using a combination of both the long-term imprecision IQC results and bias, on the basis of EQAs results.

Record of the first meeting of the working group, London, 6-7 December 1977 (includes terms of reference)

International Nuclear Information System (INIS)

The items discussed include the presentation and adoption of the Group Working Paper on: terms of reference, prime objectives, topics and assessments, criteria for proliferation resistance, the organization of the Group, including the establishment of two sub-groups, schedule of work, assignment of work to be done, and the contributions to be made by international organizations

Primary hydatid disease of the femur: unsuspected and incidental MRI findings with long-term curative results on medical treatment alone

International Nuclear Information System (INIS)

Poyanli, A.; Sencer, S.; Akan, K.; Poyanli, O.; Sayrak, H.

2001-01-01

This report describes the early magnetic resonance imaging (MRI) findings and long-term follow-up results of albendazole treatment in a 16-year-old girl with primary hydatid disease of the femur diagnosed incidentally during the course of a post-traumatic knee infection. As far as we know, this is the first report of the early MRI findings and long-term outcome of medical treatment in primary hydatid disease of the femur in this age group. (orig.)

Primary hydatid disease of the femur: unsuspected and incidental MRI findings with long-term curative results on medical treatment alone

Energy Technology Data Exchange (ETDEWEB)

Poyanli, A.; Sencer, S. [Dept. of Radiology, Istanbul Faculty of Medicine (Turkey); Akan, K.; Poyanli, O. [Dept. of Orthopaedics and Traumatology, Goeztepe SSK Educational Hospital, Istanbul (Turkey); Sayrak, H. [Dept. of Pathology, Goeztepe SSK Educational Hospital, Istanbul (Turkey)

2001-11-01

This report describes the early magnetic resonance imaging (MRI) findings and long-term follow-up results of albendazole treatment in a 16-year-old girl with primary hydatid disease of the femur diagnosed incidentally during the course of a post-traumatic knee infection. As far as we know, this is the first report of the early MRI findings and long-term outcome of medical treatment in primary hydatid disease of the femur in this age group. (orig.)

Long-Term Follow-Up Study of Young Adults Treated for Unilateral Complete Cleft Lip, Alveolus, and Palate by a Treatment Protocol Including Two-Stage Palatoplasty: Speech Outcomes

Directory of Open Access Journals (Sweden)

Isabelle Francisca Petronella Maria Kappen

2017-05-01

Full Text Available BackgroundNo consensus exists on the optimal treatment protocol for orofacial clefts or the optimal timing of cleft palate closure. This study investigated factors influencing speech outcomes after two-stage palate repair in adults with a non-syndromal complete unilateral cleft lip and palate (UCLP.MethodsThis was a retrospective analysis of adult patients with a UCLP who underwent two-stage palate closure and were treated at our tertiary cleft centre. Patients ≥17 years of age were invited for a final speech assessment. Their medical history was obtained from their medical files, and speech outcomes were assessed by a speech pathologist during the follow-up consultation.ResultsForty-eight patients were included in the analysis, with a mean age of 21 years (standard deviation, 3.4 years. Their mean age at the time of hard and soft palate closure was 3 years and 8.0 months, respectively. In 40% of the patients, a pharyngoplasty was performed. On a 5-point intelligibility scale, 84.4% received a score of 1 or 2; meaning that their speech was intelligible. We observed a significant correlation between intelligibility scores and the incidence of articulation errors (P<0.001. In total, 36% showed mild to moderate hypernasality during the speech assessment, and 11%–17% of the patients exhibited increased nasalance scores, assessed through nasometry.ConclusionsThe present study describes long-term speech outcomes after two-stage palatoplasty with hard palate closure at a mean age of 3 years old. We observed moderate long-term intelligibility scores, a relatively high incidence of persistent hypernasality, and a high pharyngoplasty incidence.

Long-Term Follow-Up Study of Young Adults Treated for Unilateral Complete Cleft Lip, Alveolus, and Palate by a Treatment Protocol Including Two-Stage Palatoplasty: Speech Outcomes

Science.gov (United States)

Bittermann, Dirk; Janssen, Laura; Bittermann, Gerhard Koendert Pieter; Boonacker, Chantal; Haverkamp, Sarah; de Wilde, Hester; Van Der Heul, Marise; Specken, Tom FJMC; Koole, Ron; Kon, Moshe; Breugem, Corstiaan Cornelis; Mink van der Molen, Aebele Barber

2017-01-01

Background No consensus exists on the optimal treatment protocol for orofacial clefts or the optimal timing of cleft palate closure. This study investigated factors influencing speech outcomes after two-stage palate repair in adults with a non-syndromal complete unilateral cleft lip and palate (UCLP). Methods This was a retrospective analysis of adult patients with a UCLP who underwent two-stage palate closure and were treated at our tertiary cleft centre. Patients ≥17 years of age were invited for a final speech assessment. Their medical history was obtained from their medical files, and speech outcomes were assessed by a speech pathologist during the follow-up consultation. Results Forty-eight patients were included in the analysis, with a mean age of 21 years (standard deviation, 3.4 years). Their mean age at the time of hard and soft palate closure was 3 years and 8.0 months, respectively. In 40% of the patients, a pharyngoplasty was performed. On a 5-point intelligibility scale, 84.4% received a score of 1 or 2; meaning that their speech was intelligible. We observed a significant correlation between intelligibility scores and the incidence of articulation errors (P<0.001). In total, 36% showed mild to moderate hypernasality during the speech assessment, and 11%–17% of the patients exhibited increased nasalance scores, assessed through nasometry. Conclusions The present study describes long-term speech outcomes after two-stage palatoplasty with hard palate closure at a mean age of 3 years old. We observed moderate long-term intelligibility scores, a relatively high incidence of persistent hypernasality, and a high pharyngoplasty incidence. PMID:28573094

The long-term environmental and medical effects of nuclear war

International Nuclear Information System (INIS)

1986-03-01

Part 1 describes the physical structure of the atmosphere and reviews recent studies which have considered the atmospheric perturbations which could follow a nuclear war according to various scenarios. Part 2 describes the biological consequences of predicted atmospheric and climatic changes, concentrating on the long term implications for health and human well- being. Part 3 outlines some policy implications arising out of these environmental consequences and includes the conclusions and a summary of the report. (author)

Impact of chronic kidney disease on long-term ischemic and bleeding outcomes in medically managed patients with acute coronary syndromes

DEFF Research Database (Denmark)

Melloni, Chiara; Cornel, Jan H; Hafley, Gail

2016-01-01

AIMS: We aimed to study the relationship of chronic kidney disease stages with long-term ischemic and bleeding outcomes in medically managed acute coronary syndrome patients and the influence of more potent antiplatelet therapies on platelet reactivity by chronic kidney disease stage. METHODS...... AND RESULTS: We estimated creatinine clearance for 8953 medically managed acute coronary syndrome patients enrolled in the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes trial. Patients were classified by chronic kidney disease stage: normal renal...... function/mild (creatinine clearance >60 mL/min); moderate (creatinine clearance 30-60 mL/min); severe (creatinine clearance event rates through 30 months were evaluated for ischemic (cardiovascular death, myocardial infarction or stroke; primary end point) and bleeding (Global Use...

Medical Business Ethics in the XXI century

International Nuclear Information System (INIS)

Moya Pueyo, V.

2009-01-01

Since ancient times the medical professional practice included moral rules in order to assure a correct approach of capital problems. These rules evolve and are now gathered in the Deontological Codes watching the Constitution and other higher Laws. There has been an increase of interest for none strictly clinical matter since the appearance of the term Bioethics. The book Deontologia medica en el siglo XXI tackles problems of first interest in the present times, thru statistics and analysis, trying to help the medical doctors that have to take ethic decisions. (Author)

Medical ethics in peace and in the armed conflict.

Science.gov (United States)

Schapowal, Andreas G; Baer, Hans-Ulrich

2002-08-01

Global medical ethics on the basis of the General Declaration of Human Rights by the United Nations is a key subject for the 21st century. World Health Organization's new definition of health includes "spiritual health," a term that has to be defined in international consensus despite different anthropologies, cultures, and religions. Old issues in medical ethics such as assisted suicide are still waiting for global consensus among the "pro-life" and "pro-choice" parties. So far The Netherlands and Belgium are the only countries where euthanasia has been legalized, whereas the U.S. Supreme Court has denied a right of medically assisted suicide. The respect of nature is also the basis for guidelines in new issues in medical ethics such as gene therapy and human cloning, which are controversially discussed. Military medical ethics should provide regulations for morally correct decisions in armed conflicts including the war against international terrorism and in peacekeeping missions. Triage of the wounded, distribution of medical aid, and critical incident stress debriefing for soldiers and their relatives are key issues.

General practitioners' views on (long-term) prescription and use of problematic and potentially inappropriate medication for oldest-old patients-A qualitative interview study with GPs (CIM-TRIAD study).

Science.gov (United States)

Pohontsch, Nadine Janis; Heser, Kathrin; Löffler, Antje; Haenisch, Britta; Parker, Debora; Luck, Tobias; Riedel-Heller, Steffi G; Maier, Wolfgang; Jessen, Frank; Scherer, Martin

2017-02-17

Potentially inappropriate medication (PIM) is defined as medication with uncertain therapeutic effects and/or potential adverse drug reactions outweighing the clinical benefits. The prescription rate of PIM for oldest-old patients is high despite the existence of lists of PIM (e.g. the PRISCUS list) and efforts to raise awareness. This study aims at identifying general practitioners' views on PIM and aspects affecting the (long-term) use of PIM. As part of the CIM-TRIAD study, we conducted semi-structured, qualitative interviews with 47 general practitioners, discussing 25 patients with and 22 without PIM (according to the PRISCUS list). The interview guideline included generic and patient-specific questions. Interviews were digitally recorded and transcribed verbatim. We content analyzed the interviews using deductive and inductive category development. The majority of the general practitioners were not aware of the PRISCUS list. Agents deemed potentially inappropriate from the general practitioners' point of view and the PRISCUS list are not completely superimposable. General practitioners named their criteria to identify appropriate medication for elderly patients (e.g. renal function, cognitive state) and emphasized the importance of monitoring. We identified prescription- (e.g. benzodiazepines on alternative private prescription), medication- (e.g. subjective perception that PIM has no alternative), general practitioner- (e.g. general practitioner relies on specialists), patient- (e.g. "demanding high-user", positive subjective benefit-risk-ratio) and system-related aspects (e.g. specialists lacking holistic view, interface problems) related to the (long term) use of PIM. While the PRISCUS list does not seem to play a decisive role in general practice, general practitioners are well aware of risks associated with PIM. Our study identifies some starting points for a safer handling of PIM, e.g. stronger dissemination of the PRISCUS list, better compensation of

Glossary of medical English. Language trainer and dictionary

International Nuclear Information System (INIS)

Friedbichler, I.; Friedbichler, M.

2003-01-01

Content divided into the following parts: Basic medical terms; health care; body structures and functions; complex body functions; medical science; clinical terms. Use illustrated by means of examples. Appendix: Index of english terms and abbreviations and of german terms

Pseudospin symmetry in the relativistic Manning-Rosen potential including a Pekeris-type approximation to the pseudo-centrifugal term

International Nuclear Information System (INIS)

Wei Gaofeng; Dong Shihai

2010-01-01

Based on the Sturm-Liouville theorem and shape invariance formalism, we study by applying a Pekeris-type approximation to the pseudo-centrifugal term the pseudospin symmetry of a Dirac nucleon subjected to scalar and vector Manning-Rosen potentials including the spin-orbit coupling term. A quartic energy equation and spinor wave functions with arbitrary spin-orbit coupling quantum number k are presented. The bound states are calculated numerically. The relativistic Manning-Rosen potential could not trap a Dirac nucleon in the limit case β→∞.

International short-term medical missions: a systematic review of recommended practices.

Science.gov (United States)

Roche, Stephanie D; Ketheeswaran, Pavinarmatha; Wirtz, Veronika J

2017-01-01

To identify practices for conducting international short-term medical missions (STMMs) recommended in the literature and examine how these link STMMs to recipient countries' existing health systems. Systematic review of PubMed-indexed articles on STMMs and their bibliographies using preferred reporting items for systematic reviews and meta-analyses guidelines. Recommendations were organized using the World Health Organization Health Systems Framework. In 92 publications, 67 % offered at least one recommendation that would link STMMs to the recipient country's health system. Among these recommendations, most focused on service delivery and few on health financing and governance. There is a lack of consensus around a proper standard of care, patient selection, and trip duration. Comprehensive global standards are needed for STMM work to ensure that services are beneficial both to patients and to the broader healthcare systems of recipient countries. By providing an overview of the current recommendations and important gaps where practice recommendations are needed, this study can provide relevant input into the development of global standards for STMMs.

Finding Important Terms for Patients in Their Electronic Health Records: A Learning-to-Rank Approach Using Expert Annotations

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Zheng, Jiaping; Yu, Hong

2016-01-01

Background Many health organizations allow patients to access their own electronic health record (EHR) notes through online patient portals as a way to enhance patient-centered care. However, EHR notes are typically long and contain abundant medical jargon that can be difficult for patients to understand. In addition, many medical terms in patients’ notes are not directly related to their health care needs. One way to help patients better comprehend their own notes is to reduce information overload and help them focus on medical terms that matter most to them. Interventions can then be developed by giving them targeted education to improve their EHR comprehension and the quality of care. Objective We aimed to develop a supervised natural language processing (NLP) system called Finding impOrtant medical Concepts most Useful to patientS (FOCUS) that automatically identifies and ranks medical terms in EHR notes based on their importance to the patients. Methods First, we built an expert-annotated corpus. For each EHR note, 2 physicians independently identified medical terms important to the patient. Using the physicians’ agreement as the gold standard, we developed and evaluated FOCUS. FOCUS first identifies candidate terms from each EHR note using MetaMap and then ranks the terms using a support vector machine-based learn-to-rank algorithm. We explored rich learning features, including distributed word representation, Unified Medical Language System semantic type, topic features, and features derived from consumer health vocabulary. We compared FOCUS with 2 strong baseline NLP systems. Results Physicians annotated 90 EHR notes and identified a mean of 9 (SD 5) important terms per note. The Cohen’s kappa annotation agreement was .51. The 10-fold cross-validation results show that FOCUS achieved an area under the receiver operating characteristic curve (AUC-ROC) of 0.940 for ranking candidate terms from EHR notes to identify important terms. When including term

Impact of cardiovascular risk factors on medical expenditure: evidence from epidemiological studies analysing data on health checkups and medical insurance.

Science.gov (United States)

Nakamura, Koshi

2014-01-01

Concerns have increasingly been raised about the medical economic burden in Japan, of which approximately 20% is attributable to cardiovascular disease, including coronary heart disease and stroke. Because the management of risk factors is essential for the prevention of cardiovascular disease, it is important to understand the relationship between cardiovascular risk factors and medical expenditure in the Japanese population. However, only a few Japanese epidemiological studies analysing data on health checkups and medical insurance have provided evidence on this topic. Patients with cardiovascular risk factors, including obesity, hypertension, and diabetes, may incur medical expenditures through treatment of the risk factors themselves and through procedures for associated diseases that usually require hospitalization and sometimes result in death. Untreated risk factors may cause medical expenditure surges, mainly due to long-term hospitalization, more often than risk factors preventively treated by medication. On an individual patient level, medical expenditures increase with the number of concomitant cardiovascular risk factors. For single risk factors, personal medical expenditure may increase with the severity of that factor. However, on a population level, the medical economic burden attributable to cardiovascular risk factors results largely from a single, particularly prevalent risk factor, especially from mildly-to-moderately abnormal levels of the factor. Therefore, cardiovascular risk factors require management on the basis of both a cost-effective strategy of treating high-risk patients and a population strategy for reducing both the ill health and medical economic burdens that result from cardiovascular disease.

Synonymy in the English-origin Romanian Medical Terminology

Directory of Open Access Journals (Sweden)

Oana BADEA

2013-01-01

Full Text Available The Romanian medical terminology has been enriched quite a lot lately. This phenomena was not only due to the significant influence of the English language, but also because of the relationships developed between the already existing terms and the new ones. Thus, the present study comprises the analysis on Romanian medical terms of Englsih origin and their native synonymous correspondents in the Romanian medical terminology. The dictionnaries used to select the synonymous pairs of medical terms were the Medical Dictionary (2010 and The Great Dictionary of Neologisms (2008

Towards a collaborative filtering approach to medication reconciliation.

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Hasan, Sharique; Duncan, George T; Neill, Daniel B; Padman, Rema

2008-11-06

A physicians prescribing decisions depend on knowledge of the patients medication list. This knowledge is often incomplete, and errors or omissions could result in adverse outcomes. To address this problem, the Joint Commission recommends medication reconciliation for creating a more accurate list of a patients medications. In this paper, we develop techniques for automatic detection of omissions in medication lists, identifying drugs that the patient may be taking but are not on the patients medication list. Our key insight is that this problem is analogous to the collaborative filtering framework increasingly used by online retailers to recommend relevant products to customers. The collaborative filtering approach enables a variety of solution techniques, including nearest neighbor and co-occurrence approaches. We evaluate the effectiveness of these approaches using medication data from a long-term care center in the Eastern US. Preliminary results suggest that this framework may become a valuable tool for medication reconciliation.

Research-oriented medical education for graduate medical students.

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Deo, Madhav G

2013-01-01

In most parts of the world, medical education is predominantly geared to create service personnel for medical and health services. Training in research is ignored, which is a major handicap for students who are motivated to do research. The main objective of this study was to develop, for such students, a cost-effective 'in-study' research training module that could be adopted even by medical colleges, which have a modest research infrastructure, in different regions of India. Short-duration workshops on the clinical and laboratory medicine research methods including clinical protocol development were held in different parts of India to facilitate participation of students from various regions. Nine workshops covering the entire country were conducted between July 2010 and December 2011. Participation was voluntary and by invitation only to the recipients of the Indian Council of Medical Research-Short-term Studentship programme (ICMR- STS), which was taken as an index of students' research motivation. Faculty was drawn from the medical institutions in the region. All expenses on students, including their travel, and that of the faculty were borne by the academy. Impact of the workshop was judged by the performance of the participants in pre- and post-workshop tests with multiple-choice questions (MCQs) containing the same set of questions. There was no negative marking. Anonymous student feedback was obtained using a questionnaire. Forty-one per cent of the 1009 invited students attended the workshops. These workshops had a positive impact on the participants. Only 20% students could pass and just 2.3% scored >80% marks in the pre-workshop test. There was a three-fold increase in the pass percentage and over 20% of the participants scored >80% marks (A grade) in the post-workshop test. The difference between the pre- and post- workshop performance was statistically significant at all the centres. In the feedback from participants, the workshop received an average

Profile of graduates of Israeli medical schools in 1981--2000: educational background, demography and evaluation of medical education programs.

Science.gov (United States)

Bitterman, Noemi; Shalev, Ilana

2005-05-01

In light of changes in the medical profession, the different requirements placed on physicians and the evolving needs of the healthcare system, the need arose to examine the medical education curriculum in Israel. This survey, conducted by the Samuel Neaman Institute for Science and Technology, summarizes 20 years of medical education in Israel's four medical schools, as the first stage in mapping the existing state of medical education in Israel and providing a basis for decision-making on future medical education programs. To characterize the academic background of graduates, evaluate their attitudes towards current and alternative medical education programs, and examine subgroups among graduates according to gender, medical school, high school education, etc. The survey included graduates from all four Israeli medical schools who graduated between the years 1981 and 2000 in a sample of 1:3. A questionnaire and stamped return envelope were sent to every third graduate; the questionnaire included open and quantitative questions graded on a scale of 1 to 5. The data were processed for the entire graduate population and further analyzed according to subgroups such as medical schools, gender, high school education, etc. The response rate was 41.3%. The survey provided a demographic profile of graduates over a 20 year period, their previous educational and academic background, additional academic degrees achieved, satisfaction, and suggestions for future medical education programs. The profile of the medical graduates in Israel is mostly homogenous in terms of demographics, with small differences among the four medical schools. In line with recommendations of the graduates, and as an expression of the changing requirements in the healthcare system and the medical profession, the medical schools should consider alternative medical education programs such as a bachelor's degree in life sciences followed by MD studies, or education programs that combine medicine with

Combined Racial and Gender Differences in the Long-Term Predictive Role of Education on Depressive Symptoms and Chronic Medical Conditions.

Science.gov (United States)

Assari, Shervin

2017-06-01

Despite a well-established literature on the protective effect of education on health, less is known about group differences in the mechanisms underlying this association. Using a life course approach and cumulative advantage theory, this study compared Black men, Black women, White men, and White women to assess the long-term gradient (education as a continuous measure) and threshold (>12 years) effects of baseline education on change in chronic medical conditions (CMC) and depressive symptoms (DS) from baseline to 25 years later. Data came from the Americans' Changing Lives Study, 1986-2011. The study followed Black and White respondents for up to 25 years, among whom 1271 individuals who had survived and were under follow-up were interviewed in 2011 and reported their number of chronic medical conditions and depressive symptoms (Center for Epidemiological Studies-Depression; CES-D 11). Multi-group structural equation modeling was used to compare gradient and threshold effects of education on change in chronic medical conditions and depressive symptoms from baseline (1986) to 25 years later (2011) among Black men, Black women, White men, and White women. There were group differences in the long-term association between education measured as a gradient and the change in depressive symptoms and chronic medical conditions during the follow-up, and in the association between education measured at the threshold of 12 years on change in depressive symptoms from baseline to follow-up. However, the association between education measured at this threshold and change in chronic medical conditions did not differ across race-gender groups. With the exception of Black men, who showed a gradient protective effect for baseline education against increase in the number of chronic medical associations (threshold or gradient) with change in chronic medical conditions. Among White men and White women, education had a threshold protective effect against increase in depressive

Comparing the Long-Term Retention of a Physiology Course for Medical Students with the Traditional and Problem-Based Learning

Science.gov (United States)

Pourshanazari, A. A.; Roohbakhsh, A.; Khazaei, M.; Tajadini, H.

2013-01-01

The rapid improvements in medical sciences and the ever-increasing related data, however, require novel methods of instruction. One such method, which has been given less than due attention in Iran, is problem-based learning (PBL). In this study, we aimed to evaluate the impact of study skills and the PBL methods on short and long-term retention…

A Fifth Option for Funding Long-Term Care in Canada - Shift the Resources from Medical Treatment and Universal Pension Entitlements.

Science.gov (United States)

Emery, J C Herbert

2016-01-01

Needs for non-medical residential care services, long-term care (LTC), will increase over the next 30 years as Canada's population ages. Adams and Vanin (2016) explore four options for raising the public and private monies required to meet LTC needs. In this commentary, I raise a fifth option for finding the resources to meet emerging LTC needs. An alternative approach is to divert resources from Canada's well-resourced, but inefficient, medical treatment system. The dividend of provinces pursuing long overdue reforms to medicare is the liberation of public funds to finance emerging priorities for Canadians like LTC.

Prospective evaluation of dermatologic surgery complications including patients on multiple antiplatelet and anticoagulant medications.

Science.gov (United States)

Bordeaux, Jeremy S; Martires, Kathryn J; Goldberg, Dori; Pattee, Sean F; Fu, Pingfu; Maloney, Mary E

2011-09-01

Few prospective studies have evaluated the safety of dermatologic surgery. We sought to determine rates of bleeding, infection, flap and graft necrosis, and dehiscence in outpatient dermatologic surgery, and to examine their relationship to type of repair, anatomic location of repair, antibiotic use, antiplatelet use, or anticoagulant use. Patients presenting to University of Massachusetts Medical School Dermatology Clinic for surgery during a 15-month period were prospectively entered. Medications, procedures, and complications were recorded. Of the 1911 patients, 38% were on one anticoagulant or antiplatelet medication, and 8.0% were on two or more. Risk of hemorrhage was 0.89%. Complex repair (odds ratio [OR] = 5.80), graft repair (OR = 7.58), flap repair (OR = 11.93), and partial repair (OR = 43.13) were more likely to result in bleeding than intermediate repair. Patients on both clopidogrel and warfarin were 40 times more likely to have bleeding complications than all others (P = .03). Risk of infection was 1.3%, but was greater than 3% on the genitalia, scalp, back, and leg. Partial flap necrosis occurred in 1.7% of flaps, and partial graft necrosis occurred in 8.6% of grafts. Partial graft necrosis occurred in 20% of grafts on the scalp and 10% of grafts on the nose. All complications resolved without sequelae. The study was limited to one academic dermatology practice. The rate of complications in dermatologic surgery is low, even when multiple oral anticoagulant and antiplatelet medications are continued, and prophylactic antibiotics are not used. Closure type and use of warfarin or clopidogrel increase bleeding risk. However, these medications should be continued to avoid adverse thrombotic events. Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Adverse effects and Drug Interactions Associated with Inhaled Recreational and Medical Marijuana

Directory of Open Access Journals (Sweden)

Maisha Kelly Freeman

2016-06-01

Full Text Available Objectives: To provide an overview of the addiction potential; adverse effects (e.g., cardiovascular, immune dysfunction, respiratory system, mental health disorders; drug interactions; effects of accidental exposure; crime statistics; and pharmacist’s considerations for the use of inhaled medical marijuana. Methods: A PubMed search was conducted from 1966 to March 2016 to identify articles in which the safety of inhaled medical marijuana was assessed. Key MeSH search terms included medical marijuana with a subheading for adverse effect. Only articles in adult patients were considered. In addition, medical marijuana or cannabis plus one of the following search terms were searched: drug interactions, herb-drug interactions, drug-related side effects and adverse drug reactions, substance-related disorders, addiction, and abuse. A free-text search was also conducted to identify articles not included in the MeSH term search. A bibliographic search was also conducted. Articles were included if they addressed adverse effects of medical marijuana for the treatment of a condition. Meta-analyses, randomized controlled clinical trials, and case reports were included in the review if the primary focus of the article related to the adverse effect profile of inhaled medical marijuana. Medical marijuana efficacy studies were not assessed. In the absence of this information, case reports or reports of inhaled recreational marijuana use was used. Studies were excluded if published in languages other than English. In addition, studies highlighting mechanisms of action, studies of pharmacodynamics or pharmacokinetic effects were excluded, unless these effects were due to drug-drug interactions. Prescription products containing marijuana or derivatives were excluded from evaluation. An Internet search was conducted to locate the most up-to-date information on the laws concerning medical marijuana. Key findings: A PubMed search revealed 58 articles and 28 of

Long-term Primary Medical Therapy with Somatostatin Analogs in Acromegaly

Directory of Open Access Journals (Sweden)

Deng-Huang Su

2006-01-01

Full Text Available To cure acromegalic patients, transsphenoidal surgery is considered first, especially for microadenoma. However, less than 50% of patients with macroadenoma achieve satisfactory biochemical control. Moreover, surgery may cause hypopituitarism. Medical therapy may offer the prospect of near normalization of growth hormone (GH/insulin-like growth factor-1 levels with substantial tumor shrinkage in a significant number of patients. Here, we report two cases of acromegaly under treatment with somato-statin analogs alone for more than 10 years. Case 1 was a 54-year-old man with a pituitary macro-adenoma. He received 4 years of octreotide treatment followed by 6 years of prolonged-release (PR lanreotide resulting in normal GH level. Case 2 was a 60-year-old woman with a 1.3 cm pituitary tumor. She received 8 years of octreotide treatment followed by 6 years of PR lanreotide resulting in subnormal GH level and gallbladder sludge. She had received bilateral total hip replacement for hip osteoarthritis at the age of 59 years. These cases illustrate that long-term treatment with somatostatin analogs offers an alternative choice in selected acromegalic patients, such as those with pituitary tumor who cannot be cured by surgery, those who have unacceptable anesthetic risk and those who refuse surgery.

Medical exposures requirements, present situation and prospects

International Nuclear Information System (INIS)

Cardenas Herrera, Juan

2012-01-01

Scope of medical exposures is studied, these include: exposure to patients as part of their diagnosis or treatment, exposures to persons who knowingly have assisted patients, exposures volunteers included in biomedical research programs. Medical exposures have contributed their benefits for human health improvement: possess a necessary character that people have to be exposed to radiation doses to achieve their goals, convergence of risk and benefit in the same individual is presented, variability is implicated in dose given to patients in terms of size and distribution, have contributed significantly to the doses received by the world population. Despite the above attributes and generally contribute to the direct benefit of the patient, long has been given less attention than other forms of exposure, there still potential for dose reduction to patients as a result of the applications of ionizing radiation. Currently have used for nuclear medicine diagnostic x-ray procedures, exams MN, radiotherapy, tomography, both medical and dental radiology. (author) [es

Long-term effects of an educational intervention on self-medication and appropriate drug use in single-sex secondary public schools, Quito, Ecuador.

Science.gov (United States)

Maldonado, Juan-Carlos; Meléndez, Sergio D; Figueras, Albert

2007-01-01

*Self-medication is extensively practised in both developed and less-developed countries, sometimes inappropriately. *Educational intervention in secondary schools has been proven to be useful. *Most educational interventions in adolescent populations have focused on the reduction of addictive substance abuse. *Educational intervention can improve knowledge about self-medication and reduce misconceptions about diarrhoea, common cold and vitamins in an adolescent population. *A specific lecture followed by small working-group seminars produces better results than a general lecture alone in terms of 'knowledge' and 'attitude'. *The positive effects of the intervention are detectable even 1 year later. Yearly reinforcing interventions while in secondary school would allow long-lasting effects. Improving knowledge about rational drug use at an early age may be a good way to increase the population's awareness of health, medicines and self-medication. We set out to evaluate the short- and long-term effects of an educational intervention to promote rational drug use and self-medication in secondary school students. A non-randomized, controlled clinical trial. The participants were 367 female students (10-13 years old) from two secondary public schools of the metropolitan district of Quito (Ecuador). The educational campaign had two components [a specific lecture (intervention and control schools) and subsequent small working group seminars (intervention school)] providing short and clear messages of five topics related to rational drug use. The main outcome measures were an increase in 'knowledge' short term (1 month) and long term (up to 1 year) after intervention and the relative risk (RR) reduction in misconceptions or wrong ideas about medicine use. The intervention group showed a significant increase in knowledge both short and long term and in comparison with the control group, mainly regarding oral rehydration salts preparation (+59.4%; P < 0.001), lack of

A nonlinear model for fluid flow in a multiple-zone composite reservoir including the quadratic gradient term

International Nuclear Information System (INIS)

Wang, Xiao-Lu; Fan, Xiang-Yu; Nie, Ren-Shi; Huang, Quan-Hua; He, Yong-Ming

2013-01-01

Based on material balance and Darcy's law, the governing equation with the quadratic pressure gradient term was deduced. Then the nonlinear model for fluid flow in a multiple-zone composite reservoir including the quadratic gradient term was established and solved using a Laplace transform. A series of standard log–log type curves of 1-zone (homogeneous), 2-zone and 3-zone reservoirs were plotted and nonlinear flow characteristics were analysed. The type curves governed by the coefficient of the quadratic gradient term (β) gradually deviate from those of a linear model with time elapsing. Qualitative and quantitative analyses were implemented to compare the solutions of the linear and nonlinear models. The results showed that differences of pressure transients between the linear and nonlinear models increase with elapsed time and β. At the end, a successful application of the theoretical model data against the field data shows that the nonlinear model will be a good tool to evaluate formation parameters more accurately. (paper)

Medical treatment of radiation injuries-Current US status

Energy Technology Data Exchange (ETDEWEB)

Jarrett, D.G. [OSA - CBD and CDP, 3050 Defense Pentagon, Room 3C257, Washington, DC 20301-3050 (United States)], E-mail: david.jarrett@us.army.mil; Sedlak, R.G.; Dickerson, W.E. [Uniformed Services University, Armed Forces Radiobiology Research Institute, 8901 Wisconsin Avenue, Bethesda, MD 20889-5603 (United States); Reeves, G.I. [Northrop Grumman IT, 8211 Terminal Road, Lorton, VA 22079-1421 (United States)

2007-07-15

A nuclear incident or major release of radioactive materials likely would result in vast numbers of patients, many of whom would require novel therapy. Fortunately, the numbers of radiation victims in the United States (USA) have been limited to date. If a mass-casualty situation occurs, there will be a need to perform rapid, accurate dose estimates and to provide appropriate medications and other treatment to ameliorate radiation injury. The medical management of radiation injury is complex. Radiation injury may include acute radiation sickness (ARS) from external and/or internal radiation exposure, internal organ damage from incorporated radioactive isotopes, and cutaneous injury. Human and animal data have shown that optimal medical care may nearly double the survivable dose of ionizing radiation. Current treatment strategies for radiation injuries are discussed with concentration on the medical management of the hematopoietic syndrome. In addition, priority areas for continuing and future research into both acute deterministic injuries and also long-term stochastic sequelae of radiation exposure have been identified. There are several near-term novel therapies that appear to offer excellent prognosis for radiation casualties, and these are also described.

Linking CHHiP prostate cancer RCT with GP records: A study proposal to investigate the effect of co-morbidities and medications on long-term symptoms and radiotherapy-related toxicity

Directory of Open Access Journals (Sweden)

Agnieszka Lemanska

2017-06-01

Full Text Available Background: Patients receiving cancer treatment often have one or more co-morbid conditions that are treated pharmacologically. Co-morbidities are recorded in clinical trials usually only at baseline. However, co-morbidities evolve and new ones emerge during cancer treatment. The interaction between multi-morbidity and cancer recovery is significant but poorly understood. Purpose: To investigate the effect of co-morbidities (e.g. cardiovascular and diabetes and medications (e.g. statins, antihypertensives, metformin on radiotherapy-related toxicity and long-term symptoms in order to identify potential risk factors. The possible protective effect of medications such as statins or antihypertensives in reducing radiotherapy-related toxicity will also be explored. Methods: Two datasets will be linked. (1 CHHiP (Conventional or Hypofractionated High Dose Intensity Modulated Radiotherapy for Prostate Cancer randomised control trial. CHHiP contains pelvic symptoms and radiation-related toxicity reported by patients and clinicians. (2 GP (General Practice data from RCGP RSC (Royal College of General Practitioners Research and Surveillance Centre. The GP records of CHHiP patients will be extracted, including cardiovascular co-morbidities, diabetes and prescription medications. Statistical analysis of the combined dataset will be performed in order to investigate the effect. Conclusions: Linking two sources of healthcare data is an exciting area of big healthcare data research. With limited data in clinical trials (not all clinical trials collect information on co-morbidities or medications and limited lengths of follow-up, linking different sources of information is increasingly needed to investigate long-term outcomes. With increasing pressures to collect detailed information in clinical trials (e.g. co-morbidities, medications, linkage to routinely collected data offers the potential to support efficient conduct of clinical trials. Keywords: Data

Randomized Comparison of Isosorbide Mononitrate and PGE2 Gel for Cervical Ripening at Term including High Risk Pregnancy

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Kavita Agarwal

2014-01-01

Full Text Available Aims. Prostaglandin E2 is the most commonly used drug for cervical ripening prior to labour induction. However, there are concerns regarding uterine tachysystole and nonreassuring fetal heart (N-RFH. Isosorbide mononitrate (IMN has been used successfully for cervical ripening. The present study was conducted to compare the two drugs for cervical ripening at term in hospital. Methods. Two hundred women with term pregnancies referred for induction of labour with Bishop score less than 6 were randomly allocated to receive either 40 mg IMN tablet vaginally (n=100 or 0.5 mg PGE2 gel intracervically (n=100. Adverse effects, progress, and outcomes of labour were assessed. Results. PGE2 group had significantly higher postripening mean Bishop score, shorter time from start of medication to vaginal delivery (13.37 ± 10.67 hours versus 30.78 ± 17.29 hours, and shorter labour-delivery interval compared to IMN group (4.53 ± 3.97 hours versus 7.34 ± 5.51 hours. However, PGE2 group also had significantly higher incidence of uterine tachysystole (15% and N-RFH (11% compared to none in IMN group, as well as higher caesarean section rate (27% versus 17%. Conclusions. Cervical ripening with IMN was less effective than PGE2 but resulted in fewer adverse effects and was safer especially in high risk pregnancies.

Rewriting and suppressing UMLS terms for improved biomedical term identification

NARCIS (Netherlands)

K.M. Hettne (Kristina); E.M. van Mulligen (Erik); M.J. Schuemie (Martijn); R.J.A. Schijvenaars (Bob); J.A. Kors (Jan)

2010-01-01

textabstractBackground: Identification of terms is essential for biomedical text mining. We concentrate here on the use of vocabularies for term identification, specifically the Unified Medical Language System (UMLS). To make the UMLS more suitable for biomedical text mining we implemented and

Therminological problems in medical thermography

International Nuclear Information System (INIS)

Rozenfel'd, L.G.; Kolotilov, N.N.

1988-01-01

Some problems of medicotechnical terminology of clinical thermography are discussed. A short hystorical review of stages of the recovery of infrared rays and their medical application was given. An analysis of a number of terms is based on the rules of medical terminology and state standards. An obligatory use in literature of correct terms, mainly of the Greek and Latin origin, is proposed. Commonly used terms on the basis of modern anatomical terminology are recommended for thermogram description

Therminological problems in medical thermography

Energy Technology Data Exchange (ETDEWEB)

Rozenfel' d, L G; Kolotilov, N N

1988-01-01

Some problems of medicotechnical terminology of clinical thermography are discussed. A short hystorical review of stages of the recovery of infrared rays and their medical application was given. An analysis of a number of terms is based on the rules of medical terminology and state standards. An obligatory use in literature of correct terms, mainly of the Greek and Latin origin, is proposed. Commonly used terms on the basis of modern anatomical terminology are recommended for thermogram description.

Recommended standardized terminology of the anterior female pelvis based on a structured medical literature review.

Science.gov (United States)

Jeppson, Peter C; Balgobin, Sunil; Washington, Blair B; Hill, Audra Jolyn; Lewicky-Gaupp, Christina; Wheeler, Thomas; Ridgeway, Beri; Mazloomdoost, Donna; Balk, Ethan M; Corton, Marlene M; DeLancey, John

2018-07-01

The use of imprecise and inaccurate terms leads to confusion amongst anatomists and medical professionals. We sought to create recommended standardized terminology to describe anatomic structures of the anterior female pelvis based on a structured review of published literature and selected text books. We searched MEDLINE from its inception until May 2, 2016, using 11 medical subject heading terms to identify studies reporting on anterior female pelvic anatomy; any study type published in English was accepted. Nine textbooks were also included. We screened 12,264 abstracts, identifying 200 eligible studies along with 13 textbook chapters from which we extracted all pertinent anatomic terms. In all, 67 unique structures in the anterior female pelvis were identified. A total of 59 of these have been previously recognized with accepted terms in Terminologia Anatomica, the international standard on anatomical terminology. We also identified and propose the adoption of 4 anatomic regional terms (lateral vaginal wall, pelvic sidewall, pelvic bones, and anterior compartment), and 2 structural terms not included in Terminologia Anatomica (vaginal sulcus and levator hiatus). In addition, we identified 2 controversial terms (pubourethral ligament and Grafenberg spot) that require additional research and consensus from the greater medical and scientific community prior to adoption or rejection of these terms. We propose standardized terminology that should be used when discussing anatomic structures in the anterior female pelvis to help improve communication among researchers, clinicians, and surgeons. Copyright © 2018 Elsevier Inc. All rights reserved.

Intensive medical student involvement in short-term surgical trips provides safe and effective patient care: a case review

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Macleod Jana B

2011-09-01

Full Text Available Abstract Background The hierarchical nature of medical education has been thought necessary for the safe care of patients. In this setting, medical students in particular have limited opportunities for experiential learning. We report on a student-faculty collaboration that has successfully operated an annual, short-term surgical intervention in Haiti for the last three years. Medical students were responsible for logistics and were overseen by faculty members for patient care. Substantial planning with local partners ensured that trip activities supplemented existing surgical services. A case review was performed hypothesizing that such trips could provide effective surgical care while also providing a suitable educational experience. Findings Over three week-long trips, 64 cases were performed without any reported complications, and no immediate perioperative morbidity or mortality. A plurality of cases were complex urological procedures that required surgical skills that were locally unavailable (43%. Surgical productivity was twice that of comparable peer institutions in the region. Student roles in patient care were greatly expanded in comparison to those at U.S. academic medical centers and appropriate supervision was maintained. Discussion This demonstration project suggests that a properly designed surgical trip model can effectively balance the surgical needs of the community with an opportunity to expose young trainees to a clinical and cross-cultural experience rarely provided at this early stage of medical education. Few formalized programs currently exist although the experience above suggests the rewarding potential for broad-based adoption.

Body Implanted Medical Device Communications

Science.gov (United States)

Yazdandoost, Kamya Yekeh; Kohno, Ryuji

The medical care day by day and more and more is associated with and reliant upon concepts and advances of electronics and electromagnetics. Numerous medical devices are implanted in the body for medical use. Tissue implanted devices are of great interest for wireless medical applications due to the promising of different clinical usage to promote a patient independence. It can be used in hospitals, health care facilities and home to transmit patient measurement data, such as pulse and respiration rates to a nearby receiver, permitting greater patient mobility and increased comfort. As this service permits remote monitoring of several patients simultaneously it could also potentially decrease health care costs. Advancement in radio frequency communications and miniaturization of bioelectronics are supporting medical implant applications. A central component of wireless implanted device is an antenna and there are several issues to consider when designing an in-body antenna, including power consumption, size, frequency, biocompatibility and the unique RF transmission challenges posed by the human body. The radiation characteristics of such devices are important in terms of both safety and performance. The implanted antenna and human body as a medium for wireless communication are discussed over Medical Implant Communications Service (MICS) band in the frequency range of 402-405MHz.

The origins of medical physics.

Science.gov (United States)

Duck, Francis A

2014-06-01

The historical origins of medical physics are traced from the first use of weighing as a means of monitoring health by Sanctorius in the early seventeenth century to the emergence of radiology, phototherapy and electrotherapy at the end of the nineteenth century. The origins of biomechanics, due to Borelli, and of medical electricity following Musschenbroek's report of the Leyden Jar, are included. Medical physics emerged as a separate academic discipline in France at the time of the Revolution, with Jean Hallé as its first professor. Physiological physics flowered in Germany during the mid-nineteenth century, led by the work of Adolf Fick. The introduction of the term medical physics into English by Neil Arnott failed to accelerate its acceptance in Britain or the USA. Contributions from Newton, Euler, Bernoulli, Nollet, Matteucci, Pelletan, Gavarret, d'Arsonval, Finsen, Röntgen and others are noted. There are many origins of medical physics, stemming from the many intersections between physics and medicine. Overall, the early nineteenth-century definition of medical physics still holds today: 'Physics applied to the knowledge of the human body, to its preservation and to the cure of its illnesses'. Copyright © 2014 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Assessment of Medical Risks and Optimization of their Management using Integrated Medical Model

Science.gov (United States)

Fitts, Mary A.; Madurai, Siram; Butler, Doug; Kerstman, Eric; Risin, Diana

2008-01-01

The Integrated Medical Model (IMM) Project is a software-based technique that will identify and quantify the medical needs and health risks of exploration crew members during space flight and evaluate the effectiveness of potential mitigation strategies. The IMM Project employs an evidence-based approach that will quantify probability and consequences of defined in-flight medical risks, mitigation strategies, and tactics to optimize crew member health. Using stochastic techniques, the IMM will ultimately inform decision makers at both programmatic and institutional levels and will enable objective assessment of crew health and optimization of mission success using data from relevant cohort populations and from the astronaut population. The objectives of the project include: 1) identification and documentation of conditions that may occur during exploration missions (Baseline Medical Conditions List [BMCL), 2) assessment of the likelihood of conditions in the BMCL occurring during exploration missions (incidence rate), 3) determination of the risk associated with these conditions and quantify in terms of end states (Loss of Crew, Loss of Mission, Evacuation), 4) optimization of in-flight hardware mass, volume, power, bandwidth and cost for a given level of risk or uncertainty, and .. validation of the methodologies used.

Innovation in medical education: summer studentships.

Science.gov (United States)

Cleland, Jennifer; Engel, Naomi; Dunlop, Ross; Kay, Christine

2010-03-01

few doctors choose academic medicine as a career. Reasons suggested for this include a lack of exposure. Thus, we wished to broaden the opportunities available for undergraduate medical students to experience academic medicine, specifically medical education. The approach selected was to establish a programme of competitive Teaching Development Awards: the 'Summer Studentship Scheme'. this article describes the approach taken, including an overview of the organisation of the Summer Studentship Scheme, and provides preliminary data on gains from the programme. Twenty studentships were funded over a 3-year period. The projects covered a wide range of topics. Information on what the students gained from the projects and supervisor views of the programme were sought by questionnaire and self-reflective statements. the academic gains to date include nine presentations at national conferences and four published papers. All student respondents (87%) agreed that they would recommend a summer studentship to another student. Supervising a studentship (86% response rate) was seen as a positive experience. a relatively small level of funding can lead to great gains, in terms of academic output, internally, and in terms of external dissemination, as well as in gains to participating students and staff. We plan to track the career developments of participating students to see if they are more likely to pursue academic medicine as their peers. Blackwell Publishing Ltd 2010.

["Vocational perspective"--short-term efficacy of a group treatment for patients with extensive work-related problems during medical rehabilitation].

Science.gov (United States)

Bönisch, A; Dorn, M; Ehlebracht-König, I

2012-01-01

To analyze the short-term efficacy of the Vocational Perspective programme for patients identified as having extensive work-related problems during rheumatology or orthopaedic inpatient rehabilitation. The primary objectives of the programme on patient level are to convey information about the legal provisions regarding earning incapacity and occupational reintegration, to suggest strategies for dealing with one's own occupational situation, and to strengthen the motivation to stay employed. The programme is explicitly designed for patients who wish to retire or have applied for a pension. On the systemic level, the main goals are to facilitate doctor-patient communication and to increase rehabilitation teams' awareness of occupational problems. In a controlled quasi-experimental design, 359 subjects were consecutively assigned to either the control group (CG, n=177) or the intervention group (IG, n=182). The control group received standard care only, whereas the intervention group additionally participated in the 5-part Vocational Perspective programme. Evaluation criteria were assessed by questionnaire at the beginning (t1) and at end of rehabilitation (t2). Survey participation was 92.2% at t2. The socio-medically relevant knowledge status was objectively documented using a specially designed knowledge questionnaire. Aspects of treatment satisfaction were evaluated using individual items, and the subjective prognosis of gainful employment was assessed using the Subjective Prognosis of Gainful Employment (SPE) scale. Facilitation of communication between doctor and patient was operationalized at patient level in terms of patient satisfaction with medical care, and increased awareness of the rehabilitation team was operationalized in terms of the rate of recommendations to apply for vocational reintegration (LTA) services at discharge. Emotional and functional parameters were exploratively analyzed (anxiety and depression using the IRES 3.1 scales, and

42 CFR 137.410 - For the purposes of section 110 of the Act [25 U.S.C. 450m-1] does the term contract include...

Science.gov (United States)

2010-10-01

....C. 450m-1] does the term contract include compacts, funding agreements, and construction project... the term contract include compacts, funding agreements, and construction project agreements entered into under Title V? Yes, for the purposes of section 110 of the Act [25 U.S.C. 450m-1] the term...

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

Science.gov (United States)

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

2015-01-01

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

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

Directory of Open Access Journals (Sweden)

Jeremy Snyder

2015-04-01

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

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

Science.gov (United States)

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

2015-01-01

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

A Randomized Double-Blind Controlled Trial Comparing Davanloo Intensive Short-Term Dynamic Psychotherapy as Internet-Delivered Vs Treatment as Usual for Medically Unexplained Pain: A 6-Month Pilot Study.

Science.gov (United States)

Chavooshi, Behzad; Mohammadkhani, Parvaneh; Dolatshahi, Behrouz

2016-01-01

Research has shown that Intensive Short-Term Dynamic Psychotherapy (ISTDP) can effectively decrease pain intensity and improve quality of life in patients with medically unexplained pain. Understanding that not all patients with medically unexplained pain have access to in-person ISTDP, this study aims to investigate the efficacy of an Internet-delivered ISTDP for individuals with medically unexplained pain using Skype in comparison with treatment as usual. In this randomized controlled trial, 100 patients were randomly allocated into Internet-delivered ISTDP (n = 50) and treatment-as- usual (n = 50) groups. Treatment intervention consisted of 16 weekly, hour-long therapy sessions. The primary outcome was perceived pain assessed using the Numeric Pain Rating Scale. The secondary outcome included Depression Anxiety Stress Scale-21, Emotion Regulation Questionnaire, Mindful Attention Awareness Scale, and Quality-of-Life Inventory. Blind assessments were conducted at the baseline, posttreatment, and at a 6-month follow-up. In the intention-to-treat analysis, pain symptoms in the intervention group were significantly reduced (p Skype can significantly improve pain intensity and clinical symptoms of medically unexplained pain. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

[Pharmacist as gatekeeper: combating medication abuse and dependence].

Science.gov (United States)

Shimane, Takuya

2013-01-01

  The nonmedical use of medications, including psychotropic drugs, is a growing health problem in Japan. According to a nationwide survey of mental hospitals, the proportion of patients with sedative (mainly benzodiazepine)-related disorders has more than doubled over the last decade. An association between psychotropic drug overdose and suicide risk has also been reported. Furthermore, over-the-counter drug abuse is still a serious problem in Japan. In recent years, pharmacists have been expected to act as gatekeepers, making timely identifications of suicide risk or substance abuse and directing these individuals to appropriate medical care facilities. In August 2012, the revised Comprehensive Suicide Measures Act identified pharmacists as one professional group that should act as gatekeepers. This article begins by reviewing the fundamental terms involved in understanding the nonmedical use of medications, including abuse, dependence, and intoxication. The current situation of substance abuse and dependence is then introduced through a summary of several epidemiological surveys conducted in Japan. Finally, the role of pharmacists as gatekeepers in preventing substance abuse and dependence on medications is discussed.

The value of self-medication: summary of existing evidence.

Science.gov (United States)

Noone, Joshua; Blanchette, Christopher M

2018-02-01

The aim of this review was to identify the international evidence that is currently available on the economic value of self-care through responsible self-medication, in terms of the measures related to access to treatment, time, and productivity. A targeted literature search was conducted for 1990-2016, including data gathered from members of the World Self-Medication Industry and searches on PubMed, EBSCOHost, and Google Scholar. Specific searches of individual drug classes known to be switched to non-prescription status in this period were also conducted. A total of 71 articles were identified, of which 17 (11 modeling studies, six retrospective analyses) were included in the review. Evidence from modeling studies and retrospective analyses of grouped data across a range of common conditions for which non-prescription medications are available in different countries/regions showed that the use of non-prescription products for the treatment of common conditions or for symptom management (e.g. allergies, chronic pain, migraine, vaginitis, gastrointestinal symptoms, or common cold symptoms) had considerable value to patients, payers, and employers alike in terms of cost savings and improved productivity. Potential benefits of self-medication were also identified in preventative healthcare strategies, such as those for cardiovascular health and osteoporosis. This review was limited by a targeted, but non-systematic approach to literature retrieval, as well as the inclusion of unpublished reports/white papers and patient self-reported data. The evidence identified in this literature review shows that responsible, appropriate self-medication with non-prescription products can provide significant economic benefits for patients, employers, and healthcare systems worldwide.

Novel remote electronic medication supply model for opioid-dependent outpatients with polypharmacy--first long-term case study.

Science.gov (United States)

Allemann, Samuel S; Dürsteler, Kenneth M; Strasser, Johannes; Vogel, Marc; Stoeckle, Marcel; Hersberger, Kurt E; Arnet, Isabelle

2017-08-16

Patients with substance use disorders grow older thanks to effective treatments. Together with a high prevalence of comorbidities, psychological problems, and low social support, these patients are at high risk for medication non-adherence. Established treatment facilities face challenges to accommodate these complex patients within their setting. Electronic medication management aids (e-MMAs) might be appropriate to simultaneously monitor and improve adherence for these patients. We report the first long-term experiences with a novel remote electronic medication supply model for two opioid-dependent patients with HIV. John (beginning dementia, 52 years, 6 tablets daily at 12 am) and Mary (frequent drug holidays, 48 years, 5-6 tablets daily at 8 pm) suffered from disease progression due to non-adherence. We electronically monitored adherence and clinical outcomes during 659 (John) and 953 (Mary) days between July 2013 and April 2016. Both patients retrieved over 90% of the pouches within 75 min of the scheduled time. Technical problems occurred in 4% (John) and 7.2% (Mary) of retrievals, but on-site support was seldom required. Viral loads fell below detection limits during the entire observation period. Continuous medication supply and persistence with treatment of over 1.7 years, timing adherence of more than 90%, and suppressed HIV viral load are first results supporting the feasibility of the novel supply model for patients on opioid-assisted treatment and polypharmacy.

Incidence and cost of medications dispensed despite electronic medical record discontinuation.

Science.gov (United States)

Baranowski, Patrick J; Peterson, Kristin L; Statz-Paynter, Jamie L; Zorek, Joseph A

2015-01-01

To determine the incidence and cost of medications dispensed despite discontinuation (MDDD) of the medications in the electronic medical record within an integrated health care organization. Dean Health System, with medical clinics and pharmacies linked by an electronic medical record, and a shared health plan and pharmacy benefits management company. Pharmacist-led quality improvement project using retrospective chart review. Electronic medical records, pharmacy records, and prescription claims data from patients 18 years of age or older who had a prescription filled for a chronic condition from June 2012 to August 2013 and submitted a claim through the Dean Health Plan were aggregated and cross-referenced to identify MDDD. Descriptive statistics were used to characterize demographics and MDDD incidence. Fisher's exact test and independent samples t tests were used to compare MDDD and non-MDDD groups. Wholesale acquisition cost was applied to each MDDD event. 7,406 patients met inclusion criteria. For 223 (3%) patients with MDDD, 253 independent events were identified. In terms of frequency per category, antihypertensive agents topped the list, followed, in descending order, by anticonvulsants, antilipemics, antidiabetics, and anticoagulants. Nine medications accounted for 59% (150 of 253) of all MDDD events; these included (again in descending order): gabapentin, atorvastatin, simvastatin, hydrochlorothiazide, lisinopril, warfarin, furosemide, metformin, and metoprolol. Mail-service pharmacies accounted for the highest incidence (5.3%) of MDDD, followed by mass merchandisers (4.6%) and small chains (3.9%). The total cost attributable to MDDD was $9,397.74. Development of a technology-based intervention to decrease the incidence of MDDD may be warranted to improve patient safety and decrease health care costs.

Medical terminology in online patient-patient communication: evidence of high health literacy?

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Fage-Butler, Antoinette M; Nisbeth Jensen, Matilde

2016-06-01

Health communication research and guidelines often recommend that medical terminology be avoided when communicating with patients due to their limited understanding of medical terms. However, growing numbers of e-patients use the Internet to equip themselves with specialized biomedical knowledge that is couched in medical terms, which they then share on participatory media, such as online patient forums. Given possible discrepancies between preconceptions about the kind of language that patients can understand and the terms they may actually know and use, the purpose of this paper was to investigate medical terminology used by patients in online patient forums. Using data from online patient-patient communication where patients communicate with each other without expert moderation or intervention, we coded two data samples from two online patient forums dedicated to thyroid issues. Previous definitions of medical terms (dichotomized into technical and semi-technical) proved too rudimentary to encapsulate the types of medical terms the patients used. Therefore, using an inductive approach, we developed an analytical framework consisting of five categories of medical terms: dictionary-defined medical terms, co-text-defined medical terms, medical initialisms, medication brand names and colloquial technical terms. The patients in our data set used many medical terms from all of these categories. Our findings suggest the value of a situated, condition-specific approach to health literacy that recognizes the vertical kind of knowledge that patients with chronic diseases may have. We make cautious recommendations for clinical practice, arguing for an adaptive approach to medical terminology use with patients. © 2015 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Study of long term structural and functional changes in medically controlled glaucoma

Directory of Open Access Journals (Sweden)

Achyut N Pandey

2014-02-01

Full Text Available AIM:Prospectively analyze the long term structural and functional changes in patients of primary open angle glaucoma (POAG receiving medical therapy (beta blockers and non beta blockers. In this study an attempt has been made to evaluate whether medical reduction of IOP prevents or delays the progression of glaucomatous visual field loss and/or optic nerve damage in patients with open angle glaucoma.METHODS:Study conducted over a period of 27 months, at a tertiary eye care hospital including both eyes of 40 patients with POAG. Group 1 (20 patients, 40 eyes received beta-blockers, and Group 2 (20 patients, 40 eyes received non-beta-blockers. Each patient underwent intraocular pressure measurement, best corrected visual acuity, slit-lamp, fundus examination, gonioscopy, central corneal thickness, visual field assessment by Humphrey automated perimetry and retinal nerve fibre layer thickness by Stratus optical coherence tomography at baseline and at two subsequent visits. The average time interval between each visit was 10-11 months. The statistical analysis was done using one-way analysis of variance (ANOVA. Post-hoc test, using tukey’ method were adopted. Probablity (P value of 0.05 or less was considered to be statistically significant.RESULTS:A total of 80 eyes of 40 patients of POAG were enrolled, 24 males, 16 females, age group 50-80 years. In both beta and non beta blocker group, reduction (improvement in mean IOP from initial levels to the levels achieved at the 2nd and 3rd visits was statistically significant. One way ANOVA (df=2, fisher f value=11.64, P=0.000, one way ANOVA (df=3, fisher f value=35.61, P=0.000. Both mean deviation (MD and pattern standard deviation (PSD in both beta and non beta blockers at different visits were not statistically significant. Retinal nerve fibre layer thickness (RNFL -only mean inferior retinal nerve fibre layer, the difference between the mean value in beta and non beta blocker groupwere statistically

Discrepancies in general surgery medical terminology between South and North Korea.

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Hur, Keunyoung; Park, Do-Eon; Oh, Heung-Kwon; Yang, Hyun Hui; Ko, Dayoung; Kim, Min-Hyun; Kim, Myung Jo; Kang, Sung Il; Kim, Duck-Woo; Kang, Sung-Bum

2018-03-01

The purpose of this study was to categorize surgery-related medical terminologies used in South and North Korea and to compare and analyze discrepancies observed in the terms. This study collected medical terminology used in the North Korean medical book "Surgery" and compared it to medical terminology found in the medical glossary of South Korea. The order of the subtitle was described according to the Instruction to Authors. In total, there were 2,168 individual medical terms, of which only 1,004 words (46.3%) were identical to South Korean medical terms. There were 581 similar terms (26.8%), 265 different terms (12.2%), and 318 terms that are nonexistent in South Korea (14.7%). Less than half of the medical terms used in North Korea match those used in South Korea. It is expected that the prolongation of the current division of South and North Korea will only worsen this discrepancy. Further efforts to bridge the gap through academic exchange between South Korea and North Korea are required in preparation for an era of reunification.

The association of depression and anxiety with medical symptom burden in patients with chronic medical illness.

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Katon, Wayne; Lin, Elizabeth H B; Kroenke, Kurt

2007-01-01

Primary care patients with anxiety and depression often describe multiple physical symptoms, but no systematic review has studied the effect of anxiety and depressive comorbidity in patients with chronic medical illnesses. MEDLINE databases were searched from 1966 through 2006 using the combined search terms diabetes, coronary artery disease (CAD), congestive heart failure (CHF), asthma, COPD, osteoarthritis (OA), rheumatoid arthritis (RA), with depression, anxiety and symptoms. Cross-sectional and longitudinal studies with >100 patients were included as were all randomized controlled trials that measure the impact of improving anxiety and depressive symptoms on medical symptom outcomes. Thirty-one studies involving 16,922 patients met our inclusion criteria. Patients with chronic medical illness and comorbid depression or anxiety compared to those with chronic medical illness alone reported significantly higher numbers of medical symptoms when controlling for severity of medical disorder. Across the four categories of common medical disorders examined (diabetes, pulmonary disease, heart disease, arthritis), somatic symptoms were at least as strongly associated with depression and anxiety as were objective physiologic measures. Two treatment studies also showed that improvement in depression outcome was associated with decreased somatic symptoms without improvement in physiologic measures. Accurate diagnosis of comorbid depressive and anxiety disorders in patients with chronic medical illness is essential in understanding the cause and in optimizing the management of somatic symptom burden.

Medical tourism in the Caribbean.

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Ramírez de Arellano, Annette B

2011-01-01

Although travel for medical reasons has a long history, it has more recently evolved from a cottage industry to a worldwide enterprise. A number of countries are positioning themselves to attract visitors who are willing to travel to obtain health services that are more accessible, less expensive, or more available than in their countries of origin. This has in turn given rise to medical packages that combine tourism with health. Several Caribbean nations - including Cuba, Barbados, Jamaica, and Puerto Rico - hope to expand their revenues in this new market. Each country has selected specific service niches and promotes its services accordingly. While Cuba has been promoting its services to other countries for several decades, medical tourism is just beginning in the other islands. Ultimately, these nations' economic success will hinge on their comparative advantage vis-à-vis other options, while their success in terms of improving their own health care depends on the extent to which the services for tourists are also available to the islands' populations.

Medication errors: definitions and classification

Science.gov (United States)

Aronson, Jeffrey K

2009-01-01

To understand medication errors and to identify preventive strategies, we need to classify them and define the terms that describe them. The four main approaches to defining technical terms consider etymology, usage, previous definitions, and the Ramsey–Lewis method (based on an understanding of theory and practice). A medication error is ‘a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient’. Prescribing faults, a subset of medication errors, should be distinguished from prescription errors. A prescribing fault is ‘a failure in the prescribing [decision-making] process that leads to, or has the potential to lead to, harm to the patient’. The converse of this, ‘balanced prescribing’ is ‘the use of a medicine that is appropriate to the patient's condition and, within the limits created by the uncertainty that attends therapeutic decisions, in a dosage regimen that optimizes the balance of benefit to harm’. This excludes all forms of prescribing faults, such as irrational, inappropriate, and ineffective prescribing, underprescribing and overprescribing. A prescription error is ‘a failure in the prescription writing process that results in a wrong instruction about one or more of the normal features of a prescription’. The ‘normal features’ include the identity of the recipient, the identity of the drug, the formulation, dose, route, timing, frequency, and duration of administration. Medication errors can be classified, invoking psychological theory, as knowledge-based mistakes, rule-based mistakes, action-based slips, and memory-based lapses. This classification informs preventive strategies. PMID:19594526

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

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Reinhardt, Uwe E

2017-07-01

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

Training the next generation of physician researchers - Vanderbilt Medical Scholars Program.

Science.gov (United States)

Brown, Abigail M; Chipps, Teresa M; Gebretsadik, Tebeb; Ware, Lorraine B; Islam, Jessica Y; Finck, Luke R; Barnett, Joey; Hartert, Tina V

2018-01-04

As highlighted in recent reports published by the Physician-Scientist Workforce Working Group at the National Institutes of Health, the percentage of physicians conducting research has declined over the past decade. Various programs have been put in place to support and develop current medical student interest in research to alleviate this shortage, including The Vanderbilt University School of Medicine Medical Scholars Program (MSP). This report outlines the long-term program goals and short-term outcomes on career development of MSP alumni, to shed light on the effectiveness of research training programs during undergraduate medical training to inform similar programs in the United States. MSP alumni were asked to complete an extensive survey assessing demographics, accomplishments, career progress, future career plans, and MSP program evaluation. Fifty-five (81%) MSP alumni responded, among whom 12 had completed all clinical training. The demographics of MSP alumni survey respondents are similar to those of all Vanderbilt medical students and medical students at all other Association of American Medical College (AAMC) medical schools. MSP alumni published a mean of 1.9 peer-reviewed manuscripts (95% CI:1.2, 2.5), and 51% presented at national meetings. Fifty-eight percent of respondents reported that MSP participation either changed their career goals or helped to confirm or refine their career goals. Results suggest that the MSP program both prepares students for careers in academic medicine and influences their career choices at an early juncture in their training. A longer follow-up period is needed to fully evaluate the long-term outcomes of some participants.

Curriculum Mapping with Academic Analytics in Medical and Healthcare Education.

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Komenda, Martin; Víta, Martin; Vaitsis, Christos; Schwarz, Daniel; Pokorná, Andrea; Zary, Nabil; Dušek, Ladislav

2015-01-01

No universal solution, based on an approved pedagogical approach, exists to parametrically describe, effectively manage, and clearly visualize a higher education institution's curriculum, including tools for unveiling relationships inside curricular datasets. We aim to solve the issue of medical curriculum mapping to improve understanding of the complex structure and content of medical education programs. Our effort is based on the long-term development and implementation of an original web-based platform, which supports an outcomes-based approach to medical and healthcare education and is suitable for repeated updates and adoption to curriculum innovations. We adopted data exploration and visualization approaches in the context of medical curriculum innovations in higher education institutions domain. We have developed a robust platform, covering detailed formal metadata specifications down to the level of learning units, interconnections, and learning outcomes, in accordance with Bloom's taxonomy and direct links to a particular biomedical nomenclature. Furthermore, we used selected modeling techniques and data mining methods to generate academic analytics reports from medical curriculum mapping datasets. We present a solution that allows users to effectively optimize a curriculum structure that is described with appropriate metadata, such as course attributes, learning units and outcomes, a standardized vocabulary nomenclature, and a tree structure of essential terms. We present a case study implementation that includes effective support for curriculum reengineering efforts of academics through a comprehensive overview of the General Medicine study program. Moreover, we introduce deep content analysis of a dataset that was captured with the use of the curriculum mapping platform; this may assist in detecting any potentially problematic areas, and hence it may help to construct a comprehensive overview for the subsequent global in-depth medical curriculum

Teaching corner: raising the bar: ethical considerations of medical student preparation for short-term immersion experiences.

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Kittle, Nathan; McCarthy, Virginia

2015-03-01

Short-term international medical outreach experiences are becoming more popular among medical students. As the popularity of these trips grows, participants, scholars, and institutions have become more aware of the potential pitfalls of such experiences. Loyola University Chicago Stritch School of Medicine (SSOM) has an approximately 20-year international service immersion (ISI) program that has sent more than 1,400 participants to more than 30 countries. Recently, ISI programming has been adjusted to provide students more formal sessions exploring the ethics of the ISI trips. Students are required to attend both pre- and post-trip educational sessions covering a wide range of relevant global health topics as well as participating in in-country reflections and post-trip debriefings. This recent adjustment has evolved further to become the foundation for the SSOM's four-year Global Health Honors program that not only encourages an ethical foundation for the student's ISI experience but also hopes to provide a foundation for students as they look toward a future career in global health.

Medication use in Australian children with asthma: user's perspective.

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Grover, Charu; Armour, Carol; Van Asperen, Peter Paul; Moles, Rebekah Jane; Saini, Bandana

2013-04-01

Medication use-related issues remain problematic in childhood asthma despite effective treatment strategies and public investment into improved asthma management strategies in industrialized countries. This study aimed to carry out an in-depth exploration of the views of parents/carers and children with asthma on medication use. Semi-structured qualitative interviews were conducted with a purposive convenience sample of children with asthma and their parents recruited from general practices in Sydney. Interviews were tape-recorded, transcribed verbatim, and thematically analyzed. A total of 52 interviews (26 parents/carers and 26 children with asthma) were conducted. Major themes which emerged from the children's interviews included issues such as self-image, resistance to medication use, and lack of responsibility in medication taking. Parental or carer issues included lack of clear understanding of how medications worked, as well as administration difficulties, cost constraints, and beliefs about medications contrary to quality use. This is one of the few research studies exploring the viewpoint of children with asthma about their medications in Australia. Despite investment in dissemination of professional, targeted evidence-based asthma management strategies in healthcare, there seems to be a lack of depth in terms of what parents understand about their child's asthma. Effective communication about medication usage, especially the inclusion of the child in the consultation to empower them to be involved in their own asthma care, may be the answer.

Thomas N Bonner (1923-2003), medical historian.

Science.gov (United States)

Bickel, Marcel H

2016-05-01

Thomas Bonner made a long academic career, teaching medical history and higher education at several American universities and presiding over three of these. He engaged in politics for 2 years. As a historian of medicine, he published important books on topics including Midwestern medicine, medical education in the United States and in European countries, the entry of women into medicine in the 19th century and on the educator Abraham Flexner. His works were based on exhaustive research, penetrating analysis, language skills and the ability to explain complex information in understandable terms. Bonner lived a passionate life of commitment and devotion to various worthwhile causes. © The Author(s) 2014.

Using scores to identify patients at risk of short term mortality at arrival to the acute medical unit

DEFF Research Database (Denmark)

Brabrand, Mikkel; Hallas, Peter; Hansen, Søren Nygaard

2017-01-01

Introduction: "Early warning scores" (EWS) have been developed to quantify levels of vital sign abnormality. However, many scores have not been validated. The aim of this study was to validate six scores that all rely on vital signs: Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine...... Score (REMS) and the National Early Warning Score (NEWS) and the Goodacre, Groarke and Worthing physiological scores. Methods: A posthoc single-center observational cohort study of prospectively collected vital signs on acutely admitted medical patients to a Danish hospital. All adult patients arriving...... at an acute medical unit at a 450-bed regional teaching hospital were included. Upon arrival, we registered initial vital signs and only the first presentation in the study period was included. Patients were included from 1 June to 31 October 2012. All-cause 24-h mortality and overall in-hospital mortality...

Segmentation of medical images using explicit anatomical knowledge

Science.gov (United States)

Wilson, Laurie S.; Brown, Stephen; Brown, Matthew S.; Young, Jeanne; Li, Rongxin; Luo, Suhuai; Brandt, Lee

1999-07-01

Knowledge-based image segmentation is defined in terms of the separation of image analysis procedures and representation of knowledge. Such architecture is particularly suitable for medical image segmentation, because of the large amount of structured domain knowledge. A general methodology for the application of knowledge-based methods to medical image segmentation is described. This includes frames for knowledge representation, fuzzy logic for anatomical variations, and a strategy for determining the order of segmentation from the modal specification. This method has been applied to three separate problems, 3D thoracic CT, chest X-rays and CT angiography. The application of the same methodology to such a range of applications suggests a major role in medical imaging for segmentation methods incorporating representation of anatomical knowledge.

Weight change associated with the use of migraine-preventive medications.

Science.gov (United States)

Taylor, Frederick R

2008-06-01

Medications administered long term, such as those used for migraine prophylaxis, are often associated with weight change as a side effect. Such effects may compromise general health status, exacerbate coexisting medical conditions, and affect medication adherence. Weight gain should be of particular concern in patients with migraine, as there is evidence that overweight and obese patients with migraine are at risk for an increased frequency and severity of migraine attacks. This article reviews weight-change data from recent clinical studies of migraine-preventive medications in children, adolescents, and adults with migraine. A PubMed search was conducted for English-language articles published between January 1970 and November 2007. Among the search terms were migraine prevention, migraine prophylaxis, migraine treatment, antidepressant drug, beta-adrenergic-receptor blockers, antiepileptic drug, anticonvulsant drug, weight gain, and weight loss. Studies that reported weight-change data (gain, loss, or neutral) were included. When available, double-blind, placebo-controlled studies were selected for review. Open-label, retrospective or prospective trials may also have been included. Most of the migraine-preventive medications classified by the United States Headache Consortium as group 1 based on the high level of evidence for their efficacy--for instance, amitriptyline, propranolol, and divalproex sodium-have been associated with varying degrees of weight gain. The exceptions are timolol, which is weight neutral, and topiramate, which is associated with weight loss. Among the drugs that have been associated with weight gain, a higher incidence of weight gain was observed with amitriptyline and divalproex sodium than with propranolol. Weight-change effects require careful consideration when selecting migraine-preventive medications, and weight should be monitored carefully over the course of any migraine treatment plan.

Modelling the long-term consequences of a hypothetical dispersal of radioactivity in an urban area including remediation alternatives

International Nuclear Information System (INIS)

Thiessen, K.M.; Andersson, K.G.; Batandjieva, B.; Cheng, J.-J.; Hwang, W.T.; Kaiser, J.C.; Kamboj, S.; Steiner, M.; Tomas, J.; Trifunovic, D.; Yu, C.

2009-01-01

The Urban Remediation Working Group of the International Atomic Energy Agency's EMRAS (Environmental Modelling for Radiation Safety) program was organized to address issues of remediation assessment modelling for urban areas contaminated with dispersed radionuclides. The present paper describes the second of two modelling exercises. This exercise was based on a hypothetical dispersal of radioactivity in an urban area from a radiological dispersal device, with reference surface contamination at selected sites used as the primary input information. Modelling endpoints for the exercise included radionuclide concentrations and external dose rates at specified locations, contributions to the dose rates from individual surfaces, and annual and cumulative external doses to specified reference individuals. Model predictions were performed for a 'no action' situation (with no remedial measures) and for selected countermeasures. The exercise provided an opportunity for comparison of three modelling approaches, as well as a comparison of the predicted effectiveness of various countermeasures in terms of their short-term and long-term effects on predicted doses to humans.

Short- and long-term health consequences of sleep disruption.

Science.gov (United States)

Medic, Goran; Wille, Micheline; Hemels, Michiel Eh

2017-01-01

Sleep plays a vital role in brain function and systemic physiology across many body systems. Problems with sleep are widely prevalent and include deficits in quantity and quality of sleep; sleep problems that impact the continuity of sleep are collectively referred to as sleep disruptions. Numerous factors contribute to sleep disruption, ranging from lifestyle and environmental factors to sleep disorders and other medical conditions. Sleep disruptions have substantial adverse short- and long-term health consequences. A literature search was conducted to provide a nonsystematic review of these health consequences (this review was designed to be nonsystematic to better focus on the topics of interest due to the myriad parameters affected by sleep). Sleep disruption is associated with increased activity of the sympathetic nervous system and hypothalamic-pituitary-adrenal axis, metabolic effects, changes in circadian rhythms, and proinflammatory responses. In otherwise healthy adults, short-term consequences of sleep disruption include increased stress responsivity, somatic pain, reduced quality of life, emotional distress and mood disorders, and cognitive, memory, and performance deficits. For adolescents, psychosocial health, school performance, and risk-taking behaviors are impacted by sleep disruption. Behavioral problems and cognitive functioning are associated with sleep disruption in children. Long-term consequences of sleep disruption in otherwise healthy individuals include hypertension, dyslipidemia, cardiovascular disease, weight-related issues, metabolic syndrome, type 2 diabetes mellitus, and colorectal cancer. All-cause mortality is also increased in men with sleep disturbances. For those with underlying medical conditions, sleep disruption may diminish the health-related quality of life of children and adolescents and may worsen the severity of common gastrointestinal disorders. As a result of the potential consequences of sleep disruption, health care

The Muddle of Medicalization

DEFF Research Database (Denmark)

Sholl, Jonathan

2017-01-01

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

AACE/ACE Disease State Clinical Review: Medical Management of Cushing Disease.

Science.gov (United States)

Hamrahian, Amir H; Yuen, Kevin C J; Hoffman, Andrew R

2014-07-01

To review available medical therapies for patients with Cushing disease and to provide a roadmap for their use in clinical practice. PubMed searches were performed to identify all of the available published data on medical management of Cushing disease. Medical therapy is usually not the first-line treatment for patients with Cushing disease but may be used to improve clinical manifestations of Cushing disease in patients who are not suitable candidates for surgery, following unsuccessful surgery or recurrence, or as a "bridge therapy" in those who have undergone radiotherapy. Medical therapy may also be used in preoperative preparation of patients with severe disease. Current available medical options for patients with Cushing disease include centrally acting agents, steroidogenesis inhibitors, and a glucocorticoid receptor antagonists. At present, there are no head-to-head studies comparing the efficacy, tolerability, and safety of different U.S. Food and Drug Administration (FDA)- and non-FDA-approved drugs in patients with Cushing disease. With the initiation of new studies and the completion of ongoing clinical trials, the number of FDA-approved drugs for medical treatment of Cushing disease is expected to increase. Medical therapy has an important adjunctive role in the management of patients with Cushing disease. The decision to initiate medical treatment depends on many factors, including patient characteristics and preference. Long-term studies are needed to better define the clinical efficacy, safety, and tolerability of medical treatment of Cushing disease, including the role of combination therapies.

Short-term glucocorticoid administration in patients with protracted and chronic gout arthritis. Part 2 — comparison of different medication forms efficacy

Directory of Open Access Journals (Sweden)

A A Fedorova

2008-01-01

Full Text Available Objective. To compare efficacy of different glucocorticoid (GC medication forms in protracted and chronic gout arthritis. Material and methods. 59 pts with tophaceous gout (crystal-verified diagnosis and arthritis of three and more joints lasting more than a months in spite of treatment with sufficient doses of nonsteroidal anti-inflammatory drugs were included. Median age of pts was 56 [48;63], median disease duration — 15,2 years [7,4;20], median swollen joint count at the examination — 8 [5; 11]. The patients were randomized into 2 groups. Methylprednisolone (MP 500 mg/day iv during 2 days and placebo im once was administered in one of them, betamethasone (BM 7 mg im once and placebo iv twice — in the other. Results. Number of pts with full resolution of arthritis, recurrent exacerbation, insufficient arthritis resolution or clinically insignificant response was comparable in both groups. More rapid decrease of pain at moving was achieved during the first 2-3 days after GC administration in pts with full resolution of arthritis (p=0,03 in group receiving MP in comparison with BM. At day 14 joint damage measures did not differ between groups. Conclusion. Efficacy of short-term glucocorticoid administration does not depend on mode of administration and GC medication form (methylprednisolone 500 mg/day iv during 2 days or betamethasone 7 mg im once.

System dynamics in medical education: a tool for life.

Science.gov (United States)

Rubin, David M; Richards, Christopher L; Keene, Penelope A C; Paiker, Janice E; Gray, A Rosemary T; Herron, Robyn F R; Russell, Megan J; Wigdorowitz, Brian

2012-05-01

A course in system dynamics has been included in the first year of our university's six-year medical curriculum. System Dynamics is a discipline that facilitates the modelling, simulation and analysis of a wide range of problems in terms of two fundamental concepts viz. rates and levels. Many topics encountered in the medical school curriculum, from biochemistry to sociology, can be understood in this way. The course was introduced following a curriculum review process in which it was concluded that knowledge of systems would serve to enhance problem-solving skills and clinical reasoning. The specific characteristics of system dynamics, the widespread use of digital computers, and the availability of suitable software made it possible to introduce the course at this level. The syllabus comprises a brief review of relevant mathematics followed by system dynamics topics taught in the context of examples, which are primarily but not exclusively medical. It is anticipated that this will introduce new thought processes to medical students, including holistic thinking and improved graphical visualisation skills.

Identification and Evaluation of Medical Translator Mobile Applications Using an Adapted APPLICATIONS Scoring System.

Science.gov (United States)

Khander, Amrin; Farag, Sara; Chen, Katherine T

2017-12-22

With an increasing number of patients requiring translator services, many providers are turning to mobile applications (apps) for assistance. However, there have been no published reviews of medical translator apps. To identify and evaluate medical translator mobile apps using an adapted APPLICATIONS scoring system. A list of apps was identified from the Apple iTunes and Google Play stores, using the search term, "medical translator." Apps not found on two different searches, not in an English-based platform, not used for translation, or not functional after purchase, were excluded. The remaining apps were evaluated using an adapted APPLICATIONS scoring system, which included both objective and subjective criteria. App comprehensiveness was a weighted score defined by the number of non-English languages included in each app relative to the proportion of non-English speakers in the United States. The Apple iTunes and Google Play stores. Medical translator apps identified using the search term "medical translator." Main Outcomes and Measures: Compilation of medical translator apps for provider usage. A total of 524 apps were initially found. After applying the exclusion criteria, 20 (8.2%) apps from the Google Play store and 26 (9.2%) apps from the Apple iTunes store remained for evaluation. The highest scoring apps, Canopy Medical Translator, Universal Doctor Speaker, and Vocre Translate, scored 13.5 out of 18.7 possible points. A large proportion of apps initially found did not function as medical translator apps. Using the APPLICATIONS scoring system, we have identified and evaluated medical translator apps for providers who care for non-English speaking patients.

Do we have to Include HCI Issues in Clinical Trials of Medical Devices?

DEFF Research Database (Denmark)

Nielsen, Lene; Christensen, Lars Rune; Sabers, Anne

2017-01-01

Digital devices play an important role in medical treatment and will in the future play a larger role in connection to cures of health-related issues. Traditionally medicine has been tested by clinical double blind, randomized trials to document the efficacy and safety profile. When it comes to t...

MEDICAL SERVICES OR MEDICAL CARE – AN URGENT ISSUE FOR PUBLIC HEALTH INSTITUTIONS

Directory of Open Access Journals (Sweden)

E. V. Pesennikova

2017-01-01

Full Text Available Purpose. To consider the relationship between the concepts of “medical service” and “medical care” in the work of public medical institutions, based on the analysis of normative legal documents of the modern period.Materials and methods. In the course of the research, more than 18 legal and regulatory documents that were published during the period from 1990 to 2017 were analyzed, an analysis of judicial practice and related literature sources (periodicals was carried out.Results. The analysis made it possible to distinguish the stages in the development of the organizational and legal framework for the provision of paid medical services in the Russian Federation and the dynamics of the relationship between the terms “medical care” and “medical service”. It was revealed that the concept of “medical services” appeared much later and was associated with the development of paid medical services and the need to establish legal aspects of health care. The provision of medical assistance is regulated mainly by public law, and the provision of medical services is governed by private law. The term “medical care” is broader than the “medical service” from the standpoint of the social aspect. At the same time, the concept of “medical service” can be considered more widely than medical care in cases when it is not only about measures aimed at treating the patient, but also about providing additional services to the patient in the process of receiving medical care.Conclusion. Thus, we concluded that the categories of medical care and medical services should not be identified, but also not completely different concepts, but rather enter into a partial intersection relationship. The need to distinguish between the concepts of “medical care” and “medical service” is dictated not only by the category relations or opinion of the population and the medical community, but also by the need for legal support for the process of

EsPRit: ethics committee proposals for Long Term Medical Data Registries in rapidly evolving research fields - a future-proof best practice approach.

Science.gov (United States)

Oberbichler, S; Hackl, W O; Hörbst, A

2017-10-18

Long-term data collection is a challenging task in the domain of medical research. Many effects in medicine require long periods of time to become traceable e.g. the development of secondary malignancies based on a given radiotherapeutic treatment of the primary disease. Nevertheless, long-term studies often suffer from an initial lack of available information, thus disallowing a standardized approach for their approval by the ethics committee. This is due to several factors, such as the lack of existing case report forms or an explorative research approach in which data elements may change over time. In connection with current medical research and the ongoing digitalization in medicine, Long Term Medical Data Registries (MDR-LT) have become an important means of collecting and analyzing study data. As with any clinical study, ethical aspects must be taken into account when setting up such registries. This work addresses the problem of creating a valid, high-quality ethics committee proposal for medical registries by suggesting groups of tasks (building blocks), information sources and appropriate methods for collecting and analyzing the information, as well as a process model to compile an ethics committee proposal (EsPRit). To derive the building blocks and associated methods software and requirements engineering approaches were utilized. Furthermore, a process-oriented approach was chosen, as information required in the creating process of ethics committee proposals remain unknown in the beginning of planning an MDR-LT. Here, we derived the needed steps from medical product certification. This was done as the medical product certification itself also communicates a process-oriented approach rather than merely focusing on content. A proposal was created for validation and inspection of applicability by using the proposed building blocks. The proposed best practice was tested and refined within SEMPER (Secondary Malignoma - Prospective Evaluation of the

Journey of a cystinuric patient with a long-term follow-up from a medical stone clinic: necessity to be SaFER (stone and fragments entirely removed).

Science.gov (United States)

Moore, Sacha L; Somani, Bhaskar K; Cook, Paul

2018-04-25

There is a lack of studies looking at the longitudinal follow-up of patients with cystine stones. We wanted to assess the journey of cystinuric patients through our specialist metabolic stone clinic to improve the understanding of episodes, interventions and current outcomes in this patient cohort. After ethical approval, all patients who attended our metabolic stone clinic from 1994 to 2014 with at least one cystine stone episode were included in our study. Data were retrospectively analysed for patient demographics, stone episodes or intervention, clinical parameters and patient compliance. Over a period of 21 years, 16 patients with a median age of 15.5 years underwent a mean follow-up of 8.6 years (1-21 years). The mean number of surgical interventions was 3.1 (1-8/patient), but patients who were stone free after their first treatment had lower recurrences (p = 0.91) and lower number of interventions during their follow-up (2.7/patient, compared to those who were not stone free at 4/patient). During their follow-up period, patients with stone episodes (r 2  = 0.169). It was also noted that patients who began early medical management remained stone free during follow-up compared to those who had medical management after ≥ 2 stone episodes, of whom all had a recurrent episode. Our long-term longitudinal study of cystine stone formers highlights that patients who are stone free and receive early metabolic stone screening and medical management after their initial presentation have the lowest recurrence rates and tend to preserve their renal function. Hence, prompt referral for metabolic assessment, and the stone and fragments entirely removed (SaFER) principles are key to preventing stone episodes and improving long-term function.

Medical Progress and Supplementary Private Health Insurance

OpenAIRE

Reiner Leidl

2003-01-01

In many welfare states, tightening financial constraints suggest excluding some medical services, including new ones, from social security coverage. This may create opportunities for private health insurance. This study analyses the performance of supplementary private health insurance (SPHI) in markets for excluded services in terms of population covered, risk selection and insurer profits. Using a utility-based simulation model, the insurance market is described as a composite of sub-market...

Direct short-term effects of EBP teaching: change in knowledge, not in attitude; a cross-cultural comparison among students from European and Asian medical schools

Directory of Open Access Journals (Sweden)

Indah S. Widyahening

2012-10-01

Full Text Available Introduction: We report about the direct short-term effects of a Clinical Epidemiology and Evidence-based Medicine (CE-EBM module on the knowledge, attitude, and behavior of students in the University Medical Center Utrecht (UMCU, Universitas Indonesia (UI, and University of Malaya (UM. Methods: We used an adapted version of a 26-item validated questionnaire, including four subscales: knowledge, attitude, behavior, and future use of evidence-based practice (EBP. The four components were compared among the students in the three medical schools before the module using one-way ANOVA. At the end of the module, we measured only knowledge and attitudes. We computed Cronbach's α to assess the reliability of the responses in our population. To assess the change in knowledge and attitudes, we used the paired t-test in the comparison of scores before and after the module. Results: In total, 526 students (224 UI, 202 UM, and 100 UMCU completed the questionnaires. In the three medical schools, Cronbach's α for the pre-module total score and the four subscale scores always exceeded 0.62. UMCU students achieved the highest pre-module scores in all subscales compared to UI and UM with the comparison of average (SD score as the following: knowledge 5.04 (0.4 vs. 4.73 (0.69 and 4.24 (0.74, p<0.001; attitude 4.52 (0.64 vs. 3.85 (0.68 and 3.55 (0.63, p<0.001; behavior 2.62 (0.55 vs. 2.35 (0.71 and 2.39 (0.92, p=0.016; and future use of EBP 4.32 (0.59 vs. 4.08 (0.62 and 3.7 (0.71, p<0.01. The CE-EBM module increased the knowledge of the UMCU (from average 5.04±0.4 to 5.35±0.51; p<0.001 and UM students (from average 4.24±0.74 to 4.53±0.72; p<0.001 but not UI. The post-module scores for attitude did not change in the three medical schools. Conclusion: EBP teaching had direct short-term effects on knowledge, not on attitude. Differences in pre-module scores are most likely related to differences in the system and infrastructure of both medical schools and their

History of the term prostate.

Science.gov (United States)

Josef Marx, Franz; Karenberg, Axel

2009-02-01

We comprehensively review the history of the word "prostate" and related terms from 600 BC to the present. Both medical and non-medical ancient texts were searched to clarify the term's etymology and use. Anatomy textbooks of the 16th through the 18th century were analyzed to identify descriptions, illustrations and various expressions used by contemporary authors to designate the prostate. In ancient Greek the masculine term "prostatēs" meant "president" and was exclusively used in a non-medical sense. It was not until the Renaissance that anatomists discovered the organ naming it "glandulous body." In 1600 the French physician du Laurens introduced the metaphoric denomination "prostatae." However he and his contemporaries misinterpreted the history of the organ and the term, choose the wrong gender when translating it into Latin, and believed that it designated a double organ. Only in the 1800s was this anatomical error corrected while the grammatical one lived on. The history of the term "prostate" is a prime example of the difficulties with which the development of a precise urologic terminology had to struggle. At the same time this retrospective view provides a stimulus to avoid linguistic ambiguity in the future.

Furosemide Prescription During the Dry State Is a Predictor of Long-Term Survival of Stable, Optimally Medicated Patients With Systolic Heart Failure.

Science.gov (United States)

Sargento, Luis; Simões, Andre Vicente; Longo, Susana; Lousada, Nuno; Reis, Roberto Palma Dos

2017-05-01

Furosemide is associated with poor prognosis in patients with heart failure and reduced ejection fraction (HFrEF). To evaluate the association between daily furosemide dose prescribed during the dry state and long-term survival in stable, optimally medicated outpatients with HFrEF. Two hundred sixty-six consecutive outpatients with left ventricular ejection fraction failure therapy, were followed up for 3 years in a heart failure unit. The end point was all-cause death. There were no changes in New York Heart Association class and therapeutics, including diuretics, and no decompensation or hospitalization during 6 months. Furosemide doses were categorized as low or none (0-40 mg/d), intermediate (41-80 mg/d), and high (>80 mg). Cox regression was adjusted for significant confounders. The 3-year mortality rate was 33.8%. Mean dose of furosemide was 57.3 ± 21.4 mg/d. A total of 47.6% of patients received the low dose, 42.1% the intermediate dose, and 2.3% the high dose. Receiver operating characteristics for death associated with furosemide dose showed an area under the curve of 0.74 (95% confidence interval [CI]: 0.68-0.79; P 40 mg/d. An increasing daily dose of furosemide was associated with worse prognosis. Those receiving the intermediate dose (hazard ratio [HR] = 4.1; 95% CI: 2.57-6.64; P 40 mg/d, in a propensity score-matched cohort, had a greater risk of mortality than those receiving a low dose (HR = 4.02; 95% CI: 1.8-8.8; P = .001) and those not receiving furosemide (HR = 3.9; 95% CI: 0.07-14.2; P = .039). Furosemide administration during the dry state in stable, optimally medicated outpatients with HFrEF is unfavorably associated with long-term survival. The threshold dose was 40 mg/d.

Adverse effects and Drug Interactions Associated with Inhaled Recreational and Medical Marijuana

OpenAIRE

Maisha Kelly Freeman; Pilar Z Murphy

2016-01-01

Objectives: To provide an overview of the addiction potential; adverse effects (e.g., cardiovascular, immune dysfunction, respiratory system, mental health disorders); drug interactions; effects of accidental exposure; crime statistics; and pharmacist’s considerations for the use of inhaled medical marijuana. Methods: A PubMed search was conducted from 1966 to March 2016 to identify articles in which the safety of inhaled medical marijuana was assessed. Key MeSH search terms included med...

Medications and Impaired Driving: A Review of the Literature

Science.gov (United States)

Hetland, Amanda; Carr, David B

2013-01-01

Objective To describe the association of specific medication classes with driving outcomes and provide clinical recommendations. Data sources The MEDLINE and EMBASE databases were searched for articles published from January 1973 to June 2013 on specific classes of medications known to be associated with driving impairment. The search included outcome terms such as automobile driving, motor vehicle crash, driving simulator, and road tests. Study selection and data extraction Only English-language articles that contained findings from observational or interventional designs were included. Cross-sectional studies, case series, and case reports were excluded. Studies of ≥ 10 subjects were included in this review. Data synthesis Driving is an important task and activity for the majority of adults. Unfortunately, some specific classes of commonly prescribed medications have been associated with driving impairment as measured by road performance, driving simulation, and/or motor vehicle crashes. This review of 30 studies identified findings with barbiturates, benzodiazepines, certain non-benzodiazepine hypnotics, various antidepressants, opioid and non-steroidal analgesics, anticonvulsants, antipsychotics, antiparkinsonian agents, skeletal muscle relaxants, antihistamines, anticholinergic medications, and hypoglycemic agents. Additional studies identifying medication impacts on sedation, sleep latency, and psychomotor function – as well as the role of alcohol – are also discussed. Conclusions Psychotropic agents and those with CNS side effects were associated with various measures of impaired driving performance. It is difficult to determine if such associations are actually a result of medication use or perhaps the medical diagnosis itself. Regardless, clinicians should be aware of the increased risk of impaired driving with specific populations and classes of medications when prescribing these agents, educate their patients, and/or consider safer alternatives

Synonymy in the English-origin Romanian Medical Terminology

OpenAIRE

Oana BADEA

2013-01-01

The Romanian medical terminology has been enriched quite a lot lately. This phenomena was not only due to the significant influence of the English language, but also because of the relationships developed between the already existing terms and the new ones. Thus, the present study comprises the analysis on Romanian medical terms of Englsih origin and their native synonymous correspondents in the Romanian medical terminology. The dictionnaries used to select the synonymous pairs of medical ter...

Assessment of YouTube videos as a source of information on medication use in pregnancy.

Science.gov (United States)

Hansen, Craig; Interrante, Julia D; Ailes, Elizabeth C; Frey, Meghan T; Broussard, Cheryl S; Godoshian, Valerie J; Lewis, Courtney; Polen, Kara N D; Garcia, Amanda P; Gilboa, Suzanne M

2016-01-01

When making decisions about medication use in pregnancy, women consult many information sources, including the Internet. The aim of this study was to assess the content of publicly accessible YouTube videos that discuss medication use in pregnancy. Using 2023 distinct combinations of search terms related to medications and pregnancy, we extracted metadata from YouTube videos using a YouTube video Application Programming Interface. Relevant videos were defined as those with a medication search term and a pregnancy-related search term in either the video title or description. We viewed relevant videos and abstracted content from each video into a database. We documented whether videos implied each medication to be "safe" or "unsafe" in pregnancy and compared that assessment with the medication's Teratogen Information System (TERIS) rating. After viewing 651 videos, 314 videos with information about medication use in pregnancy were available for the final analyses. The majority of videos were from law firms (67%), television segments (10%), or physicians (8%). Selective serotonin reuptake inhibitors (SSRIs) were the most common medication class named (225 videos, 72%), and 88% of videos about SSRIs indicated that they were unsafe for use in pregnancy. However, the TERIS ratings for medication products in this class range from "unlikely" to "minimal" teratogenic risk. For the majority of medications, current YouTube video content does not adequately reflect what is known about the safety of their use in pregnancy and should be interpreted cautiously. However, YouTube could serve as a platform for communicating evidence-based medication safety information. Copyright © 2015 John Wiley & Sons, Ltd.

Teaching law in medical schools: first, reflect.

Science.gov (United States)

Campbell, Amy T

2012-01-01

Law is now routinely included in the medical school curriculum, often incorporated into bioethics and/or practice of medicine coursework. There seems to lack, however, a systematic understanding of what works in terms of getting across an effective depth and breadth of legal knowledge for medical students - or what such would even look like. Moreover, and more critically, while some literature addresses these what, when, how, and who questions, a more fundamental question is left unanswered: why teach law in medical school? This article suggests a process to reveal a more consensual understanding of this latter question. The author highlights findings and recommendations of some of the leading literature to date related to teaching law in medical schools, and also recent U.K. projects addressing legal teaching in medical schools. Reflecting on these materials and activities, the author suggests that we take a "pause" before we argue for more or different legal topics within the medical curriculum. Before we alter the curricula for more and/or different "law," first, it is critical to have a meaningful, stakeholder-driven, consensus-seeking discussion of the goals of legal education: why do we think it matters that medical students learn about "the law"? © 2012 American Society of Law, Medicine & Ethics, Inc.

An Evaluation of Free Medical Applications for Android Smartphones

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Roxana D. CAPRAŞ

2016-12-01

Full Text Available ntroduction: The field of healthcare applications (apps currently holds potential to improve the daily medical practice by implementing evidence-based healthcare tools. The purpose of this study was to describe the main characteristics of Android-based healthcare applications available in Google Play and to identify those applications that are evidence-based. Methods: The study was undertaken between the 1st of July and the 30th of August 2016. An evaluation form was developed to characterize the healthcare apps available in Google Play retrieved for the following keywords: (medical apps and (evidence based medical apps respectively. Only the free apps were considered eligible for the purpose of our study. Besides the general characteristics, several criteria with regards to interactivity, functionality, esthetics, contents, benefits, as well as evidence-based aspects were considered. Results: A number of 147 healthcare apps were displayed based on the used keywords and were included in the analysis. 42 of them were excluded due to the need for payment, malfunction after installation or games/animations that used medical terms. The remaining 105 apps were then analyzed by the evaluation criteria established in the research protocol. This study shows that until this point, mobile medical applications are mostly designed for consumers or medical students and less for medical professionals. 2 medical application include evidence based medical information and 19 applications were developed in this direction. The majority of the applications were developed in USA. 60% of the analyzed applications have the capacity of improving the quality of medical care. Conclusions: We found only 2 "ideal" mobile medical applications that brought together all the requirements that every application designed for medical use should fulfill.

PRESENT AND FUTURE PERSPECTIVES IN INTERNATIONAL MEDICAL ASSISTANCE

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Carmen Stadoleanu

2012-12-01

Full Text Available Paneuropean development of patients’ rights represent a relatively recent concern, the legislative norms of which aim at granting to patients real-time access to all sorts of medical services. To this end, the European Union implemented a unitary normative professional and juridical background: Directive 2011/24/U.E. on the rights of patients to international treatments. Consequently, the patients are free to choose themselves the suppliers of medical services which do not include hospitalization, without a previous authorisation (country, doctor and medical institution while, in the case of long-term treatments, a principial authorisation will be necessary. In both cases, the carrier of the therapeutic service receives the payment for his actions at the level of those established at national level, the difference being usually payed by the patient.

Academic education and training in Medical Physics in Argentina

International Nuclear Information System (INIS)

Mairal, L.; Ruggeri, R.; Sansogne, R.; Salinas, F.; Brunetto, M.; Valda, A.; Sanz, D.; Velez, G.; Stefanic, A.; Bourel, V.

2013-01-01

This work describes the current offer for academic and clinical training in medical physics in Argentina; as well as the specific requirements for professional licensing in some specializations, known as individual national license. Reference is made to current local legislation, highlighting the fact that diagnostic radiology does not include the requirement of medical physicist’s compulsory advice. Thus, the labor supply is negligible in this area, to the detriment of the quality of this practice, mainly in terms of radiation protection for patients. Additionally, it is important to highlight the absence of the legal definition of a medical physicist as a health professional in the structure of Health Ministries, which increases disadvantages to those who practice this discipline in public health institutions. Finally, it is noted the absence of doctoral programs in medical physics and its impact on research, development and teaching. (author)

Developing standard transmission system for radiology reporting including key images

International Nuclear Information System (INIS)

Kim, Seon Chil

2007-01-01

Development of hospital information system and Picture Archiving Communication System is not new in the medical field, and the development of internet and information technology are also universal. In the course of such development, however, it is hard to share medical information without a refined standard format. Especially in the department of radiology, the role of PACS has become very important in interchanging information with other disparate hospital information systems. A specific system needs to be developed that radiological reports are archived into a database efficiently. This includes sharing of medical images. A model is suggested in this study in which an internal system is developed where radiologists store necessary images and transmit them is the standard international clinical format, Clinical Document Architecture, and share the information with hospitals. CDA document generator was made to generate a new file format and separate the existing storage system from the new system. This was to ensure the access to required data in XML documents. The model presented in this study added a process where crucial images in reading are inserted in the CDA radiological report generator. Therefore, this study suggests a storage and transmission model for CDA documents, which is different from the existing DICOM SR. Radiological reports could be better shared, when the application function for inserting images and the analysis of standard clinical terms are completed

STS-1 medical report

Science.gov (United States)

Pool, S. L. (Editor); Johnson, P. C., Jr. (Editor); Mason, J. A. (Editor)

1981-01-01

The report includes a review of the health of the crew before, during and immediately after the first Shuttle orbital flight (April 12-14, 1981). Areas reviewed include: health evaluation, medical debriefing of crewmembers, health stabilization program, medical training, medical kit carried inflight; tests and countermeasures for space motion sickness, cardiovascular profile, biochemistry and endocrinology results; hematology and immunology analyses; medical microbiology; food and nutrition; potable water; shuttle toxicology; radiological health; cabin acoustical noise. Also included is information on: environmental effects of Shuttle launch and landing, medical information management; and management, planning and implementation of the medical program.

Teleconferencing in medical education: a useful tool.

Science.gov (United States)

Lamba, Pankaj

2011-01-01

Education and healthcare are basic needs for human development. Technological innovation has broadened the access to higher quality healthcare and education without regard to time, distance or geopolitical boundaries. Distance learning has gained popularity as a means of learning in recent years due to widely distributed learners, busy schedules and rising travel costs. Teleconferencing is also a very useful tool as a distance learning method.Teleconferencing is a real-time and live interactive programme in which one set of participants are at one or more locations and the other set of participants are at another. The teleconference allows for interaction, including audio and/or video, and possibly other modalities, between at least two sites. Various methods are available for setting up a teleconferencing unit. A detailed review of the trend in the use of teleconferencing in medical education was conducted using Medline and a literature search.Teleconferencing was found to be a very useful tool in continuing medical education (CME), postgraduate medical education, undergraduate medical education, telementoring and many other situations. The use of teleconferencing in medical education has many advantages including savings in terms of travel costs and time. It gives access to the best educational resources and experience without any limitations of boundaries of distance and time. It encourages two-way interactions and facilitates learning in adults. Despite having some pitfalls in its implementation it is now being seen as an important tool in facilitating learning in medicine and many medical schools and institutions are adapting this novel tool.

Open-source hardware for medical devices.

Science.gov (United States)

Niezen, Gerrit; Eslambolchilar, Parisa; Thimbleby, Harold

2016-04-01

Open-source hardware is hardware whose design is made publicly available so anyone can study, modify, distribute, make and sell the design or the hardware based on that design. Some open-source hardware projects can potentially be used as active medical devices. The open-source approach offers a unique combination of advantages, including reducing costs and faster innovation. This article compares 10 of open-source healthcare projects in terms of how easy it is to obtain the required components and build the device.

Short- and long-term health consequences of sleep disruption

Directory of Open Access Journals (Sweden)

Medic G

2017-05-01

Full Text Available Goran Medic,1,2 Micheline Wille,1 Michiel EH Hemels1 1Market Access, Horizon Pharma B.V., Utrecht, 2Unit of Pharmacoepidemiology & Pharmacoeconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands Abstract: Sleep plays a vital role in brain function and systemic physiology across many body systems. Problems with sleep are widely prevalent and include deficits in quantity and quality of sleep; sleep problems that impact the continuity of sleep are collectively referred to as sleep disruptions. Numerous factors contribute to sleep disruption, ranging from lifestyle and environmental factors to sleep disorders and other medical conditions. Sleep disruptions have substantial adverse short- and long-term health consequences. A literature search was conducted to provide a nonsystematic review of these health consequences (this review was designed to be nonsystematic to better focus on the topics of interest due to the myriad parameters affected by sleep. Sleep disruption is associated with increased activity of the sympathetic nervous system and hypothalamic–pituitary–adrenal axis, metabolic effects, changes in circadian rhythms, and proinflammatory responses. In otherwise healthy adults, short-term consequences of sleep disruption include increased stress responsivity, somatic pain, reduced quality of life, emotional distress and mood disorders, and cognitive, memory, and performance deficits. For adolescents, psychosocial health, school performance, and risk-taking behaviors are impacted by sleep disruption. Behavioral problems and cognitive functioning are associated with sleep disruption in children. Long-term consequences of sleep disruption in otherwise healthy individuals include hypertension, dyslipidemia, cardiovascular disease, weight-related issues, metabolic syndrome, type 2 diabetes mellitus, and colorectal cancer. All-cause mortality is also increased in men with sleep disturbances. For those with

Faculty development programs for medical teachers in India

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SANJAY ZODPEY

2016-04-01

Full Text Available Introduction: India has the highest number of medical colleges in the world and subsequently the higher number of medical teachers. There is a dire need of adopting a systematic approach to faculty development to enhance quality education to meet health challenges for 21st Century. This manuscript provides a landscape of faculty development programs in India, identifying gaps and opportunities for reforms in faculty development. Methods: Conventionally, FDPs are organized by medical colleges and universities through Basic Courses and Advanced Courses focusing on pedagogy. Medical Council of India is facilitating FDPs through 18 selected regional centers to enable medical teachers to avail modern education technology for teaching from July 2009. Foundation for Advancement of International Medical Education and Research has three Regional Institutes in India. Results: Recommendations include the need for formulating a national strategy for faculty development to not only enhance the quantity of medical teachers but also the quality of medical education; providing support for Departments of Medical Education/Regional Centers in terms of finance and staffing and incorporation of teaching skills in postgraduate training. Conclusion: Distance learning courses focusing on educational leadership and pedagogy for medical teachers can be an option to reach a wider audience. FDPs can be an asset in recruiting and retaining teachers as they offer valued professional development opportunities.

Professionalism perspectives among medical students of a novel medical graduate school in Malaysia.

Science.gov (United States)

Haque, Mainul; Zulkifli, Zainal; Haque, Seraj Zohurul; Kamal, Zubair M; Salam, Abdus; Bhagat, Vidya; Alattraqchi, Ahmed Ghazi; Rahman, Nor Iza A

2016-01-01

Defining professionalism in this constantly evolving world is not easy. How do you measure degrees of benevolence and compassion? If it is so obvious to our profession, what professionalism is, then why is it so difficult to teach it to medical students and residents? Today's definition of medical professionalism is evolving - from autonomy to accountability, from expert opinion to evidence-based medicine, and from self-interest to teamwork and shared responsibility. However, medical professionalism is defined as the basis for the trust in the patient-physician relationship, caring and compassion, insight, openness, respect for patient dignity, confidentiality, autonomy, presence, altruism, and those qualities that lead to trust-competence, integrity, honesty, morality, and ethical conduct. The purpose of this study is to explore professionalism in terms of its fundamental elements among medical students of Universiti Sultan Zainal Abidin (UniSZA). This was a cross-sectional study carried out on medical students of UniSZA. The study population included preclinical and clinical medical students of UniSZA from Year I to Year V of academic session 2014/2015. The simple random sampling technique was used to select the sample. Data were collected using a validated instrument. The data were then compiled and analyzed using SPSS Version 21. Out of 165 questionnaires distributed randomly among Year I to Year V medical students of UniSZA, 144 returned, giving a response rate of 87%. Among the study participants, 38% (54) and 62% (90) were males and females, respectively. The grand total score was 170.92±19.08. A total of 166.98±20.15 and 173.49±18.09 were the total professionalism score of male and female study participants, respectively, with no statistically significant (P=0.61) differences. This study found almost similar levels of familiarity with all fundamental issues of professionalism with no statistically (P>0.05) significant differences. Medical faculty members

Expert Involvement and Adherence to Medical Evidence in Medical Mobile Phone Apps

DEFF Research Database (Denmark)

Subhi, Yousif; Bube, Sarah Hjartbro; Rolskov Bojsen, Signe

2015-01-01

BACKGROUND: Both clinicians and patients use medical mobile phone apps. Anyone can publish medical apps, which leads to contents with variable quality that may have a serious impact on human lives. We herein provide an overview of the prevalence of expert involvement in app development and whether...... or not app contents adhere to current medical evidence. OBJECTIVE: To systematically review studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. METHODS: We systematically searched 3 databases (PubMed, The Cochrane Library, and EMBASE......), and included studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. Two authors performed data extraction independently. Qualitative analysis of the included studies was performed. RESULTS: Based on inclusion criteria, 52 studies were included...

Medical Students' Perspective Towards Their Future Medical Practice

African Journals Online (AJOL)

Objectives:To evaluate the influencing factors towards choice of the medical profession and attitude towards future medical practice. Subjects and methods: One hundred thirty four students of the Gondar College of Medical Sciences were included in the study. Data was collected by using self-administered questionnaires.

The critical role of ethics training in medical education

Directory of Open Access Journals (Sweden)

A Nicolaides

2014-01-01

Full Text Available When one thinks of the issue of medical ethics the Hippocratic Oath comes to mind. In terms of this oath, one would assume that the goal of medical ethics is to improve the quality of patient care by means of the identification and analysis, and hopefully resolution of any ethical complications that arise in the course of medical practice. This is not always the case and sadly, many Physicians' are unhappy with the practice of medicine and its ethical obligations. Such attitudes may have severe public health implications for the South African medical profession. It is thus essential to provide even more effective ethics training which includes moral reasoning during medical school and residency training. At a time when there appears to be less public confidence in doctors and where practitioner morale is at an all-time low, and patients complain of substandard medical treatment, it is important to reconsider the question of medical ethics. This paper seeks to scrutinize the principles of the Hippocratic Oath and questions whether medical practitioners of contemporary medicine adhere to its principles and are taught ethics during their medical courses. This will provide a greater understanding of the role of modern medical ethics education in promoting ethical practice.

Basic concepts and issues: a primer on distribution and sales representative agreements in the medical device and durable medical equipment industries.

Science.gov (United States)

Burow, Heiko E; Kolls, Raymond C

2006-01-01

Counsel for a manufacturer of medical devices or durable medical equipment must have working knowledge of various legal disciplines to draft contracts with intermediaries (sales representatives and distributors) for the marketing and sale of the manufacturer's products. If the manufacturer wishes to sell its products abroad, counsel must become familiar with the laws and business practices of the target country, and methods of gaining access to the foreign market. This Article gives readers an overview of the applicable legal principles, under U.S. and foreign laws, in the areas of agency, contracts, healthcare regulation, consumer protection, intellectual property protection, and dealer protection. To aid counsel in drafting intermediary agreements, specific contractual terms and issues are explored in depth, including: appointment clauses, performance provisions, provisions concerning pricing and payment, protective clauses (shielding the manufacturer from liability), term and termination provisions, independent contractor clauses, export control clauses, recordkeeping and audit provisions, choice of law clauses, and dispute resolution clauses.

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

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Burford, Bryan

2012-02-01

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

Trusting early learners with critical professional activities through emergency medical technician certification.

Science.gov (United States)

Brenner, Judith; Bird, Jeffrey; Ginzburg, Samara B; Kwiatkowski, Thomas; Papasodero, Vincent; Rennie, William; Schlegel, Elisabeth; Ten Cate, Olle; Willey, Joanne M

2018-03-08

Two dominant themes face medical education: developing integrated curricula and improving the undergraduate medical education (UME) to graduate medical education (GME) transition. An innovative solution to both of these challenges at the Zucker School of Medicine has been the application of the cognitive apprenticeship framework in requiring emergency medical technician (EMT) certification during the first course in medical school as the core on which to build an integrated curriculum and provide entrustable clinical skills. Beginning with the Class of 2011, student feedback about the short-term impact of the experience was collected annually. In addition, perceptions of near graduates and alumni were surveyed in 2017 to explore the long-term impact of the experience. Theme analysis was conducted via inductive coding. Both first-year and more experienced learners report the value of the EMT curriculum as an integrated component of the first course of medical school. Reported positive long-term impacts included the first-hand observation of social determinants of health and interprofessionalism. Negative comments by early learners focused on course logistics, whereas older learners recalled the variability of clinical experiences during ambulance runs. The integration of the EMT curriculum as a core component of the first course serves multiple purposes: 1) it provides the foundation of a spiral learning approach; 2) it contextualizes the basic sciences within clinical practice; 3) it provides opportunities for students to engage in authentic clinical activities under the guidance of mentors; 4) it introduces students to the interdisciplinary nature of medicine; and 5) it serves as the first entrustable professional activity (EPA) for our students.

Efficacy of burnout interventions in the medical education pipeline.

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Williams, Daniel; Tricomi, Gian; Gupta, Jay; Janise, Annie

2015-02-01

Little is known about the efficacy of current interventions to mitigate burnout among medical students and residents, despite its association with mood disorders, absenteeism, low job satisfaction, and medical errors. This review summarizes the efficacy data of burnout interventions and how each modality is used. OVID-SP Medline, Google Scholar and PsychINFO were searched for combinations of medical subject headings (MeSH) terms: premedical students, medical students, internships, intern, medical graduate, clinical clerkship, and residents in combination with a keyword group of burnout, professional burnout, suicide, attempted suicide, and prevention. Studies with data on the efficacy from burnout prevention programs were included for review. Nineteen studies were selected for inclusion in this review. Eleven different types of interventions and combinations of interventions were used. There were six studies on the impact of the 2003 duty-hour restrictions by the Accreditation Council for Graduate Medical Education on burnout. Other approaches included self-development groups, conversion to a pass-fail grading system and training in mindfulness, communication, and stress management. Half of the intervention approaches had at least one study demonstrating benefit in reducing burnout. Self-development groups, the Respiratory One Method for relaxation, and conversion to a pass-fail grading system appear to reduce burnout. The burnout data on mindfulness training and the 2003 resident duty-hour restrictions are mixed. There were no studies available on burnout among premedical students or suicide prevention among medical students or residents. There is a growing body of evidence-based interventions to mitigate burnout which can be used in the development of future programs. More research is needed to identify and intervene against burnout earlier in the medical education pipeline, including at the undergraduate level.

Dienogest in long-term treatment of endometriosis

Directory of Open Access Journals (Sweden)

Schindler AE

2011-07-01

Full Text Available Adolf E SchindlerInstitute for Medical Research and Education, Essen, GermanyAbstract: Endometriosis is a chronic disease primarily affecting women of childbearing age, in which endometriotic lesions form outside the uterus, typically leading to painful symptoms, fatigue, and infertility. The symptoms of endometriosis may cause significant impairment in quality of life and represent a substantial economic burden to patients, families, and society. There is no cure for endometriosis; management consists of alleviating pain and other symptoms, reducing endometriotic lesions, and improving quality of life. Recurrence after surgical intervention is common, while the clinical evidence to support the efficacy and safety of many medications currently used in endometriosis is limited. Dienogest is an oral progestin that has been investigated extensively in the treatment of endometriosis in two clinical programs performed in Europe and Japan, including dose-ranging, placebo-controlled, active comparator-controlled, and long-term (up to 65 weeks studies. These studies demonstrated that dienogest 2 mg daily effectively alleviates the painful symptoms of endometriosis, reduces endometriotic lesions, and improves indices of quality of life. Dienogest showed a favorable safety and tolerability profile in these studies, with predictable adverse effects, high rates of patient compliance, and low withdrawal rates. This review article describes the clinical trial evidence that characterizes the efficacy and safety of dienogest in endometriosis, including two studies characterizing dienogest in long-term use. The relevance of these findings to the management of endometriosis in clinical practice is discussed.Keywords: dienogest, endometriosis, progestins, long-term treatment, quality of life, symptoms, pain

Suffering in Silence: Medical Error and its Impact on Health Care Providers.

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Robertson, Jennifer J; Long, Brit

2018-04-01

All humans are fallible. Because physicians are human, unintentional errors unfortunately occur. While unintentional medical errors have an impact on patients and their families, they may also contribute to adverse mental and emotional effects on the involved provider(s). These may include burnout, lack of concentration, poor work performance, posttraumatic stress disorder, depression, and even suicidality. The objectives of this article are to 1) discuss the impact medical error has on involved provider(s), 2) provide potential reasons why medical error can have a negative impact on provider mental health, and 3) suggest solutions for providers and health care organizations to recognize and mitigate the adverse effects medical error has on providers. Physicians and other providers may feel a variety of adverse emotions after medical error, including guilt, shame, anxiety, fear, and depression. It is thought that the pervasive culture of perfectionism and individual blame in medicine plays a considerable role toward these negative effects. In addition, studies have found that despite physicians' desire for support after medical error, many physicians feel a lack of personal and administrative support. This may further contribute to poor emotional well-being. Potential solutions in the literature are proposed, including provider counseling, learning from mistakes without fear of punishment, discussing mistakes with others, focusing on the system versus the individual, and emphasizing provider wellness. Much of the reviewed literature is limited in terms of an emergency medicine focus or even regarding physicians in general. In addition, most studies are survey- or interview-based, which limits objectivity. While additional, more objective research is needed in terms of mitigating the effects of error on physicians, this review may help provide insight and support for those who feel alone in their attempt to heal after being involved in an adverse medical event

Building integrated mental health and medical programs for vulnerable populations post-disaster: connecting children and families to a medical home.

Science.gov (United States)

Madrid, Paula A; Sinclair, Heidi; Bankston, Antoinette Q; Overholt, Sarah; Brito, Arturo; Domnitz, Rita; Grant, Roy

2008-01-01

and concern about stigma. Once the mental health service became trusted in the community, frequent diagnoses for school-age children included disruptive behavior disorders and learning problems, with underlying depression, anxiety, and stress disorders. Mood and anxiety disorders and substance abuse were prevalent among the adolescents and adults, including parents. There is a critical and long-term need for medical and mental health services among affected populations following a disaster due to natural hazards. Most patients required both medical and mental health care, which underscores the value of co-locating these services.

Strategies to improve medication adherence in patients with schizophrenia: the role of support services

Directory of Open Access Journals (Sweden)

El-Mallakh P

2015-04-01

Full Text Available Peggy El-Mallakh, Jan FindlayCollege of Nursing, University of Kentucky, Lexington, KY, USAAbstract: The purpose of this review is to describe research over the past 10 years on the role of support services in promoting medication adherence in mental health consumers diagnosed with schizophrenia. A literature search was conducted using the terms “medication adherence,” “schizophrenia,” and “support services,” using Medline, PubMed, and CINAHL. Reference lists from published studies were also reviewed to identify additional research studies. Twenty-two articles focused on support-service intervention studies, and these were selected for review. Available support-service interventions include adherence therapy, electronic reminders via text messages and telephones, cognitive–behavioral and motivational strategies, and financial incentives. Support-service intervention strategies need to be tailored to the specific needs of mental health consumers with schizophrenia. More research is needed to investigate effective support services to enhance long-term adherence and adherence to medications for medical illnesses in this population.Keywords: schizophrenia, medication adherence, support services, therapy, interventions

Academic education and training in Medical Physics in Argentina

International Nuclear Information System (INIS)

Mairal, L.; Sansogne, R.; Brunetto, M.; Valda, A.; Sanz, D.; Velez, G.; Stefanic, A.; Bourel, V.; Ruggeri, R.; Salinas, F.

2012-01-01

This work describes the current offer for academic and clinical training in medical physics in Argentina; as well as the specific requirements for professional licensing in some specializations, known as individual national license. Reference is made to current local legislation, highlighting the fact that diagnostic radiology does not include the requirement of medical physicist's compulsory advice. Thus, the labor supply is negligible in this area, to the detriment of the quality of this practice, mainly in terms of radiation protection for patients. Additionally, it is important to highlight the absence of the legal definition of a medical physicist as a health professional in the structure of Health Ministries, which increases disadvantages to those who practice this discipline in public health institutions. Finally, it is noted the absence of doctoral programs in medical physics and its impact on research, development and teaching (author)

Pharmacological Interventions Including Medical Injections for Neck Pain: An Overview as Part of the ICON§ Project

Science.gov (United States)

Peloso, Paul M; Khan, Mahweesh; Gross, Anita R; Carlesso, Lisa; Santaguida, Lina; Lowcock, Janet; MacDermid, Joy C; Walton, Dave; Goldsmith, Charlie H; Langevin, Pierre; Shi, Qiyun

2013-01-01

Objectives: To conduct an overview (review-of-reviews) on pharmacological interventions for neck pain. Search Strategy: Computerized databases and grey literature were searched from 2006 to 2012. Selection Criteria: Systematic reviews of randomized controlled trials (RCT) in adults with acute to chronic neck pain reporting effects of pharmacological interventions including injections on pain, function/disability, global perceived effect, quality of life and patient satisfaction. Data Collection & Analysis: Two independent authors selected articles, assessed risk of bias and extracted data The GRADE tool was used to evaluate the body of evidence and an external panel provided critical review. Main Results: We found 26 reviews reporting on 47 RCTs. Most pharmacological interventions had low to very low quality methodologic evidence with three exceptions. For chronic neck pain, there was evidence of: a small immediate benefit for eperison hydrochloride (moderate GRADE, 1 trial, 157 participants);no short-term pain relieving benefit for botulinum toxin-A compared to saline (strong GRADE; 5 trial meta-analysis, 258 participants) nor for subacute/chronic whiplash (moderate GRADE; 4 trial meta-analysis, 183 participants) including reduced pain, disability or global perceived effect; andno long-term benefit for medial branch block of facet joints with steroids (moderate GRADE; 1 trial, 120 participants) over placebo to reduce pain or disability; Reviewers' Conclusions: While in general there is a lack of evidence for most pharmacological interventions, current evidence is against botulinum toxin-A for chronic neck pain or subacute/chronic whiplash; against medial branch block with steroids for chronic facet joint pain; but in favour of the muscle relaxant eperison hydrochloride for chronic neck pain. PMID:24155805

Medical writing, revising and editing

DEFF Research Database (Denmark)

Pilegaard, Morten

2006-01-01

The globalization of science makes medical writing, editing and revision a rapidly growing field of linguistic study and practice. Medical science texts are written according to uniform, general guidelines and medical genres have become highly conventionalized in terms of structure and linguistic...... form. Medical editing often takes the form of peer review and mainly addresses issues of contents and overall validity. Medical revision incorporates the checking of the macrostructure and the microstructure of the text, its language and style and its suitability for the target reader or client...

A proposal for a worldwide definition of health resort medicine, balneology, medical hydrology and climatology

Science.gov (United States)

Gutenbrunner, Christoph; Bender, Tamas; Cantista, Pedro; Karagülle, Zeki

2010-09-01

Health Resort Medicine, Balneology, Medical Hydrology and Climatology are not fully recognised as independent medical specialties at a global international level. Analysing the reasons, we can identify both external (from outside the field) and internal (from inside the field) factors. External arguments include, e.g. the lack of scientific evidence, the fact that Balneotherapy and Climatotherapy is not used in all countries, and the fact that Health Resort Medicine, Balneology, Medical Hydrology and Climatology focus only on single methods and do not have a comprehensive concept. Implicit barriers are the lack of international accepted terms in the field, the restriction of being allowed to practice the activities only in specific settings, and the trend to use Balneotherapy mainly for wellness concepts. Especially the implicit barriers should be subject to intense discussions among scientists and specialists. This paper suggests one option to tackle the problem of implicit barriers by making a proposal for a structure and description of the medical field, and to provide some commonly acceptable descriptions of content and terminology. The medical area can be defined as “medicine in health resorts” (or “health resort medicine”). Health resort medicine includes “all medical activities originated and derived in health resorts based on scientific evidence aiming at health promotion, prevention, therapy and rehabilitation”. Core elements of health resort interventions in health resorts are balneotherapy, hydrotherapy, and climatotherapy. Health resort medicine can be used for health promotion, prevention, treatment, and rehabilitation. The use of natural mineral waters, gases and peloids in many countries is called balneotherapy, but other (equivalent) terms exist. Substances used for balneotherapy are medical mineral waters, medical peloids, and natural gases (bathing, drinking, inhalation, etc.). The use of plain water (tap water) for therapy is called

A proposal for a worldwide definition of health resort medicine, balneology, medical hydrology and climatology.

Science.gov (United States)

Gutenbrunner, Christoph; Bender, Tamas; Cantista, Pedro; Karagülle, Zeki

2010-09-01

Health Resort Medicine, Balneology, Medical Hydrology and Climatology are not fully recognised as independent medical specialties at a global international level. Analysing the reasons, we can identify both external (from outside the field) and internal (from inside the field) factors. External arguments include, e.g. the lack of scientific evidence, the fact that Balneotherapy and Climatotherapy is not used in all countries, and the fact that Health Resort Medicine, Balneology, Medical Hydrology and Climatology focus only on single methods and do not have a comprehensive concept. Implicit barriers are the lack of international accepted terms in the field, the restriction of being allowed to practice the activities only in specific settings, and the trend to use Balneotherapy mainly for wellness concepts. Especially the implicit barriers should be subject to intense discussions among scientists and specialists. This paper suggests one option to tackle the problem of implicit barriers by making a proposal for a structure and description of the medical field, and to provide some commonly acceptable descriptions of content and terminology. The medical area can be defined as "medicine in health resorts" (or "health resort medicine"). Health resort medicine includes "all medical activities originated and derived in health resorts based on scientific evidence aiming at health promotion, prevention, therapy and rehabilitation". Core elements of health resort interventions in health resorts are balneotherapy, hydrotherapy, and climatotherapy. Health resort medicine can be used for health promotion, prevention, treatment, and rehabilitation. The use of natural mineral waters, gases and peloids in many countries is called balneotherapy, but other (equivalent) terms exist. Substances used for balneotherapy are medical mineral waters, medical peloids, and natural gases (bathing, drinking, inhalation, etc.). The use of plain water (tap water) for therapy is called hydrotherapy

Evaluation of the medical student research programme in Norwegian medical schools. A survey of students and supervisors

Directory of Open Access Journals (Sweden)

Tømmerås Karin

2009-07-01

Full Text Available Abstract Background The Medical Student Research Programme is a national education and grant scheme for medical students who wish to carry out research in parallel with their studies. The purpose of the programme is to increase recruitment of people with a standard medical degree to medical research. The Research Programme was established in 2002 and underwent a thorough evaluation during the spring of 2007. The evaluation should investigate if the programme had fulfilled its objectives of increased recruitment to medical research, in addition to the students' and supervisors' satisfaction of the programme, and unwanted differences between the universities. Methods Data was collected from students, supervisors and administrative staff via web-based questionnaires. Information about admission, implementation, results achieved and satisfaction was analysed and compared between the four Norwegian medical schools. In addition, the position of the scheme in relation to the national Quality Reform of Higher Education was analysed. Results At the end of 2006, the Medical Student Research Programme had recruited 265 medical students to research. These consisted of 214 active students, 35 who had completed their studies and only 17 who had dropped out. Both students and supervisors were generally very satisfied with the scheme, including the curriculum, the results achieved and the administrative service. The majority of students wanted to continue their research towards a PhD and, of those who had completed the Medical Student Research Programme, practically all had published one or several scientific papers. The survey showed only small differences between the four medical schools, despite their choice of somewhat different solutions in terms of administration and organisation. The Medical Student Research Programme satisfies the majority of the demands of the Quality Reform, however as an integrated research programme aimed at a PhD it presupposes

Evaluation of the medical student research programme in Norwegian medical schools. A survey of students and supervisors

Science.gov (United States)

Hunskaar, Steinar; Breivik, Jarle; Siebke, Maje; Tømmerås, Karin; Figenschau, Kristian; Hansen, John-Bjarne

2009-01-01

Background The Medical Student Research Programme is a national education and grant scheme for medical students who wish to carry out research in parallel with their studies. The purpose of the programme is to increase recruitment of people with a standard medical degree to medical research. The Research Programme was established in 2002 and underwent a thorough evaluation during the spring of 2007. The evaluation should investigate if the programme had fulfilled its objectives of increased recruitment to medical research, in addition to the students' and supervisors' satisfaction of the programme, and unwanted differences between the universities. Methods Data was collected from students, supervisors and administrative staff via web-based questionnaires. Information about admission, implementation, results achieved and satisfaction was analysed and compared between the four Norwegian medical schools. In addition, the position of the scheme in relation to the national Quality Reform of Higher Education was analysed. Results At the end of 2006, the Medical Student Research Programme had recruited 265 medical students to research. These consisted of 214 active students, 35 who had completed their studies and only 17 who had dropped out. Both students and supervisors were generally very satisfied with the scheme, including the curriculum, the results achieved and the administrative service. The majority of students wanted to continue their research towards a PhD and, of those who had completed the Medical Student Research Programme, practically all had published one or several scientific papers. The survey showed only small differences between the four medical schools, despite their choice of somewhat different solutions in terms of administration and organisation. The Medical Student Research Programme satisfies the majority of the demands of the Quality Reform, however as an integrated research programme aimed at a PhD it presupposes access to PhD courses before the

Long-term effects of prenatal progesterone exposure

DEFF Research Database (Denmark)

Vedel, C.; Larsen, H.; Holmskov, Anni

2016-01-01

children from 498 twin pregnancies, were followed-up. PREDICT was a placebo-controlled randomized clinical trial examining the effect of progesterone for prevention of preterm delivery in unselected twin pregnancies. Medical histories of the children were reviewed and neurophysiological development...... does not seem to have long-term harmful effects during childhood, but future studies should focus on cardiac disease in the child. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.......OBJECTIVES: To perform a neurophysiological follow-up at 48 or 60 months of age in children exposed prenatally to progesterone compared with a placebo and evaluate their medical histories up to 8 years of age. METHODS: In this study, Danish participants of the PREDICT study, including 989 surviving...

The Path to a Reliable Supply of Medical Radioisotopes

International Nuclear Information System (INIS)

Gas, Serge; Westmacott, Chad; Cameron, Ron; Lokhov, Alexey

2011-06-01

Medical imaging techniques using technetium-99m account for roughly 80% of all nuclear medicine procedures, representing over 30 million examinations worldwide every year. Disruptions in the supply chain of these medical isotopes - which have half-lives of 66 hours for molybdenum-99 ( 99 Mo) and 6 hours for technetium-99m ( 99m Tc), and thus must be produced continually - can lead to cancellations or delays in important medical testing services. Unfortunately, supply reliability has declined over the past decade, due to unexpected or extended shutdowns at the few ageing, 99 Mo-producing, research reactors and processing facilities. These shutdowns have created global supply shortages. At the request of its member countries, the OECD Nuclear Energy Agency (NEA) established the High-level Group on the Security of Supply of Medical Radioisotopes (HLG-MR) in 2009. During its two-year mandate, the HLG-MR assessed the factors rendering the supply chain vulnerable and identified practical measures - near, medium and long term - to ensure the security of supply of this important medical isotope. Building on its findings and assessments, the HLG-MR developed a comprehensive policy approach to encourage long-term supply security of 99 Mo/' 99m Tc, detailing the essential steps to be taken by governments, industry and the health community to address the vulnerabilities within the supply chain, including changing an economic structure that does not support or reinforce reliable supply

Inadequate recording of alcohol-drinking, tobacco-smoking and discharge diagnosis in medical in-patients: failure to recognize risks including drug interactions.

Science.gov (United States)

Bairstow, B M; Burke, V; Beilin, L J; Deutscher, C

1993-11-01

The records of 62 men and 43 women, 14-88 years old, admitted to general medical wards in a public teaching hospital during 1991 were examined for discharge medications and for the recording of alcohol-drinking, tobacco-smoking and discharge diagnosis. Drinking and smoking status was unrecorded in 22.9% and 21.9% of patients respectively. Twenty-four patients had 31 potential drug interactions which were related to the number of drugs prescribed and to drinking alcohol; 10.5% of the patients had interactions involving alcohol and 2.9% tobacco. Six patients received relatively or absolutely contraindicated drugs, including one asthmatic given two beta-blockers. The drugs prescribed indicated that some patients had conditions such as gastro-oesophageal disorders, diabetes and obstructive airways disease which had not been recorded. Inadequate recording of diagnoses, alcohol and smoking status creates risks to patients and may cause opportunities for preventive care to be missed. This study provides the basis for the development of undergraduate and postgraduate education programmes to address these issues and so decrease risks to patients which arise from inadequate recording practices. Incomplete diagnoses also adversely affect hospital funding where this depends on case-mix diagnostic groups. Quality assurance programmes and other strategies are being implemented to improve medical recording and prescribing habits.

Value-Added Clinical Systems Learning Roles for Medical Students That Transform Education and Health: A Guide for Building Partnerships Between Medical Schools and Health Systems.

Science.gov (United States)

Gonzalo, Jed D; Lucey, Catherine; Wolpaw, Terry; Chang, Anna

2017-05-01

To ensure physician readiness for practice and leadership in changing health systems, an emerging three-pillar framework for undergraduate medical education integrates the biomedical and clinical sciences with health systems science, which includes population health, health care policy, and interprofessional teamwork. However, the partnerships between medical schools and health systems that are commonplace today use health systems as a substrate for learning. Educators need to transform the relationship between medical schools and health systems. One opportunity is the design of authentic workplace roles for medical students to add relevance to medical education and patient care. Based on the experiences at two U.S. medical schools, the authors describe principles and strategies for meaningful medical school-health system partnerships to engage students in value-added clinical systems learning roles. In 2013, the schools began large-scale efforts to develop novel required longitudinal, authentic health systems science curricula in classrooms and workplaces for all first-year students. In designing the new medical school-health system partnerships, the authors combined two models in an intersecting manner-Kotter's change management and Kern's curriculum development steps. Mapped to this framework, they recommend strategies for building mutually beneficial medical school-health system partnerships, including developing a shared vision and strategy and identifying learning goals and objectives; empowering broad-based action and overcoming barriers in implementation; and generating short-term wins in implementation. Applying this framework can lead to value-added clinical systems learning roles for students, meaningful medical school-health system partnerships, and a generation of future physicians prepared to lead health systems change.

A review of teaching skills development programmes for medical students.

Science.gov (United States)

Marton, Gregory E; McCullough, Brendan; Ramnanan, Christopher J

2015-02-01

The CanMEDS role of Scholar requires that medical trainees develop their skills as medical educators. The development of teaching skills in undergraduate medical students is therefore desirable, especially in view of the teaching obligations in residency programmes. The goal of this review was to identify the characteristics and outcomes of programmes designed to develop the teaching skills of undergraduate medical students. The authors searched medical literature databases using combinations of the search terms 'medical student', 'teacher', 'teaching skills', 'peer teaching', 'near-peer teaching' and 'student as teacher'. Twenty papers fit the predetermined search criteria, which included original characterisations of specific programmes involving undergraduate medical students. Three types of initiative were identified in the reviewed articles: peer teaching programmes; teaching workshops, and community outreach programmes. The majority of study participants were students in Years 3 and 4. Subjective self-evaluation by participants using Likert scale-based surveys was by far the most commonly used method of measuring project outcomes. Objective, quantitative teaching-related outcomes were rarely noted in the reports reviewed. Self-perceived improvements in teaching skills were noted by participants in most of the reports. Other perceived benefits included increases in organisational skills, knowledge and confidence in giving feedback. Although several types of programmes have been shown to subjectively improve the teaching skills of undergraduate medical students, characterisation of the objective outcomes of these initiatives is lacking and requires further study. © 2015 John Wiley & Sons Ltd.

Short-Term Medical Costs of a VHA Health Information Exchange: A CHEERS-Compliant Article

Science.gov (United States)

French, Dustin D.; Dixon, Brian E.; Perkins, Susan M.; Myers, Laura J.; Weiner, Michael; Zillich, Allan J.; Haggstrom, David A.

2016-01-01

Abstract The Virtual Lifetime Electronic Record (VLER) Health program provides the Veterans Health Administration (VHA) a framework whereby VHA providers can access the veterans’ electronic health record information to coordinate healthcare across multiple sites of care. As an early adopter of VLER, the Indianapolis VHA and Regenstrief Institute implemented a regional demonstration program involving bi-directional health information exchange (HIE) between VHA and non-VHA providers. The aim of the study is to determine whether implementation of VLER HIE reduces 1 year VHA medical costs. A cohort evaluation with a concurrent control group compared VHA healthcare costs using propensity score adjustment. A CHEERs compliant checklist was used to conduct the cost evaluation. Patients were enrolled in the VLER program onsite at the Indianapolis VHA in outpatient clinics or through the release-of-information office. VHA cost data (in 2014 dollars) were obtained for both enrolled and nonenrolled (control) patients for 1 year prior to, and 1 year after, the index date of patient enrollment. There were 6104 patients enrolled in VLER and 45,700 patients in the control group. The annual adjusted total cost difference per patient was associated with a higher cost for VLER enrollees $1152 (95% CI: $807–1433) (P < 0.01) (in 2014 dollars) than VLER nonenrollees. Short-term evaluation of this demonstration project did not show immediate reductions in healthcare cost as might be expected if HIE decreased redundant medical tests and treatments. Cost reductions from shared health information may be realized with longer time horizons. PMID:26765453

Racial differences in long-term adherence to oral antidiabetic drug therapy: a longitudinal cohort study

Directory of Open Access Journals (Sweden)

Meigs James B

2009-02-01

Full Text Available Abstract Background Adherence to oral antidiabetic medications is often suboptimal. Adherence differences may contribute to health disparities for black diabetes patients, including higher microvascular event rates, greater complication-related disability, and earlier mortality. Methods In this longitudinal retrospective cohort study, we used 10 years of patient-level claims and electronic medical record data (1/1/1992–12/31/2001 to assess differences in short- and long-term adherence to oral antidiabetic medication among 1906 newly diagnosed adults with diabetes (26% black, 74% white in a managed care setting in which all members have prescription drug coverage. Four main outcome measures included: (1 time from diabetes diagnosis until first prescription of oral antidiabetic medication; (2 primary adherence (time from first prescription to prescription fill; (3 time until discontinuation of oral antidiabetic medication from first prescription; and (4 long-term adherence (amount dispensed versus amount prescribed over a 24-month follow-up from first oral antidiabetic medication prescription. Results Black patients were as likely as whites to initiate oral therapy and fill their first prescription, but experienced higher rates of medication discontinuation (HR: 1.8, 95% CI: 1.2, 2.7 and were less adherent over time. These black-white differences increased over the first six months of therapy but stabilized thereafter for patients who initiated on sulfonylureas. Significant black-white differences in adherence levels were constant throughout follow-up for patients initiated on metformin therapy. Conclusion Racial differences in adherence to oral antidiabetic drug therapy persist even with equal access to medication. Early and continued emphasis on adherence from initiation of therapy may reduce persistent racial differences in medication use and clinical outcomes.

Self-medication practice among undergraduate medical students in a tertiary care medical college, West Bengal.

Science.gov (United States)

Banerjee, I; Bhadury, T

2012-01-01

Self-medication is a widely prevalent practice in India. It assumes a special significance among medical students as they are the future medical practitioners. To assess the pattern of self-medication practice among undergraduate medical students. Tertiary care medical college in West Bengal, India. A cross-sectional questionnaire-based study was conducted among the undergraduate medical students. Out of 500 students of the institute, 482 consented for the study and filled in the supplied questionnaire. Fourteen incomplete questionnaires were excluded and the remaining 468 analyzed. It was found that 267 (57.05%) respondents practiced self-medication. The principal morbidities for seeking self-medication included cough and common cold as reported by 94 students (35.21%) followed by diarrhea (68 students) (25.47%), fever (42 students) (15.73%), headache (40 students) (14.98%) and pain abdomen due to heartburn/ peptic ulcer (23 students) (8.61%). Drugs/ drug groups commonly used for self-medication included antibiotics (31.09%) followed by analgesics (23.21%), antipyretics (17.98%), antiulcer agents (8.99%), cough suppressant (7.87%), multivitamins (6.37%) and antihelminthics (4.49%). Among reasons for seeking self-medication, 126 students (47.19%) felt that their illness was mild while 76 (28.46%) preferred as it is time-saving. About 42 students (15.73%) cited cost-effectiveness as the primary reason while 23 (8.62%) preferred because of urgency. Our study shows that self-medication is widely practiced among students of the institute. In this situation, faculties should create awareness and educate their students regarding advantages and disadvantages of self-medication.

Interprofessional Medical-Legal Education of Medical Students: Assessing the Benefits for Addressing Social Determinants of Health.

Science.gov (United States)

Pettignano, Robert; Bliss, Lisa; McLaren, Susan; Caley, Sylvia

2017-09-01

Screening tools exist to help identify patient issues related to social determinants of health (SDH), but solutions to many of these problems remain elusive to health care providers as they require legal solutions. Interprofessional medical-legal education is essential to optimizing health care delivery. In 2011, the authors implemented a four-session didactic interprofessional curriculum on medical-legal practice for third-year medical students at Morehouse School of Medicine. This program, also attended by law students, focused on interprofessional collaboration to address client/patient SDH issues and health-harming legal needs. In 2011-2014, the medical students participated in pre- and postintervention surveys designed to determine their awareness of SDH's impact on health as well as their attitudes toward screening for SDH issues and incorporating resources, including a legal resource, to address them. Mean ratings were compared between pre- and postintervention respondent cohorts using independent-sample t tests. Of the 222 medical students who participated in the program, 102 (46%) completed the preintervention survey and 100 (45%) completed the postintervention survey. Postintervention survey results indicated that students self-reported an increased likelihood to screen patients for SDH issues and an increased likelihood to refer patients to a legal resource (P education into undergraduate medical education may result in an increased likelihood to screen patients for SDH and to refer patients with legal needs to a legal resource. In the future, an additional evaluation to assess the curriculum's long-term impact will be administered prior to graduation.

Short and medium-term medical follow-up program for victims of the Goiania accident, Brazil: a proposal

International Nuclear Information System (INIS)

Oliveira, A.R. de; Brandao-Mello, C.E.; Farina, R.

1988-01-01

The medical surveillance of the individuals who supposedly received high radiation doses due to the breaking of Cesium-137 source from gamma radiation therapy apparatus, is presented. The study includes a serie of evaluations and procedures such as periodic clinical examinations, and diagnostic procedures. Among the special procedures unusual in routine medical practice, the radiochemical analysis of urine and feces, and the whole-body counting are mentioned, to evaluate the total and residual body burden of Cesium-137 in the organism. Following the acute phase of radiation effects on the organism, such examinations intend to detect, early, the functional or organic changes which may appear during the first years after exposure. (M.C.K.) [pt

Short-term mechanisms influencing volumetric brain dynamics

Directory of Open Access Journals (Sweden)

Nikki Dieleman

2017-01-01

Full Text Available With the use of magnetic resonance imaging (MRI and brain analysis tools, it has become possible to measure brain volume changes up to around 0.5%. Besides long-term brain changes caused by atrophy in aging or neurodegenerative disease, short-term mechanisms that influence brain volume may exist. When we focus on short-term changes of the brain, changes may be either physiological or pathological. As such determining the cause of volumetric dynamics of the brain is essential. Additionally for an accurate interpretation of longitudinal brain volume measures by means of neurodegeneration, knowledge about the short-term changes is needed. Therefore, in this review, we discuss the possible mechanisms influencing brain volumes on a short-term basis and set-out a framework of MRI techniques to be used for volumetric changes as well as the used analysis tools. 3D T1-weighted images are the images of choice when it comes to MRI of brain volume. These images are excellent to determine brain volume and can be used together with an analysis tool to determine the degree of volume change. Mechanisms that decrease global brain volume are: fluid restriction, evening MRI measurements, corticosteroids, antipsychotics and short-term effects of pathological processes like Alzheimer's disease, hypertension and Diabetes mellitus type II. Mechanisms increasing the brain volume include fluid intake, morning MRI measurements, surgical revascularization and probably medications like anti-inflammatory drugs and anti-hypertensive medication. Exercise was found to have no effect on brain volume on a short-term basis, which may imply that dehydration caused by exercise differs from dehydration by fluid restriction. In the upcoming years, attention should be directed towards studies investigating physiological short-term changes within the light of long-term pathological changes. Ultimately this may lead to a better understanding of the physiological short-term effects of

Skylab medical technology utilization

Science.gov (United States)

Stonesifer, J. C.

1974-01-01

To perform the extensive medical experimentation on man in a long-term, zero-g environment, new medical measuring and monitoring equipment had to be developed, new techniques in training and operations were required, and new methods of collecting and analyzing the great amounts of medical data were developed. Examples of technology transfers to the public sector resulted from the development of new equipment, methods, techniques, and data. This paper describes several of the examples that stemmed directly from Skylab technology.

Use of Nonantiretroviral Medications That May Impact Neurocognition: Patterns and Predictors in a Large, Long-Term HIV Cohort Study.

Science.gov (United States)

Radtke, Kendra K; Bacchetti, Peter; Anastos, Kathryn; Merenstein, Daniel; Crystal, Howard; Karim, Roksana; Weber, Kathleen M; Edmonds, Andrew; Sheth, Anandi N; Fischl, Margaret A; Vance, David; Greenblatt, Ruth M; Rubin, Leah H

2018-06-01

Neurocognitive impairment is a frequent and often disabling comorbidity of HIV infection. In addition to antiretroviral therapies, individuals with HIV infection may commonly use nonantiretroviral medications that are known to cause neurocognitive adverse effects (NC-AE). The contribution of NC-AE to neurocognitive impairment is rarely considered in the context of HIV and could explain part of the variability in neurocognitive performance among individuals with HIV. Women's Interagency HIV Study, a prospective, multisite, observational study of US women with and without HIV. After a literature review, 79 medications (excluding statins) with NC-AE were identified and reported by Women's Interagency HIV Study participants. We examined factors associated with self-reported use of these medications over a 10-year period. Generalized estimating equations for binary outcomes were used to assess sociodemographic, behavioral, and clinical characteristics associated with NC-AE medication use. Three thousand three hundred women (71% with HIV) and data from ∼42,000 visits were studied. HIV infection was associated with NC-AE medication use (odds ratio = 1.52; 95% confidence interval: 1.35 to 1.71). After adjustment for HIV infection status, other predictors of NC-AE medication use included having health insurance, elevated depressive symptoms, prior clinical AIDS, noninjection recreational drug use, and an annual household income of <$12,000 (Ps < 0.004). NC-AE medication use was less likely among women who drank 1-7 or 8-12 alcoholic drinks/week (vs. abstaining) (P < 0.04). HIV infection was associated with NC-AE medication use, which may influence determinations of HIV-associated neurocognitive impairment. Providers should consider the impact of NC-AE medications when evaluating patients with HIV and concurrent neurocognitive symptoms.

STS-3 medical report

Science.gov (United States)

Pool, S. L. (Editor); Johnson, P. C., Jr. (Editor); Mason, J. A. (Editor)

1982-01-01

The medical operations report for STS-3, which includes a review of the health of the crew before, during, and immediately after the third Shuttle orbital flight is presented. Areas reviewed include: health evaluation, medical debriefing of crewmembers, health stabilization program, medical training, medical 'kit' carried in flight, tests and countermeasures for space motion sickness, cardiovascular profile, biochemistry and endocrinology results, hematology and immunology analyses, medical microbiology, food and nutrition, potable water, shuttle toxicology, radiological health, and cabin acoustic noise. Environmental effects of shuttle launch and landing medical information management, and management, planning, and implementation of the medical program are also dicussed.

Self-medication practices and predictors for self-medication with ...

African Journals Online (AJOL)

Background: Self-medication with antimalarials and antibiotics is highly practiced worldwide particularly in developing countries including Tanzania. This study was carried out to determine self-medication practices with antimalarials and antibiotics, and as well as predictors for self-medication among urban communities of ...

Radiation education in medical and Co-medical schools

International Nuclear Information System (INIS)

Koga, Sukehiko

2005-01-01

In the medical field, ionizing radiation is very widely in diagnostic and therapeutic procedures, Around 60% of environmental radiation, including natural background and man-made sources of radiation, is caused from medical exposure in Japan. Education of radiation in medical ad co-medical schools are mainly aimed to how effectively use the radiation, and the time shared to fundamental physics, biology and safety or protection of radiation is not so much. (author)

Stimulant ADHD medication and risk for substance abuse.

Science.gov (United States)

Chang, Zheng; Lichtenstein, Paul; Halldner, Linda; D'Onofrio, Brian; Serlachius, Eva; Fazel, Seena; Långström, Niklas; Larsson, Henrik

2014-08-01

There are persistent concerns of long-term effects of stimulant ADHD medication on the development of substance abuse. Using Swedish national registers, we studied all individuals born between 1960 and 1998 and diagnosed with ADHD (26,249 men and 12,504 women). We investigated the association between stimulant ADHD medication in 2006 and substance abuse during 2009. Substance abuse was indexed by substance-related death, crime, or hospital visits. ADHD medication was not associated with increased rate of substance abuse. Actually, the rate during 2009 was 31% lower among those prescribed ADHD medication in 2006, even after controlling for medication in 2009 and other covariates (hazard ratio: 0.69; 95% confidence interval: 0.57-0.84). Also, the longer the duration of medication, the lower the rate of substance abuse. Similar risk reductions were suggested among children and when investigating the association between stimulant ADHD medication and concomitant short-term abuse. We found no indication of increased risks of substance abuse among individuals prescribed stimulant ADHD medication; if anything, the data suggested a long-term protective effect on substance abuse. Although stimulant ADHD medication does not seem to increase the risk for substance abuse, clinicians should remain alert to the potential problem of stimulant misuse and diversion in ADHD patients. © 2013 The Authors. Journal of Child Psychology and Psychiatry © 2013 Association for Child and Adolescent Mental Health.

Clinical audit in the final year of undergraduate medical education: towards better care of future generations.

Science.gov (United States)

Mak, Donna B; Miflin, Barbara

2012-01-01

In Australia, in an environment undergoing rapidly changing requirements for health services, there is an urgent need for future practitioners to be knowledgeable, skilful and self-motivated in ensuring the quality and safety of their practice. Postgraduate medical education and vocational programs have responded by incorporating training in quality improvement into continuing professional development requirements, but undergraduate medical education has been slower to respond. This article describes the clinical audit programme undertaken by all students in the final year of the medical course at the University of Notre Dame, Fremantle, Australia, and examines the educational worth of this approach. Data were obtained from curricular documents, including the clinical audit handbook, and from evaluation questionnaires administered to students and supervisors. The clinical audit programme is based on sound educational principles, including situated and participatory learning and reflective practice. It has demonstrated multi-dimensional benefits for students in terms of learning the complexities of conducting an effective audit in professional practice, and for health services in terms of facilitating quality improvement. Although this programme was developed in a medical course, the concept is readily transferable to a variety of other health professional curricula in which students undertake clinical placements.

Ongoing disease activity and changing categories in a long-term nordic cohort study of juvenile idiopathic arthritis

DEFF Research Database (Denmark)

Nordal, Ellen; Zak, Marek; Aalto, Kristiina

2011-01-01

), including biologic medications, were used in 58.0% of the children during the observation period. Ongoing disease activity was mostly mild, but 22.9% developed some JIA-related damage. At the last follow-up, remission off medication was found in 42.4% of the children, 8.9% were in remission on medication...... results underline the need to identify early predictors of outcome, to further improve therapy and to continue long-term follow-up of children with JIA....

Health economic analyses in medical nutrition: a systematic literature review.

Science.gov (United States)

Walzer, Stefan; Droeschel, Daniel; Nuijten, Mark; Chevrou-Séverac, Hélène

2014-01-01

Medical nutrition is a specific nutrition category either covering specific dietary needs and/or nutrient deficiency in patients or feeding patients unable to eat normally. Medical nutrition is regulated by a specific bill in Europe and in the US, with specific legislation and guidelines, and is provided to patients with special nutritional needs and indications for nutrition support. Therefore, medical nutrition products are delivered by medical prescription and supervised by health care professionals. Although these products have existed for more than 2 decades, health economic evidence of medical nutrition interventions is scarce. This research assesses the current published health economic evidence for medical nutrition by performing a systematic literature review related to health economic analysis of medical nutrition. A systematic literature search was done using standard literature databases, including PubMed, the Health Technology Assessment Database, and the National Health Service Economic Evaluation Database. Additionally, a free web-based search was conducted using the same search terms utilized in the systematic database search. The clinical background and basis of the analysis, health economic design, and results were extracted from the papers finally selected. The Drummond checklist was used to validate the quality of health economic modeling studies and the AMSTAR (A Measurement Tool to Assess Systematic Reviews) checklist was used for published systematic reviews. Fifty-three papers were identified and obtained via PubMed, or directly via journal webpages for further assessment. Thirty-two papers were finally included in a thorough data extraction procedure, including those identified by a "gray literature search" utilizing the Google search engine and cross-reference searches. Results regarding content of the studies showed that malnutrition was the underlying clinical condition in most cases (32%). In addition, gastrointestinal disorders (eg

Key considerations for an economic and legal framework facilitating medical travel

Directory of Open Access Journals (Sweden)

Saba eHinrichs

2016-03-01

Full Text Available Medical travel has the capacity to counter increasing costs of healthcare by creating new markets and increased revenue for health services, potentially benefiting local populations, economies and health care systems. This paper is part of a broad, comprehensive project aimed at developing a Global Health Access Policy (GHAP. It presents key issues to consider in terms of ensuring economic viability, sustainability, and limiting risk to the many stakeholders involved in the rapidly expanding industry of medical travel. The noted economic and legal barriers to medical travel are based on a synthesis of themes found in an extensive review of the available literature. Economic considerations when setting up a GHAP include a dynamic approach to pricing that is fair to the local population. Legal considerations include the implementation of international quality standards and the protection of the rights of those travelling as well as those of local populations in recipient countries. By taking into account these opportunities, the GHAP will more adequately address existing gaps in the economic and legal regulation of medical travel.

A call to include medical humanities in the curriculum of colleges of osteopathic medicine and in applicant selection.

Science.gov (United States)

Hoff, Gary; Hirsch, Norma J; Means, J Jeffrey; Streyffeler, Lisa

2014-10-01

Medicine stands at a crossroad. Disruptive physician behavior has increased, and patient satisfaction has decreased. A growing body of knowledge demonstrates that the medical humanities assist in the creation of compassionate, resilient physicians. Incorporating medical humanities into the medical school curriculum promotes the development of compassionate, culturally sensitive physicians, and also encourages the development of resilience in health care professionals at a time when internal and external pressures on physicians are increasing. © 2014 The American Osteopathic Association.

Medications (for IBS)

Medline Plus

Full Text Available ... IBS Medications Probiotics and Antibiotics Psychological ... With Your Doctor Successful relationships with healthcare providers are an important part of managing life with a long-term digestive disorder. Working with ...

African-American and Latina Women Seeking Public Health Services: Cultural Beliefs regarding Pregnancy, including Medication-taking Behavior

Directory of Open Access Journals (Sweden)

Luz Dalia Sanchez, MD, MCP, MHA, PhD

2011-01-01

Full Text Available Objective: to describe cultural beliefs and medication-taking-behavior about pregnancy in African-American and Latina women. Design: qualitative study using phenomenological methodology; face-to-face, semi structured interviews and focus group. Thematic analysis was done to obtain themes consistent with the research objective. Setting: Maricopa County, Arizona, Department of Public-health Programs, November 2008 through April 2009.Participants: women seeking public-health services in the greater Phoenix, Arizona.Results: fifteen adult women representing two ethnic groups (seven African-Americans and eight Latinas participated. Themes derived from the interview data included: “The Dilemma: To Become or Not to Become Pregnant;” “The Ideal Stress-free World: Support System;” “Changing Worlds: Wanting Dependency;” and “The Health care System: Disconnection from Pregnancy to Postpartum.”Conclusions: based on the cultural themes: 1. pregnancies were not planned; 2. healthy life-style changes were not likely to occur during pregnancy; 3. basic facts about the biology of sexual intercourse and pregnancy were not understood, and there was no usage of any preconceptional or prenatal medications; and 4. professional health care was not desired or considered necessary (except during delivery. These cultural beliefs can contribute to negative birth outcomes, and need to be considered by pharmacists and other health-care providers. The information gained from this study can guide the implementation of educational programs developed by pharmacists that are more sensitive to the cultural beliefs and points of view of these particular women. Such programs would thus be more likely to be favorably received and utilized.

Medication interest in pregnant women

Directory of Open Access Journals (Sweden)

Rok Antolič

2011-12-01

Medication interest is comparable to literature data: relatively high for acute problems, relatively low for iron supplementation and extremely low for preventative folic acid intake. As to our knowledge, we were the ones to introduce the term »medication interest« into professional literature in Slovenia.

Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain.

Science.gov (United States)

Boehnke, Kevin F; Litinas, Evangelos; Clauw, Daniel J

2016-06-01

Opioids are commonly used to treat patients with chronic pain (CP), though there is little evidence that they are effective for long term CP treatment. Previous studies reported strong associations between passage of medical cannabis laws and decrease in opioid overdose statewide. Our aim was to examine whether using medical cannabis for CP changed individual patterns of opioid use. Using an online questionnaire, we conducted a cross-sectional retrospective survey of 244 medical cannabis patients with CP who patronized a medical cannabis dispensary in Michigan between November 2013 and February 2015. Data collected included demographic information, changes in opioid use, quality of life, medication classes used, and medication side effects before and after initiation of cannabis usage. Among study participants, medical cannabis use was associated with a 64% decrease in opioid use (n = 118), decreased number and side effects of medications, and an improved quality of life (45%). This study suggests that many CP patients are essentially substituting medical cannabis for opioids and other medications for CP treatment, and finding the benefit and side effect profile of cannabis to be greater than these other classes of medications. More research is needed to validate this finding. This article suggests that using medical cannabis for CP treatment may benefit some CP patients. The reported improvement in quality of life, better side effect profile, and decreased opioid use should be confirmed by rigorous, longitudinal studies that also assess how CP patients use medical cannabis for pain management. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

Does emotional intelligence influence success during medical school admissions and program matriculation?: a systematic review.

Science.gov (United States)

Cook, Christian Jaeger; Cook, Chad E; Hilton, Tiffany N

2016-01-01

It aimed at determining whether emotional intelligence is a predictor for success in a medical school program and whether the emotional intelligence construct correlated with other markers for admission into medical school. Three databases (PubMed, CINAHL, and ERIC) were searched up to and including July 2016, using relevant terms. Studies written in English were selected if they included emotional intelligence as a predictor for success in medical school, markers of success such as examination scores and grade point average and association with success defined through traditional medical school admission criteria and failures, and details about the sample. Data extraction included the study authors and year, population description, emotional intelligence I tool, outcome variables, and results. Associations between emotional intelligence scores and reported data were extracted and recorded. Six manuscripts were included. Overall, study quality was high. Four of the manuscripts examined emotional intelligence as a predictor for success while in medical school. Three of these four studies supported a weak positive relationship between emotional intelligence scores and success during matriculation. Two of manuscripts examined the relationship of emotional intelligence to medical school admissions. There were no significant relevant correlations between emotional intelligence and medical school admission selection. Emotional intelligence was correlated with some, but not all, measures of success during medical school matriculation and none of the measures associated with medical school admissions. Variability in success measures across studies likely explains the variable findings.

Does emotional intelligence influence success during medical school admissions and program matriculation?: a systematic review

Directory of Open Access Journals (Sweden)

Christian Jaeger Cook

2016-11-01

Full Text Available Purpose It aimed at determining whether emotional intelligence is a predictor for success in a medical school program and whether the emotional intelligence construct correlated with other markers for admission into medical school. Methods Three databases (PubMed, CINAHL, and ERIC were searched up to and including July 2016, using relevant terms. Studies written in English were selected if they included emotional intelligence as a predictor for success in medical school, markers of success such as examination scores and grade point average and association with success defined through traditional medical school admission criteria and failures, and details about the sample. Data extraction included the study authors and year, population description, emotional intelligence I tool, outcome variables, and results. Associations between emotional intelligence scores and reported data were extracted and recorded. Results Six manuscripts were included. Overall, study quality was high. Four of the manuscripts examined emotional intelligence as a predictor for success while in medical school. Three of these four studies supported a weak positive relationship between emotional intelligence scores and success during matriculation. Two of manuscripts examined the relationship of emotional intelligence to medical school admissions. There were no significant relevant correlations between emotional intelligence and medical school admission selection. Conclusion Emotional intelligence was correlated with some, but not all, measures of success during medical school matriculation and none of the measures associated with medical school admissions. Variability in success measures across studies likely explains the variable findings.

[Patients as customers? The term "customer" in the perception of medical students at the end of their university training].

Science.gov (United States)

Zimmermann, L; Körner, M; Geppert, E; Siegel, A; Stöbel, U; Bengel, J

2012-01-01

In the preceding decades a new perspective on the role of patients in the health-care system has gained ground, considering patients not merely as "suffering persons" but additionally as "customers". Physicians, however, tend to disagree with this approach because of the economic connotation of the term customer. Until now, there is only poor evidence of whether students of medicine - who are going to work as physicians in the future - agree or disagree with that approach and whether they are ready to accept patients as customers. In the following study students of medicine were interviewed on their perspectives towards that approach, in particular on their attitudes towards the idea of "the patient as customer", the appropriateness of the term consumer in different clinical settings and sectors of health care, the implementation of consumer orientation in clinical routine, and their favoured model of physician-patient relationship.As the study could not build upon data of prior similar studies, a quantitative and qualitative cross-sectional study with a descriptive-explorative design was conducted. Using a semi-standardised questionnaire, 313 medical students (response rate: 95%) were interviewed in Spring 2010. At the time of the survey, the students were enrolled at the faculty of medicine at Freiburg University, Germany, and were in their last semester which immediately preceded their exam.The future physicians do not consider patients primarily as customers. More than 80% of the respondents "absolutely" or "largely" supported the idea that patients are considerably more than customers. The analysis of the qualitative data of the study shows different results. Here, more statements were made that patients could equally be seen as customers (449 students supported this idea, 298 did not). Statements contradicting the customer approach referred mostly to the asymmetry of the physician-patient relationship and the special role of the patient. The highest level of

(including travel dates) Proposed itinerary

Indian Academy of Sciences (India)

Ashok

31 July to 22 August 2012 (including travel dates). Proposed itinerary: Arrival in Bangalore on 1 August. 1-5 August: Bangalore, Karnataka. Suggested institutions: Indian Institute of Science, Bangalore. St Johns Medical College & Hospital, Bangalore. Jawaharlal Nehru Centre, Bangalore. 6-8 August: Chennai, TN.

Short-Term Neonatal Outcome in Late Preterm vs. Term Infants

International Nuclear Information System (INIS)

Haroon, A.; Ali, S. R.; Ahmed, S.; Maheen, H.

2014-01-01

Objective: To determine the short-term neonatal outcomes in late preterm infants (LPIs) as compared to term infants and their association with maternal risk factors. Study Design: A case control, descriptive study. Place and Duration of Study: The Aga Khan University Hospital, Karachi, Pakistan, from January to December 2009. Methodology: The study included 326 late preterm babies (defined as those born between 34 to 37 weeks of gestation) and equal number of term control babies at the Aga Khan University Hospital, Karachi, Pakistan. Data, including obstetric history, maternal complications, neonatal morbidities, etc., was retrieved from patients medical records. The data was compared with the control group for complications, fetal morbidity and maternal morbidity. Results: Late preterm infants constituted 10.6% of all deliveries and 77% of all live preterm births during the study period. Respiratory distress syndrome (RDS) (16.5% vs. 0.3%, p < 0.001), growth retardation (24.8% vs. 4%, p < 0.001), hyperbilirubinemia requiring phototherapy (37.9% vs. 11%, p < 0.001), and sepsis (4.9% vs. 0.3%, p < 0.001) were found to be the major morbidities in the study group. The need for resuscitation was 12.7 times higher in the study group as compared to the term babies (21.4% vs. 1.2%, p < 0.001). NICU admissions in the study group were also higher (18.8% vs. 2.4%, p < 0.001). Hypertension (12.5% vs. 1.5%, p < 0.001), diabetes (12.5% vs. 9.2%, p < 0.001), antenatal history of UTI (1.5% vs. 0.3%, p < 0.001), and prolong rupture of membrane (8.9% vs. 4%, p < 0.001) were significant maternal morbidities in the late preterm group. Conclusion: The late preterm group had greater morbidity, compared to term neonates. Prior awareness of the morbidities associated with late preterm babies is helpful for the health care providers to anticipate and manage potential complications in late preterm infants. (author)

Transformative learning: empathy and multicultural awareness in podiatric medical education.

Science.gov (United States)

Elliott, Craig M; Toomey, Robert J; Goodman, Brooke A; Barbosa, Peter

2012-01-01

Short-term medical missions are common in medical educational settings and could possibly affect student learning. Little research has been conducted about the potential of these missions on students' transformative learning, in particular as it relates to empathy and multicultural awareness. Eight podiatric medical students who participated in short-term medical missions in 2008 and 2009 completed an electronic survey to investigate the effect of their experience as it relates to their learning. The empathy and multicultural awareness impact of the mission experience was emphasized. Qualitative questions in the survey were coded, themed, and triangulated with the quantitative responses. Six students (75%) "strongly agreed" that participating in the medical mission was a significant positive experience in their podiatric medical training. Six students felt that their experiences in serving these communities increased their personal awareness of multicultural/diversity needs in general. All of the students agreed that they will become better podiatric physicians because of their experiences in the medical missions. The qualitative data also indicate that the experience had an effect on the students' views of health care and increased empathy toward their patients. Short-term medical missions could play a significant role in the transformative learning experience in podiatric medical education. This could affect the empathy and multicultural awareness of podiatric medical students. Further and more extensive evaluations of the potential impact of short-term medical missions in podiatric medical education should be explored because it could influence curriculum and global health in the field of podiatric medicine.

The Long-Term Career Outcome Study (LTCOS): what have we learned from 40 years of military medical education and where should we go?

Science.gov (United States)

Durning, Steven J; Artino, Anthony R; Dong, Ting; Cruess, David F; Gilliland, William R; DeZee, Kent J; Saguil, Aaron; Waechter, Donna M; McManigle, John E

2012-09-01

The work of the Long-Term Career Outcome Study (LTCOS), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USU) has been a multidisciplinary effort spanning more than 5 years. Borrowing from the established program evaluation and quality assurance literature, the LTCOS team has organized its evaluation and research efforts into three phases: before medical school, during medical school, and after medical school. The purpose of this commentary is to summarize the research articles presented in this special issue and to answer two fundamental questions: (1) what has been learned from LTCOS research conducted to date, and (2) where should the LTCOS team take its evaluation and research efforts in the future? Answers to these questions are relevant to USU, and they also can inform other medical education institutions and policy makers. What is more, answers to these questions will help to ensure USU meets its societal obligation to provide the highest quality health care to military members, their families, and society at large.

Medical foods for Alzheimer's disease.

Science.gov (United States)

Shah, Raj C

2011-06-01

Alzheimer's disease (AD) is a neurodegenerative condition associated with cognitive loss, behavioural changes, functional ability decline and caregiver burden. Given the worldwide public health impact of AD, novel interventions to reduce suffering experienced by AD patients need to be developed. Foods may offer a mechanism for intervention complementary to drugs, devices, biologicals and vaccines. Apart from foods with health claims (including dietary supplements), medical foods are also being explored as an intervention option. The purpose of this article is to describe how medical foods may complement other interventions for AD patients by: (i) defining what a medical food is; (ii) discussing whether AD is a condition amenable to medical food intervention; (iii) reviewing current clinical trial data on medical foods used in participants with AD; and (iv) highlighting steps needed to establish a more comprehensive framework for developing medical foods for AD. While medical foods may be defined differently in other countries, the US Orphan Drug Act of 1998 defined a medical food as a food formulated for enteral intake, taken under physician supervision, and intended to meet the distinctive nutritional requirements identified for a disease or condition. For AD to be amenable to medical food intervention, it must: (i) result in limited or impaired capacity to ingest, digest, absorb or metabolize ordinary foodstuff or certain nutrients; or (ii) have unique, medically determined nutrient requirements; and (iii) require dietary management that cannot be achieved by modification of the normal diet alone. While these criteria are most likely met in advanced AD, identifying unique nutritional requirements in early AD that cannot be met by normal diet modification requires a better understanding of AD pathophysiology. A PubMed search using the terms 'medical food' and 'Alzheimer', limited to clinical trials published in English with human participants with AD aged >65

Assessing explicit error reporting in the narrative electronic medical record using keyword searching.

Science.gov (United States)

Cao, Hui; Stetson, Peter; Hripcsak, George

2003-01-01

Many types of medical errors occur in and outside of hospitals, some of which have very serious consequences and increase cost. Identifying errors is a critical step for managing and preventing them. In this study, we assessed the explicit reporting of medical errors in the electronic record. We used five search terms "mistake," "error," "incorrect," "inadvertent," and "iatrogenic" to survey several sets of narrative reports including discharge summaries, sign-out notes, and outpatient notes from 1991 to 2000. We manually reviewed all the positive cases and identified them based on the reporting of physicians. We identified 222 explicitly reported medical errors. The positive predictive value varied with different keywords. In general, the positive predictive value for each keyword was low, ranging from 3.4 to 24.4%. Therapeutic-related errors were the most common reported errors and these reported therapeutic-related errors were mainly medication errors. Keyword searches combined with manual review indicated some medical errors that were reported in medical records. It had a low sensitivity and a moderate positive predictive value, which varied by search term. Physicians were most likely to record errors in the Hospital Course and History of Present Illness sections of discharge summaries. The reported errors in medical records covered a broad range and were related to several types of care providers as well as non-health care professionals.

Self-medication practice among undergraduate medical students in a tertiary care medical college, West Bengal

Directory of Open Access Journals (Sweden)

I Banerjee

2012-01-01

Full Text Available Background: Self-medication is a widely prevalent practice in India. It assumes a special significance among medical students as they are the future medical practitioners. Aim: To assess the pattern of self-medication practice among undergraduate medical students. Settings and Design: Tertiary care medical college in West Bengal, India. Material and Methods: A cross-sectional questionnaire-based study was conducted among the undergraduate medical students. Results: Out of 500 students of the institute, 482 consented for the study and filled in the supplied questionnaire. Fourteen incomplete questionnaires were excluded and the remaining 468 analyzed. It was found that 267 (57.05% respondents practiced self-medication. The principal morbidities for seeking self-medication included cough and common cold as reported by 94 students (35.21% followed by diarrhea (68 students (25.47%, fever (42 students (15.73%, headache (40 students (14.98% and pain abdomen due to heartburn/ peptic ulcer (23 students (8.61%. Drugs/ drug groups commonly used for self-medication included antibiotics (31.09% followed by analgesics (23.21%, antipyretics (17.98%, antiulcer agents (8.99%, cough suppressant (7.87%, multivitamins (6.37% and antihelminthics (4.49%. Among reasons for seeking self-medication, 126 students (47.19% felt that their illness was mild while 76 (28.46% preferred as it is time-saving. About 42 students (15.73% cited cost-effectiveness as the primary reason while 23 (8.62% preferred because of urgency. Conclusion: Our study shows that self-medication is widely practiced among students of the institute. In this situation, faculties should create awareness and educate their students regarding advantages and disadvantages of self-medication.

Medical Student Perspectives of Active Learning: A Focus Group Study.

Science.gov (United States)

Walling, Anne; Istas, Kathryn; Bonaminio, Giulia A; Paolo, Anthony M; Fontes, Joseph D; Davis, Nancy; Berardo, Benito A

2017-01-01

Phenomenon: Medical student perspectives were sought about active learning, including concerns, challenges, perceived advantages and disadvantages, and appropriate role in the educational process. Focus groups were conducted with students from all years and campuses of a large U.S. state medical school. Students had considerable experience with active learning prior to medical school and conveyed accurate understanding of the concept and its major strategies. They appreciated the potential of active learning to deepen and broaden learning and its value for long-term professional development but had significant concerns about the efficiency of the process, the clarity of expectations provided, and the importance of receiving preparatory materials. Most significantly, active learning experiences were perceived as disconnected from grading and even as impeding preparation for school and national examinations. Insights: Medical students understand the concepts of active learning and have considerable experience in several formats prior to medical school. They are generally supportive of active learning concepts but frustrated by perceived inefficiencies and lack of contribution to the urgencies of achieving optimal grades and passing United States Medical Licensing Examinations, especially Step 1.

E-learning in the field of medical physics

International Nuclear Information System (INIS)

Stoeva, M.; Velkova, K.

2006-01-01

Full text: E-learning is an all-encompassing term referring to computer/mobile technology-enhanced learning. It may include the use of web-based teaching materials and hypermedia in general, multimedia CD-ROMs, web sites, discussion boards, collaborative software, e-mail, blogs, wikis, computer aided assessment, educational animation, simulations, learning management software and more, with possibly a combination of different methods being used. The objective of this paper is to present an overview of the e-learning solutions and applications in the field of Medical Physics, covering the most popular international and local e-learning projects and interactive e-learning environments. Medical physics and engineering is one of the areas where e-learning is widely used due to the fact that medical physic professionals are quite closely linked to different types of e-environments. The implementation of such systems improves education quality, information delivery and expert knowledge availability

Semantic concept-enriched dependence model for medical information retrieval.

Science.gov (United States)

Choi, Sungbin; Choi, Jinwook; Yoo, Sooyoung; Kim, Heechun; Lee, Youngho

2014-02-01

In medical information retrieval research, semantic resources have been mostly used by expanding the original query terms or estimating the concept importance weight. However, implicit term-dependency information contained in semantic concept terms has been overlooked or at least underused in most previous studies. In this study, we incorporate a semantic concept-based term-dependence feature into a formal retrieval model to improve its ranking performance. Standardized medical concept terms used by medical professionals were assumed to have implicit dependency within the same concept. We hypothesized that, by elaborately revising the ranking algorithms to favor documents that preserve those implicit dependencies, the ranking performance could be improved. The implicit dependence features are harvested from the original query using MetaMap. These semantic concept-based dependence features were incorporated into a semantic concept-enriched dependence model (SCDM). We designed four different variants of the model, with each variant having distinct characteristics in the feature formulation method. We performed leave-one-out cross validations on both a clinical document corpus (TREC Medical records track) and a medical literature corpus (OHSUMED), which are representative test collections in medical information retrieval research. Our semantic concept-enriched dependence model consistently outperformed other state-of-the-art retrieval methods. Analysis shows that the performance gain has occurred independently of the concept's explicit importance in the query. By capturing implicit knowledge with regard to the query term relationships and incorporating them into a ranking model, we could build a more robust and effective retrieval model, independent of the concept importance. Copyright © 2013 Elsevier Inc. All rights reserved.

Library Collaboration with Medical Humanities in an American Medical College in Qatar

Directory of Open Access Journals (Sweden)

Sally Birch

2013-11-01

Full Text Available The medical humanities, a cross-disciplinary field of practice and research that includes medicine, literature, art, history, philosophy, and sociology, is being increasingly incorporated into medical school curricula internationally. Medical humanities courses in Writing, Literature, Medical Ethics and History can teach physicians-in-training communication skills, doctor-patient relations, and medical ethics, as well as empathy and cross-cultural understanding. In addition to providing educational breadth and variety, the medical humanities can also play a practical role in teaching critical/analytical skills. These skills are utilized in differential diagnosis and problem-based learning, as well as in developing written and oral communications. Communication skills are a required medical competency for passing medical board exams in the U.S., Canada, the UK and elsewhere. The medical library is an integral part of medical humanities training efforts. This contribution provides a case study of the Distributed eLibrary at the Weill Cornell Medical College in Qatar in Doha, and its collaboration with the Writing Program in the Premedical Program to teach and develop the medical humanities. Programs and initiatives of the DeLib library include: developing an information literacy course, course guides for specific courses, the 100 Classic Books Project, collection development of ‘doctors’ stories’ related to the practice of medicine (including medically-oriented movies and TV programs, and workshops to teach the analytical and critical thinking skills that form the basis of humanistic approaches to knowledge. This paper outlines a ‘best practices’ approach to developing the medical humanities in collaboration among the medical library, faculty and administrative stakeholders.

Library collaboration with medical humanities in an american medical college in qatar.

Science.gov (United States)

Birch, Sally; Magid, Amani; Weber, Alan

2013-11-01

The medical humanities, a cross-disciplinary field of practice and research that includes medicine, literature, art, history, philosophy, and sociology, is being increasingly incorporated into medical school curricula internationally. Medical humanities courses in Writing, Literature, Medical Ethics and History can teach physicians-in-training communication skills, doctor-patient relations, and medical ethics, as well as empathy and cross-cultural understanding. In addition to providing educational breadth and variety, the medical humanities can also play a practical role in teaching critical/analytical skills. These skills are utilized in differential diagnosis and problem-based learning, as well as in developing written and oral communications. Communication skills are a required medical competency for passing medical board exams in the U.S., Canada, the UK and elsewhere. The medical library is an integral part of medical humanities training efforts. This contribution provides a case study of the Distributed eLibrary at the Weill Cornell Medical College in Qatar in Doha, and its collaboration with the Writing Program in the Premedical Program to teach and develop the medical humanities. Programs and initiatives of the DeLib library include: developing an information literacy course, course guides for specific courses, the 100 Classic Books Project, collection development of 'doctors' stories' related to the practice of medicine (including medically-oriented movies and TV programs), and workshops to teach the analytical and critical thinking skills that form the basis of humanistic approaches to knowledge. This paper outlines a 'best practices' approach to developing the medical humanities in collaboration among the medical library, faculty and administrative stakeholders.

A Completeness Study on Certain 2×2 Lax Pairs Including Zero Terms

Directory of Open Access Journals (Sweden)

Mike C. Hay

2011-09-01

Full Text Available We expand the completeness study instigated in [J. Math. Phys. 50 (2009, 103516, 29 pages] which found all 2×2 Lax pairs with non-zero, separable terms in each entry of each Lax matrix, along with the most general nonlinear systems that can be associated with them. Here we allow some of the terms within the Lax matrices to be zero. We cover all possible Lax pairs of this type and find a new third order equation that can be reduced to special cases of the non-autonomous lattice KdV and lattice modified KdV equations among others.

Long-term care policy for older Americans: building a continuum of care.

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Palley, Howard A

2003-01-01

This paper deals primarily with social policy considerations relevant to the development of long-term care policy for the frail elderly in the United States. However, it also includes some commentary on meeting the acute care needs of the frail elderly. It defines chronic care treatment as a mix of "short-term" and "long-term" modes of care. Furthermore, it explores the need for treatment of such long-term illnesses to recognize the importance of alternative modes of caring which include strategies, both medical and nonmedical, delivered within and outside of hospitals and nursing homes. The paper includes an analysis of public and private sector priorities based in data published by the U.S. Health Care Financing Administration. It also includes some discussion of the PACE program in the United States and some other efforts to stimulate more in-home and community-based alternatives to nursing home care. Furthermore, it includes a discussion of the policy goal of "appropriateness" in developing long-term care (as well as general health priorities) and provides a critical discussion of problems with utilizing "cost/benefit analysis." The study concludes that too exclusive a focus on nursing home care for the elderly in the United States is unfortunate-both in terms of the desires of the elderly, their families and friends and in terms of focusing on "appropriateness" as a legitimate policy goal in the development of long-term care policy for the elderly in the United States.

Needs, conditions of intervention and staff in medical physics for medical imagery

International Nuclear Information System (INIS)

Salvat, Cecile; Dieudonne, Arnaud; Guilhem, Marie-Therese; Le Du, Dominique; Pierrat, Noelle; Isambert, Aurelie; Valero, Marc; Blanchard, Vincent

2013-04-01

This guide proposes information on the types and quantification of medical physics tasks to be performed when performing medical imagery using ionizing radiations. It gives recommendations about the commitment of medical physicists (with or without support staff) and the required staff in nuclear medicine and, more generally in imagery (interventional radiology, scanography, conventional radiology). It first gives an overview of the situation in France in 2012 in terms of observations made by the ASN during inspections, and of results of a survey conducted among medical physicists involved in medical imagery. It indicates the current regulatory requirements, and international and national recommendations, and describes the commitment in imagery of medical physicists in three countries (Spain, Belgium and Germany). It analyses and describes the fields of intervention of medical physicists in imagery and identifies associated tasks in France (in equipment purchasing, equipment installation, equipment routine usage, patient care, nuclear medicine or internal vectorized radiotherapy, or staff training). Recommendations of a work-group about sizing criteria are proposed

Antipsychotic medication and remission of psychotic symptoms 10 years after a first-episode psychosis

DEFF Research Database (Denmark)

Wils, Regitze Sølling; Gotfredsen, Ditte Resendal; Hjorthøj, Carsten

2017-01-01

medication for a period of time. This study investigated the long-term outcome and characteristics of patients in remission of psychotic symptoms with no use of antipsychotic medication at the 10-year follow-up. METHODS: The study was a cohort study including 496 patients diagnosed with schizophrenia...... spectrum disorders (ICD 10: F20 and F22-29). Patients were included in the Danish OPUS Trial and followed up 10years after inclusion, where patient data was collected on socio-demographic factors, psychopathology, level of functioning and medication. FINDINGS: 61% of the patients from the original cohort...... attended the 10-year follow up and 30% of these had remission of psychotic symptoms at the time of the 10-year follow up with no current use of antipsychotic medication. This outcome was associated with female gender, high GAF-F score, participation in the labour market and absence of substance abuse...

Advanced maternal age: ethical and medical considerations for assisted reproductive technology.

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Harrison, Brittany J; Hilton, Tara N; Rivière, Raphaël N; Ferraro, Zachary M; Deonandan, Raywat; Walker, Mark C

2017-01-01

This review explores the ethical and medical challenges faced by women of advanced maternal age who decide to have children. Assisted reproductive technologies (ARTs) make post-menopausal pregnancy physiologically plausible, however, one must consider the associated physical, psychological, and sociological factors involved. A quasi-systematic review was conducted in PubMed and Ovid using the key terms post-menopause, pregnancy + MeSH terms [donations, hormone replacement therapy, assisted reproductive technologies, embryo donation, donor artificial insemination, cryopreservation]. Overall, 28 papers encompassing two major themes (ethical and medical) were included in the review. There are significant ethical considerations and medical (maternal and fetal) complications related to pregnancy in peri- and post-menopausal women. When examining the ethical and sociological perspective, the literature portrays an overall positive attitude toward pregnancy in advanced maternal age. With respect to the medical complications, the general consensus in the evaluated studies suggests that there is greater risk of complication for spontaneous pregnancy when the mother is older (eg, >35 years old). This risk can be mitigated by careful medical screening of the mother and the use of ARTs in healthy women. In these instances, a woman of advanced maternal age who is otherwise healthy can carry a pregnancy with a similar risk profile to that of her younger counterparts when using donated oocytes.

Long-Term Outcomes of 107 Cases of Primary Thyroid Mucosa-Associated Lymphoid Tissue Lymphoma at a Single Medical Institution in Japan.

Science.gov (United States)

Watanabe, Natsuko; Narimatsu, Hiroto; Noh, Jaeduk Yoshimura; Iwaku, Kenji; Kunii, Yo; Suzuki, Nami; Ohye, Hidemi; Suzuki, Miho; Matsumoto, Masako; Yoshihara, Ai; Kameyama, Kaori; Kobayashi, Kazuhiko; Kami, Masahiro; Sugino, Kiminori; Ito, Koichi

2018-02-01

Thyroid mucosa-associated lymphoid tissue (MALT) lymphoma is a type of extranodal lymphoma with a favorable prognosis. To provide information on long-term outcomes that would facilitate establishment of the optimal management strategy for thyroid lymphoma. Medical records of 107 patients (median age 67 years, 20 males, 87 females) who were diagnosed with localized thyroid MALT lymphoma stage IE or IIE at Ito Hospital were retrospectively reviewed. Overall and event-free survival (EFS). Initial treatments included radiation therapy (RT) alone (n = 58), combined modality therapy (CMT) (n = 48), or chemotherapy alone (n = 1). All 107 patients responded to the treatment, six of whom experienced relapse. Only one patient died of lymphoma. The 5-year overall survival (OS) and EFS rates were 94% [95% confidence interval (CI), 87% to 97%] and 92% (95% CI, 85% to 95%), respectively, and the 10-year OS and EFS rates were 91% (95% CI, 83% to 95%) and 84% (95% CI, 74% to 90%), respectively. Of the 106 patients with information available on adverse events, 71 patients (67%) developed hypothyroidism after primary thyroid lymphoma treatment. The CMT group showed additional chemotherapy-induced adverse reactions in the form of neutropenia, neuropathy, constipation, and pneumonia. The 5-year OS rates of patients treated with CMT and RT were 93% (95% CI, 81% to 98%) and 94% (95% CI, 84% to 98%), respectively. Long-term outcomes of localized thyroid MALT lymphoma are favorable with all initial treatment modalities. Copyright © 2017 Endocrine Society

Health economic analyses in medical nutrition: a systematic literature review

Directory of Open Access Journals (Sweden)

Walzer S

2014-03-01

Full Text Available Stefan Walzer,1,2 Daniel Droeschel,1,3 Mark Nuijten,4 Hélène Chevrou-Séverac5 1MArS Market Access and Pricing Strategy GmbH, Weil am Rhein, Germany; 2State University Baden-Wuerttemberg, Loerrach, Germany; 3Riedlingen University, SRH FernHochschule, Riedlingen, Germany; 4Ars Accessus Medica BV, Amsterdam, the Netherlands, 5Nestlé Health Science, Vevey, Switzerland Background: Medical nutrition is a specific nutrition category either covering specific dietary needs and/or nutrient deficiency in patients or feeding patients unable to eat normally. Medical nutrition is regulated by a specific bill in Europe and in the US, with specific legislation and guidelines, and is provided to patients with special nutritional needs and indications for nutrition support. Therefore, medical nutrition products are delivered by medical prescription and supervised by health care professionals. Although these products have existed for more than 2 decades, health economic evidence of medical nutrition interventions is scarce. This research assesses the current published health economic evidence for medical nutrition by performing a systematic literature review related to health economic analysis of medical nutrition. Methods: A systematic literature search was done using standard literature databases, including PubMed, the Health Technology Assessment Database, and the National Health Service Economic Evaluation Database. Additionally, a free web-based search was conducted using the same search terms utilized in the systematic database search. The clinical background and basis of the analysis, health economic design, and results were extracted from the papers finally selected. The Drummond checklist was used to validate the quality of health economic modeling studies and the AMSTAR (A Measurement Tool to Assess Systematic Reviews checklist was used for published systematic reviews. Results: Fifty-three papers were identified and obtained via PubMed, or directly

Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke.

Science.gov (United States)

Saver, Jeffrey L; Carroll, John D; Thaler, David E; Smalling, Richard W; MacDonald, Lee A; Marks, David S; Tirschwell, David L

2017-09-14

Whether closure of a patent foramen ovale reduces the risk of recurrence of ischemic stroke in patients who have had a cryptogenic ischemic stroke is unknown. In a multicenter, randomized, open-label trial, with blinded adjudication of end-point events, we randomly assigned patients 18 to 60 years of age who had a patent foramen ovale (PFO) and had had a cryptogenic ischemic stroke to undergo closure of the PFO (PFO closure group) or to receive medical therapy alone (aspirin, warfarin, clopidogrel, or aspirin combined with extended-release dipyridamole; medical-therapy group). The primary efficacy end point was a composite of recurrent nonfatal ischemic stroke, fatal ischemic stroke, or early death after randomization. The results of the analysis of the primary outcome from the original trial period have been reported previously; the current analysis of data from the extended follow-up period was considered to be exploratory. We enrolled 980 patients (mean age, 45.9 years) at 69 sites. Patients were followed for a median of 5.9 years. Treatment exposure in the two groups was unequal (3141 patient-years in the PFO closure group vs. 2669 patient-years in the medical-therapy group), owing to a higher dropout rate in the medical-therapy group. In the intention-to-treat population, recurrent ischemic stroke occurred in 18 patients in the PFO closure group and in 28 patients in the medical-therapy group, resulting in rates of 0.58 events per 100 patient-years and 1.07 events per 100 patient-years, respectively (hazard ratio with PFO closure vs. medical therapy, 0.55; 95% confidence interval [CI], 0.31 to 0.999; P=0.046 by the log-rank test). Recurrent ischemic stroke of undetermined cause occurred in 10 patients in the PFO closure group and in 23 patients in the medical-therapy group (hazard ratio, 0.38; 95% CI, 0.18 to 0.79; P=0.007). Venous thromboembolism (which comprised events of pulmonary embolism and deep-vein thrombosis) was more common in the PFO closure group

Unsupervised ensemble ranking of terms in electronic health record notes based on their importance to patients.

Science.gov (United States)

Chen, Jinying; Yu, Hong

2017-04-01

Allowing patients to access their own electronic health record (EHR) notes through online patient portals has the potential to improve patient-centered care. However, EHR notes contain abundant medical jargon that can be difficult for patients to comprehend. One way to help patients is to reduce information overload and help them focus on medical terms that matter most to them. Targeted education can then be developed to improve patient EHR comprehension and the quality of care. The aim of this work was to develop FIT (Finding Important Terms for patients), an unsupervised natural language processing (NLP) system that ranks medical terms in EHR notes based on their importance to patients. We built FIT on a new unsupervised ensemble ranking model derived from the biased random walk algorithm to combine heterogeneous information resources for ranking candidate terms from each EHR note. Specifically, FIT integrates four single views (rankers) for term importance: patient use of medical concepts, document-level term salience, word co-occurrence based term relatedness, and topic coherence. It also incorporates partial information of term importance as conveyed by terms' unfamiliarity levels and semantic types. We evaluated FIT on 90 expert-annotated EHR notes and used the four single-view rankers as baselines. In addition, we implemented three benchmark unsupervised ensemble ranking methods as strong baselines. FIT achieved 0.885 AUC-ROC for ranking candidate terms from EHR notes to identify important terms. When including term identification, the performance of FIT for identifying important terms from EHR notes was 0.813 AUC-ROC. Both performance scores significantly exceeded the corresponding scores from the four single rankers (P<0.001). FIT also outperformed the three ensemble rankers for most metrics. Its performance is relatively insensitive to its parameter. FIT can automatically identify EHR terms important to patients. It may help develop future interventions

[German influences on Romanian medical terminology].

Science.gov (United States)

Răcilă, R G; Răileanu, Irena; Rusu, V

2008-01-01

The medical terminology plays a key part both in the study of medicine as well as in its practice. Moreover, understanding the medical terms is important not only for the doctor but also for the patients who want to learn more about their condition. For these reasons we believe that the study of medical terminology is one of great interest. The aim of our paper was to evaluate the German linguistic and medical influences on the evolution of the Romanian medical terminology. Since the Romanian-German cultural contacts date back to the 12th century we had reasons to believe that the number of German medical words in Romanian would be significant. To our surprise, the Romanian language has very few German words and even less medical terms of German origin. However, when we searched the list of diseases coined after famous medical personalities, we found out that 26 % of them bore the names of German doctors and scientists. Taken together this proves that the German medical school played an important role on the evolution of Romanian medicine despite the fact that the Romanian vocabulary was slightly influenced by the German language. We explain this fact on the structural differences between the Romanian and German languages, which make it hard for German loans to be integrated in the Romanian lexis. In conclusion we state that the German influence on the Romanian medical terminology is weak despite the important contribution of the German medical school to the development of medical education and healthcare in Romania. Key

The use of Facebook in medical education--a literature review.

Science.gov (United States)

Pander, Tanja; Pinilla, Severin; Dimitriadis, Konstantinos; Fischer, Martin R

2014-01-01

The vogue of social media has changed interpersonal communication as well as learning and teaching opportunities in medical education. The most popular social media tool is Facebook. Its features provide potentially useful support for the education of medical students but it also means that some new challenges will have to be faced. This review aimed to find out how Facebook has been integrated into medical education. A systematical review of the current literature and grade of evidence is provided, research gaps are identified, links to prior reviews are drawn and implications for the future are discussed. The authors searched six databases. Inclusion criteria were defined and the authors independently reviewed the search results. The key information of the articles included was methodically abstracted and coded, synthesized and discussed in the categories study design, study participants'phase of medical education and study content. 16 articles met all inclusion criteria. 45-96% of health care professionals in all phases of their medical education have a Facebook profile. Most studies focused on Facebook and digital professionalism. Unprofessional behavior and privacy violations occurred in 0.02% to 16%. In terms of learning and teaching environment, Facebook is well accepted by medical students. It is used to prepare for exams, share online material, discuss clinical cases, organize face-to-face sessions and exchange information on clerkships. A few educational materials to teach Facebook professionalism were positively evaluated. There seems to be no conclusive evidence as to whether medical students benefit from Facebook as a learning environment on higher competence levels. Facebook influences a myriad of aspects of health care professionals, particularly at undergraduate and graduate level in medical education. Despite an increasing number of interventions, there is a lack of conclusive evidence in terms of its educational effectiveness. Furthermore, we

Measuring diversity in medical reports based on categorized attributes and international classification systems

Directory of Open Access Journals (Sweden)

Přečková Petra

2012-04-01

Full Text Available Abstract Background Narrative medical reports do not use standardized terminology and often bring insufficient information for statistical processing and medical decision making. Objectives of the paper are to propose a method for measuring diversity in medical reports written in any language, to compare diversities in narrative and structured medical reports and to map attributes and terms to selected classification systems. Methods A new method based on a general concept of f-diversity is proposed for measuring diversity of medical reports in any language. The method is based on categorized attributes recorded in narrative or structured medical reports and on international classification systems. Values of categories are expressed by terms. Using SNOMED CT and ICD 10 we are mapping attributes and terms to predefined codes. We use f-diversities of Gini-Simpson and Number of Categories types to compare diversities of narrative and structured medical reports. The comparison is based on attributes selected from the Minimal Data Model for Cardiology (MDMC. Results We compared diversities of 110 Czech narrative medical reports and 1119 Czech structured medical reports. Selected categorized attributes of MDMC had mostly different numbers of categories and used different terms in narrative and structured reports. We found more than 60% of MDMC attributes in SNOMED CT. We showed that attributes in narrative medical reports had greater diversity than the same attributes in structured medical reports. Further, we replaced each value of category (term used for attributes in narrative medical reports by the closest term and the category used in MDMC for structured medical reports. We found that relative Gini-Simpson diversities in structured medical reports were significantly smaller than those in narrative medical reports except the "Allergy" attribute. Conclusions Terminology in narrative medical reports is not standardized. Therefore it is nearly

Long-term functional outcome of pediatric stroke survivors.

Science.gov (United States)

Hurvitz, Edward; Warschausky, Seth; Berg, Michelle; Tsai, Shane

2004-01-01

To examine the long-term functional, psychosocial, and medical outcome of pediatric stroke survivors. This was a descriptive survey performed on patients with childhood stroke who participated in an earlier study. Measures included the Vineland Adaptive Behavior Scales (VABS) and the Diener Satisfaction with Life Scale. Current information on living situation, school placement, employment, and medical outcome were obtained. Twenty-nine (58%) patients participated. The mean age was 19.3 years (SD = 6.6), mean age of onset of stroke was 7.0 years (SD = 5.4), and mean follow-up time was 11.9 years (SD = 3.9). Diagnoses included hemorrhagic (31%) and ischemic (69%) stroke. All but one adult had finished high school, and the majority of participants had gone to college. 60% of patients over age 16 were employed. The average VABS levels for communication, daily living skills, socialization, and adaptive behavior fell into the moderately low range. Use of seizure medications and ADL dependence were the predictors for lower VABS levels (p life satisfaction. Patients who scored below adequate on VABS tended toward lower life satisfaction. Pediatric stroke survivors had good educational and mobility outcomes, but communication, ADL, and socialization fell into the low-moderate range. The different predictors of functional and subjective quality of life outcomes suggest that functional outcomes may mediate the relations between medical factors and satisfaction with life.

Medical physics personnel for medical imaging: requirements, conditions of involvement and staffing levels-French recommendations

International Nuclear Information System (INIS)

Isambert, Aurelie; Valero, Marc; Rousse, Carole; Blanchard, Vincent; Le Du, Dominique; Guilhem, Marie-Therese; Dieudonne, Arnaud; Pierrat, Noelle; Salvat, Cecile

2015-01-01

The French regulations concerning the involvement of medical physicists in medical imaging procedures are relatively vague. In May 2013, the ASN and the SFPM issued recommendations regarding Medical Physics Personnel for Medical Imaging: Requirements, Conditions of Involvement and Staffing Levels. In these recommendations, the various areas of activity of medical physicists in radiology and nuclear medicine have been identified and described, and the time required to perform each task has been evaluated. Criteria for defining medical physics staffing levels are thus proposed. These criteria are defined according to the technical platform, the procedures and techniques practised on it, the number of patients treated and the number of persons in the medical and paramedical teams requiring periodic training. The result of this work is an aid available to each medical establishment to determine their own needs in terms of medical physics. (authors)

Supporting ontology-based keyword search over medical databases.

Science.gov (United States)

Kementsietsidis, Anastasios; Lim, Lipyeow; Wang, Min

2008-11-06

The proliferation of medical terms poses a number of challenges in the sharing of medical information among different stakeholders. Ontologies are commonly used to establish relationships between different terms, yet their role in querying has not been investigated in detail. In this paper, we study the problem of supporting ontology-based keyword search queries on a database of electronic medical records. We present several approaches to support this type of queries, study the advantages and limitations of each approach, and summarize the lessons learned as best practices.

The integration of brain dissection within the medical neuroscience laboratory enhances learning.

Science.gov (United States)

Rae, Guenevere; Cork, R John; Karpinski, Aryn C; Swartz, William J

2016-11-01

The purpose of this study was to design a one-hour brain dissection protocol for a medical neuroscience course and evaluate the short and long-term effects of its implementation on medical students. First-year medical students (n = 166) participated in a brain dissection activity that included dissection of the basal nuclei and associated deep brain structures. Short-term retention was assessed by administering identical pre- and post-activity tests involving identification of brain structures. Following the brain dissection, the students' posttest scores were significantly higher (68.8% ± 17.8%; mean percent score ± SD) than their pretest scores (35.8% ± 20.0%) (P ≤ 0.0001). Long-term retention was evaluated by conducting an identical assessment five months after completion of the course. Students who participated in the dissection activity (n = 80) had significantly higher scores (46.6% ± 23.8%) than the students who did not participate in the dissection activity (n = 85) (38.1% ± 23.9%) (P ≤ 0.05). In addition to the long-term retention assessment, the NBME ® Subject Examination scores of students who participated in the dissection activity were significantly higher than the students who did not participate in the dissection activity (P ≤ 0.01). Results suggest that this succinct brain dissection activity may be a practical addition to an undergraduate medical neuroscience course for increasing the effectiveness of neuroanatomy training. This effect may have long-term benefits on knowledge retention and may be correlated with higher performance levels on standardized subject examinations. Anat Sci Educ 9: 565-574. © 2016 American Association of Anatomists. © 2016 American Association of Anatomists.

Medical Business Ethics in the XXI century; Deontologia medica del siglo XXI

Energy Technology Data Exchange (ETDEWEB)

Moya Pueyo, V.

2009-07-01

Since ancient times the medical professional practice included moral rules in order to assure a correct approach of capital problems. These rules evolve and are now gathered in the Deontological Codes watching the Constitution and other higher Laws. There has been an increase of interest for none strictly clinical matter since the appearance of the term Bioethics. The book Deontologia medica en el siglo XXI tackles problems of first interest in the present times, thru statistics and analysis, trying to help the medical doctors that have to take ethic decisions. (Author)

Childhood maltreatment and the medical morbidity in bipolar disorder: a case-control study.

Science.gov (United States)

Hosang, Georgina M; Fisher, Helen L; Uher, Rudolf; Cohen-Woods, Sarah; Maughan, Barbara; McGuffin, Peter; Farmer, Anne E

2017-09-07

Childhood maltreatment (abuse and neglect) can have long-term deleterious consequences, including increased risk for medical and psychiatric illnesses, such as bipolar disorder in adulthood. Emerging evidence suggests that a history of childhood maltreatment is linked to the comorbidity between medical illnesses and mood disorders. However, existing studies on bipolar disorder have not yet explored the specific influence of child neglect and have not included comparisons with individuals without mood disorders (controls). This study aimed to extend the existing literature by examining the differential influence of child abuse and child neglect on medical morbidity in a sample of bipolar cases and controls. The study included 72 participants with bipolar disorder and 354 psychiatrically healthy controls (average age of both groups was 48 years), who completed the Childhood Trauma Questionnaire, and were interviewed regarding various medical disorders. A history of any type of childhood maltreatment was significantly associated with a diagnosis of any medical illness (adjusted OR = 6.28, 95% confidence intervals 1.70-23.12, p = 0.006) and an increased number of medical illnesses (adjusted OR = 3.77, 95% confidence intervals 1.34-10.57, p = 0.012) among adults with bipolar disorder. Exposure to child abuse was more strongly associated with medical disorders than child neglect. No association between childhood maltreatment and medical morbidity was detected among controls. To summarise, individuals with bipolar disorder who reported experiencing maltreatment during childhood, especially abuse, were at increased risk of suffering from medical illnesses and warrant greater clinical attention.

Radiation Safety Awareness Among Medical Staff

International Nuclear Information System (INIS)

Szarmach, Arkadiusz; Piskunowicz, Maciej; Świętoń, Dominik; Muc, Adam; Mockałło, Gabor; Dzierżanowski, Jarosław; Szurowska, Edyta

2015-01-01

The common access to imaging methods based on ionizing radiation requires also radiation protection. The knowledge of ionizing radiation exposure risks among the medical staff is essential for planning diagnostic procedures and therapy. Evaluation of the knowledge of radiation safety during diagnostic procedures among the medical staff. The study consisted of a questionnaire survey. The questionnaire consisted of seven closed-ended questions concerning the knowledge of the effects of exposure to ionizing radiation as well as questions related to responder’s profession and work experience. The study group included a total of 150 individuals from four professional groups: nurses, doctors, medical technicians, support staff. The study was carried out in the three largest hospitals in Gdańsk between July and October 2013. The highest rates of correct answers to questions related to the issue of radiation protection were provided by the staff of radiology facilities and emergency departments with 1–5 years of professional experience. The most vulnerable group in terms of the knowledge of these issues consisted of individuals working at surgical wards with 11–15 years of professional experience. Education in the field of radiological protection should be a subject of periodic training of medical personnel regardless of position and length of service

Mediation in Medical Malpractice - Realities and Prospects

Directory of Open Access Journals (Sweden)

Alexandru Boroi

2015-05-01

Full Text Available Medical professional liability is the result of specific breaches of the medical profession, which are contained in Law 95/2006 on health reform. Beyond the motivation of blaming medical personnel activity, there are many other aspects that may give rise to controversy in terms of medical ethics, from the informed consent of the patient and to the need for reaching criminal responsibility and compensation in cases of medical malpractice.

Getting More from Flashcards: Examples from Medical Microbiology

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David S Senchina

2011-02-01

Full Text Available Four flashcard techniques, developed to stimulate in-depth studying, are discussed in this activity. For each, a medical microbiology course-based example is given. Each activity assumes that students have already familiarized themselves with the names and/or definitions on the flashcards. Smaller sets of terms should be used when first introducing the strategies; once students gain proficiency, larger numbers of flashcards may be included. Technique variations and other applications are discussed. 

Preconception sex selection for non-medical and intermediate reasons: ethical reflections.

Science.gov (United States)

de Wert, G; Dondorp, W

2010-01-01

Sex selection for non-medical reasons is forbidden in many countries. Focusing on preconception sex selection, the authors first observe that it is unclear what should count as a 'medical reason' in this context and argue for the existence of 'intermediate reasons' that do not fit well within the rigid distinction between 'medical'and 'non-medical'. The article further provides a critical review of the arguments for the prohibition of sex selection for non-medical reasons and finds that none of these are conclusive. The authors conclude that the ban should be reconsidered, but also that existing-- societal concerns about possible harmful effects should be taken seriously. Measures to this effect may include limiting the practice to couples who already have at least one child of the sex opposite to that which they now want to select ('family balancing'). Finally, a difficult set of questions is raised by concerns about the reliability and unproven (long-term) safety of the only technology (flow cytometry) proven to work.

Automated Medical Literature Retrieval

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David Hawking

2012-09-01

Full Text Available Background The constantly growing publication rate of medical research articles puts increasing pressure on medical specialists who need to be aware of the recent developments in their field. The currently used literature retrieval systems allow researchers to find specific papers; however the search task is still repetitive and time-consuming. Aims In this paper we describe a system that retrieves medical publications by automatically generating queries based on data from an electronic patient record. This allows the doctor to focus on medical issues and provide an improved service to the patient, with higher confidence that it is underpinned by current research. Method Our research prototype automatically generates query terms based on the patient record and adds weight factors for each term. Currently the patient’s age is taken into account with a fuzzy logic derived weight, and terms describing blood-related anomalies are derived from recent blood test results. Conditionally selected homonyms are used for query expansion. The query retrieves matching records from a local index of PubMed publications and displays results in descending relevance for the given patient. Recent publications are clearly highlighted for instant recognition by the researcher. Results Nine medical specialists from the Royal Adelaide Hospital evaluated the system and submitted pre-trial and post-trial questionnaires. Throughout the study we received positive feedback as doctors felt the support provided by the prototype was useful, and which they would like to use in their daily routine. Conclusion By supporting the time-consuming task of query formulation and iterative modification as well as by presenting the search results in order of relevance for the specific patient, literature retrieval becomes part of the daily workflow of busy professionals.

Undergraduate medical education in emergency medical care: a nationwide survey at German medical schools.

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Beckers, Stefan K; Timmermann, Arnd; Müller, Michael P; Angstwurm, Matthias; Walcher, Felix

2009-05-12

Since June 2002, revised regulations in Germany have required "Emergency Medical Care" as an interdisciplinary subject, and state that emergency treatment should be of increasing importance within the curriculum. A survey of the current status of undergraduate medical education in emergency medical care establishes the basis for further committee work. Using a standardized questionnaire, all medical faculties in Germany were asked to answer questions concerning the structure of their curriculum, representation of disciplines, instructors' qualifications, teaching and assessment methods, as well as evaluation procedures. Data from 35 of the 38 medical schools in Germany were analysed. In 32 of 35 medical faculties, the local Department of Anaesthesiology is responsible for the teaching of emergency medical care; in two faculties, emergency medicine is taught mainly by the Department of Surgery and in another by Internal Medicine. Lectures, seminars and practical training units are scheduled in varying composition at 97% of the locations. Simulation technology is integrated at 60% (n = 21); problem-based learning at 29% (n = 10), e-learning at 3% (n = 1), and internship in ambulance service is mandatory at 11% (n = 4). In terms of assessment methods, multiple-choice exams (15 to 70 questions) are favoured (89%, n = 31), partially supplemented by open questions (31%, n = 11). Some faculties also perform single practical tests (43%, n = 15), objective structured clinical examination (OSCE; 29%, n = 10) or oral examinations (17%, n = 6). Emergency Medical Care in undergraduate medical education in Germany has a practical orientation, but is very inconsistently structured. The innovative options of simulation technology or state-of-the-art assessment methods are not consistently utilized. Therefore, an exchange of experiences and concepts between faculties and disciplines should be promoted to guarantee a standard level of education in emergency medical care.

Undergraduate medical education in emergency medical care: A nationwide survey at German medical schools

Directory of Open Access Journals (Sweden)

Timmermann Arnd

2009-05-01

Full Text Available Abstract Background Since June 2002, revised regulations in Germany have required "Emergency Medical Care" as an interdisciplinary subject, and state that emergency treatment should be of increasing importance within the curriculum. A survey of the current status of undergraduate medical education in emergency medical care establishes the basis for further committee work. Methods Using a standardized questionnaire, all medical faculties in Germany were asked to answer questions concerning the structure of their curriculum, representation of disciplines, instructors' qualifications, teaching and assessment methods, as well as evaluation procedures. Results Data from 35 of the 38 medical schools in Germany were analysed. In 32 of 35 medical faculties, the local Department of Anaesthesiology is responsible for the teaching of emergency medical care; in two faculties, emergency medicine is taught mainly by the Department of Surgery and in another by Internal Medicine. Lectures, seminars and practical training units are scheduled in varying composition at 97% of the locations. Simulation technology is integrated at 60% (n = 21; problem-based learning at 29% (n = 10, e-learning at 3% (n = 1, and internship in ambulance service is mandatory at 11% (n = 4. In terms of assessment methods, multiple-choice exams (15 to 70 questions are favoured (89%, n = 31, partially supplemented by open questions (31%, n = 11. Some faculties also perform single practical tests (43%, n = 15, objective structured clinical examination (OSCE; 29%, n = 10 or oral examinations (17%, n = 6. Conclusion Emergency Medical Care in undergraduate medical education in Germany has a practical orientation, but is very inconsistently structured. The innovative options of simulation technology or state-of-the-art assessment methods are not consistently utilized. Therefore, an exchange of experiences and concepts between faculties and disciplines should be promoted to guarantee a standard

Medications (for IBS)

Medline Plus

Full Text Available ... What's a medication? Anything you take for a therapeutic effect counts as a medicine. It can be ... When you take something for a long-term therapeutic effect, tell your doctor about it. He or ...

Medications (for IBS)

Medline Plus

Full Text Available ... a medication? Anything you take for a therapeutic effect counts as a medicine. It can be readily ... you take something for a long-term therapeutic effect, tell your doctor about it. He or she ...

Indian medical students in public and private sector medical schools: are motivations and career aspirations different? - studies from Madhya Pradesh, India.

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Diwan, Vishal; Minj, Christie; Chhari, Neeraj; De Costa, Ayesha

2013-09-15

In recent years, there has been a massive growth in the private medical education sector in South Asia. India's large private medical education sector reflects the market driven growth in private medical education. Admission criteria to public medical schools are based on qualifying examination scores, while admission into private institutions is often dependent on relative academic merit, but also very much on the ability of the student to afford the education. This paper from Madhya Pradesh province in India aims to study and compare between first year medical students in public and private sector medical schools (i) motives for choosing a medical education (ii) career aspirations on completion of a medical degree (iii) willingness to work in a rural area in the short and long terms. Cross sectional survey of 792 first year medical students in 5 public and 4 private medical schools in the province. There were no significant differences in the background characteristics of students in public and private medical schools. Reasons for entering medical education included personal ambition (23%), parental desire (23%), prestigious/secure profession (25%) or a service motive (20%). Most students wished to pursue a specialization (91%) and work in urban areas (64%) of the country. A small proportion (7%) wished to work abroad. There were no differences in motives or career aspirations between students of public or private schools. 40% were willing to work in a rural area for 2 years after graduating; public school students were more willing to do so. There was little difference in background characteristics, motives for entering medicine or career aspirations between medical students in from public and private sector institutions.

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.

The economic burden of overseas medical treatment: a cross sectional study of Maldivian medical travelers.

Science.gov (United States)

Suzana, Mariyam; Mills, Anne; Tangcharoensathien, Viroj; Chongsuvivatwong, Virasakdi

2015-09-26

Access to tertiary care is a problem common to many small states, especially island ones. Although medical treatment overseas (MTO) may result in cost savings to high income countries, it can be a relatively high cost for low and middle income source countries. The purpose of this study was to estimate the costs of overseas medical treatment incurred by the households of medical travelers from Maldives and assess the burden of medical treatment overseas on the government and on households. A survey was conducted of inbound Maldivian medical travelers who traveled during the period June - December 2013. Participants were stratified by the source of funds used for treatment abroad. Three hundred and forty four government-subsidized and 471 privately funded Maldivians were interviewed. Self-reported data on the utilization and expenses incurred during the last visit abroad, including both expenses covered by the government and borne by the household, were collected using a researcher administered structured questionnaire. The median per capita total cost of a medical travel episode amounted to $1,470. Forty eight percent of the cost was spent on travel. Twenty six percent was spent on direct medical costs, which were markedly higher among patients subsidized by the government than self-funded patients (p = economic burden to the Maldives in terms of lost consumer spending in the local economy and catastrophic health spending by households. Geographical inequality in access to public funds for MTO and the disproportionate travel cost borne by travelers from rural areas need to be addressed in the existing Universal Health Care programme to minimize the burden of MTO. Increased investment to create more capacity in the domestic health infrastructure either through government, private or by foreign direct investment can help divert the outflow on MTO.

Military medical graduates' perceptions of organizational culture in Turkish military medical school.

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Ozer, Mustafa; Bakir, Bilal; Teke, Abdulkadir; Ucar, Muharrem; Bas, Turker; Atac, Adnan

2008-08-01

Organizational culture is the term used to describe the shared beliefs, perceptions, and expectations of individuals in organizations. In the healthcare environment, organizational culture has been associated with several elements of organizational experience that contribute to quality, such as nursing care, job satisfaction, and patient safety. A range of tools have been designed to measure organizational culture and applied in industrial, educational, and health care settings. This study has been conducted to investigate the perceptions of military medical graduates on organizational culture at Gülhane Military Medical School. A measurement of organizational culture, which was developed by the researchers from Akdeniz University, was applied to all military medical graduates in 2004. This was a Likert type scale that included 31 items. Designers of the measurement grouped all these items into five main dimensions in their previous study. The items were scored on a five-point scale anchored by 1: strongly agree and 5: strongly disagree. Study participants included all military physicians who were in clerkship training period at Gulhane Military Medical Academy in 2004. A total of 106 graduates were accepted to response the questionnaire. The mean age of participants was 25.2 +/- 1.1. At the time of study only 8 (7.5%) graduates were married. The study results have showed that the measurement tool with 31 items had a sufficient reliability with a Cronbach's alpha value of 0.91. Factor analysis has resulted a final measurement tool of 24 items with five factors. Total score and the scores of five subdimensions have been estimated and compared between groups based on living city and marital status. The study has shown the dimension of symbol received positive perceptions while the dimension of organizational structure and efficiency received the most negative perceptions. GMMS has a unique organizational culture with its weak and strong aspects. Conducting this kind

A systematic review of electronic multi-compartment medication devices with reminder systems for improving adherence to self-administered medications.

Science.gov (United States)

Paterson, Mary; Kinnear, Moira; Bond, Christine; McKinstry, Brian

2017-06-01

Many patients experience difficulties adhering to medication regimes. For people who forget or get confused about medication, there are products to help them such as multi-compartment medication devices (MMDs). Some of these, known as electronic MMDs (eMMDs), use audible and/or visual signals to prompt the patient when to take medication, dispense medications, give instructions to the patient, and contact a caregiver (mobile Internet or text to a carer) as needed. To systematically review the literature on the use of eMMDs, to determine what evidence for their effectiveness is available. A comprehensive literature search of 10 databases, plus an Internet search and hand searching was conducted, using the MeSH terms reminder systems/patient compliance/medication adherence. There were no date restrictions. Inclusion criteria were patients in any community setting, in any country and with no restrictions of age, gender, ethnicity or medical condition, using an eMMD. Peer-reviewed quantitative or qualitative studies of any design were included. Of 805 abstracts identified and 99 full text papers retrieved, six met the inclusion criteria. Five of the studies reported adherence to medication regimes; one reported design factors to improve adherence. Adherence varied by the context of the reminders, the target group and usability of the devices. The studies were small scale and only one was a well conducted randomised controlled trial. Overall methodological quality of the studies was poor. Although positive effects on adherence were reported further, rigorously conducted, studies are needed to inform the use of eMMDs. © 2016 Royal Pharmaceutical Society.

Relevance of protection quantities in medical exposures

International Nuclear Information System (INIS)

Pradhan, A.S.

2008-01-01

International Commission on Radiological Protection (ICRP) continues to classify the exposures to radiation in three categories; namely 1- occupational exposure, 2- public exposure, and 3- medical exposure. Protection quantities are primarily meant for the regulatory purpose in radiological protection for controlling and limiting stochastic risks in occupational and public exposures. These are based on two basic assumptions of 1- linear no-threshold dose-effect relationship (LNT) at low doses and 2- long-term additivity of low doses. Medical exposure are predominantly delivered to individuals (patients) undergoing diagnostic examinations, interventional procedures and radiation therapy but also include individual caring for or comforting patients incurring exposure and the volunteers of biomedical medical research programmes. Radiation protection is as relevant to occupational and public exposure as to medical exposures except that the dose limits set for the formers are not applicable to medical exposure but reference levels and dose constrains are recommended for diagnostic and interventional medical procedures. In medical institutions, both the occupational and medical exposure takes place. Since the doses in diagnostic examinations are low, it has been observed that not only the protection quantities are often used in such cases but these are extended to estimate the number of cancer deaths due to such practices. One of the striking features of the new ICRP recommendations has been to elaborate the concepts of the dosimetric quantities. The limitation of protection quantities ((Effective dose, E=Σ RT D TR .W T .W R and Equivalent Dose H T =Σ RT D TR .W R ) have been brought out and this has raised a great concern and initiated debates on the use of these quantities in medical exposures. Consequently, ICRP has set a task group to provide more details and the recommendations. It has, therefore, became important to draw the attention of medical physics community

Catastrophic Incident Recovery: Long-Term Recovery from an Anthrax Event Symposium

Energy Technology Data Exchange (ETDEWEB)

Lesperance, Ann M.

2008-06-30

On March 19, 2008, policy makers, emergency managers, and medical and Public Health officials convened in Seattle, Washington, for a workshop on Catastrophic Incident Recovery: Long-Term Recovery from an Anthrax Event. The day-long symposium was aimed at generating a dialogue about restoration and recovery through a discussion of the associated challenges that impact entire communities, including people, infrastructure, and critical systems.

Interventions to improve long-term weight loss in patients following bariatric surgery: challenges and solutions

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McGrice M

2015-06-01

Full Text Available Melanie McGrice, Kathlene Don Paul Nutrition Plus Enterprises, Melbourne, VIC, Australia Abstract: Bariatric surgery aims to provide long-term weight loss and improvement in weight-related comorbidities. Unfortunately, some patients do not achieve predicted weight loss targets and many regain a portion of their lost weight within 2–10 years postsurgery. A review of the literature found that behavioral, dietary, psychological, physical, and medical considerations can all play a role in suboptimal long-term weight loss. Recommendations to optimize long-term weight loss include ensuring that the patient understands how the procedure works, preoperative and postoperative education sessions, tailored nutritional supplements, restraint with liquid kilojoules, pureed foods, grazing and eating out of the home, an average of 60 minutes of physical activity per day, and lifelong annual medical, psychological, and dietary assessments.Keywords: weight, bariatric, surgery

Medical student and medical school teaching faculty perceptions of conflict of interest.

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Andresen, Nicholas S; Olson, Tyler S; Krasowski, Matthew D

2017-07-11

Attitudes towards conflict of interest (COI) and COI policy are shaped during medical school and influence both the education of medical students and their future medical practice. Understanding the current attitudes of medical students and medical school teaching faculty may provide insight into what is taught about COI and COI policy within the 'hidden' medical curriculum. Differences between medical student and medical school teaching faculty perceptions of COI and COI policy have not been compared in detail. The authors surveyed first year medical students and medical school teaching faculty at one academic medical center. The response rate was 98.7% (150/152) for students and 34.2% (69/202) for faculty. Students were less likely than faculty to agree that lecturers should disclose COI to any learners (4.06 vs. 4.31, p = 0.01), but more likely to agree that COI disclosure decreases the presentation of biased material (3.80 vs. 3.21, p < 0.001). Student and faculty responses for all other questions were not different. Many of these responses suggest student and faculty support for stronger COI policy at academic medical centers. Students and faculty perceptions regarding COI and COI policy are largely similar, but differ in terms of the perceived effectiveness of COI disclosure. This study also suggests that medical students and medical school teaching faculty support for stronger COI policy at academic medical centers.

A cloud collaborative medical image platform oriented by social network

Science.gov (United States)

Muniz, Frederico B.; Araújo, Luciano V.; Nunes, Fátima L. S.

2017-03-01

Computer-aided diagnosis systems using medical images and three-dimensional models as input data have greatly expanded and developed, but in terms of building suitable image databases to assess them, the challenge remains. Although there are some image databases available for this purpose, they are generally limited to certain types of exams or contain a limited number of medical cases. The objective of this work is to present the concepts and the development of a collaborative platform for sharing medical images and three-dimensional models, providing a resource to share and increase the number of images available for researchers. The collaborative cloud platform, called CATALYZER, aims to increase the availability and sharing of graphic objects, including 3D images, and their reports that are essential for research related to medical images. A survey conducted with researchers and health professionals indicated that this could be an innovative approach in the creation of medical image databases, providing a wider variety of cases together with a considerable amount of shared information among its users.

Medical slang in British hospitals.

Science.gov (United States)

Fox, Adam T; Fertleman, Michael; Cahill, Pauline; Palmer, Roger D

2003-01-01

The usage, derivation, and psychological, ethical, and legal aspects of slang terminology in medicine are discussed. The colloquial vocabulary is further described and a comprehensive glossary of common UK terms provided in appendix. This forms the first list of slang terms currently in use throughout the British medical establishment.

The Added Value of Medical Testing in Underwriting Life Insurance.

Directory of Open Access Journals (Sweden)

Jan Bronsema

Full Text Available In present-day life-insurance medical underwriting practice the risk assessment starts with a standard health declaration (SHD. Indication for additional medical screening depends predominantly on age and amount of insured capital. From a medical perspective it is questionable whether there is an association between the level of insured capital and medical risk in terms of mortality. The aim of the study is to examine the prognostic value of parameters from the health declaration and application form on extra mortality based on results from additional medical testing.A history register-based cohort study was conducted including about 15.000 application files accepted between 2007 and 2010. Blood pressure, lipids, cotinine and glucose levels were used as dependent variables in logistic regression models. Resampling validation was applied using 250 bootstrap samples to calculate area under the curves (AUC's. The AUC was used to discriminate between persons with and without at least 25% extra mortality.BMI and the overall assessment of the health declaration by an insurance physician or medical underwriter showed the strongest discrimination in multivariable analysis. Including all variables at minimum cut-off levels resulted in an AUC of 0.710 while by using a model with BMI, the assessment of the health declaration and gender, the AUC was 0.708. Including all variables at maximum cut-off levels lead to an AUC of 0.743 while a model with BMI, the assessment of the health declaration and age resulted in an AUC of 0.741.The outcome of this study shows that BMI and the overall assessment of the health declaration were the dominant variables to discriminate between applicants for life-insurance with and without at least 25 percent extra mortality. The variable insured capital set by insurers as factor for additional medical testing could not be established in this study population. The indication for additional medical testing at underwriting life

The burden of allergies--and the capacity of medications to reduce this burden-in a heavy manufacturing environment.

Science.gov (United States)

Bunn, William B; Pikelny, Dan B; Paralkar, Sadhna; Slavin, Thomas; Borden, Spencer; Allen, Harris M

2003-09-01

This article addresses the observational findings of the first systematic study undertaken by a manufacturer to address the impact of allergies and use of allergy medications on health, safety, and productivity. It provides background for 3 other papers from the same project, including an evaluation of an intervention to promote appropriate medication use among affected employees, which appear in this issue. The observational data are developed on 10,714 employees from: 1) 2 employee surveys; 2) administrative databases monitoring employee absenteeism, workers compensation, short-term disability, and group health. The results show that health, productivity, absenteeism, workplace injury, and workers compensation measures register consistent declines as allergy severity levels increase. This pattern is present but less pronounced for the short-term disability and group health measures. In addition, among the 16 measures registering a significant allergy burden, 6 posted significant advantages for the use of nonsedating antihistamines relative to other medication regimens that included sedative antihistamines. These results document the burden of allergies and the capacity of medications to reduce this burden. Effective intervention programs that target this condition can achieve improved health, productivity, and related outcomes.

Evaluation of STAT medication ordering process in a community hospital

Directory of Open Access Journals (Sweden)

Abdelaziz H

2016-06-01

Full Text Available Background: In most health care facilities, problems related to delays in STAT medication order processing time are of common concern. Objective: The purpose of this study was to evaluate processing time for STAT orders at Kimball Medical Center. Methods: All STAT orders were reviewed to determine processing time; order processing time was also stratified by physician order entry (physician entered (PE orders vs. non-physician entered (NPE orders. Collected data included medication ordered, indication, time ordered, time verified by pharmacist, time sent from pharmacy, and time charted as given to the patient. Results: A total of 502 STAT orders were reviewed and 389 orders were included for analysis. Overall, median time was 29 minutes, IQR 16–63; p<0.0001. . The time needed to process NPE orders was significantly less than that needed for PE orders (median 27 vs. 34 minutes; p=0.026. In terms of NPE orders, the median total time required to process STAT orders for medications available in the Automated Dispensing Devices (ADM was within 30 minutes, while that required to process orders for medications not available in the ADM was significantly greater than 30 minutes. For PE orders, the median total time required to process orders for medications available in the ADM (i.e., not requiring pharmacy involvement was significantly greater than 30 minutes. [Median time = 34 minutes (p<0.001]. Conclusion: We conclude that STAT order processing time may be improved by increasing the availability of medications in ADM, and pharmacy involvement in the verification process.

An update on the medical treatment of Graves' hyperthyroidism.

Science.gov (United States)

Marinò, Michele; Latrofa, Francesco; Menconi, Francesca; Chiovato, Luca; Vitti, Paolo

2014-11-01

Medical treatment of Graves' hyperthyroidism is based on the use of thionamides; namely, methimazole and propylthiouracil. In the past, methimazole was preferred by European endocrinologists, whereas propylthiouracil was the first choice for the majority of their North American colleagues. However, because of the recent definition of a better side-effect profile, methimazole is nowadays the first choice world while. Although thionamides are quite effective for the short-term control of Graves' hyperthyroidism, a relatively high proportion of patients relapses after thionamide withdrawal. Other possible medical treatments, include iodine and compounds containing iodine, perchlorate, lithium (as an adjuvant in patients undergoing radioiodine therapy), β-adrenergic antagonists, glucocorticoids, and some new molecules still under investigation. Management of Graves' hyperthyroidism using thionamides as well as the other available medical treatments is here reviewed in detail, with a special mention of situations such as pregnancy and lactation, as well as neonatal and fetal thyrotoxicosis.

Impact of Polypharmacy on Adherence to Evidence-Based Medication in Patients who Underwent Percutaneous Coronary Intervention.

Science.gov (United States)

Mohammed, Shaban; Arabi, Abdulrahaman; El-Menyar, Ayman; Abdulkarim, Sabir; AlJundi, Amer; Alqahtani, Awad; Arafa, Salah; Al Suwaidi, Jassim

2016-01-01

The primary objective of this study was to evaluate the impact of polypharmacy on primary and secondary adherence to evidence-based medication (EBM) and to measure factors associated with non-adherence among patients who underwent percutaneous coronary intervention (PCI). We conducted a retrospective analysis for patients who underwent PCI at a tertiary cardiac care hospital in Qatar. Patients who had polypharmacy (defined as ≥6 medications) were compared with those who had no polypharmacy at hospital discharge in terms of primary and secondary adherence to dual antiplatelet therapy (DAPT), beta-blockers (BB), angiotensin converting enzyme inhibitors (ACEIs) and statins. A total of 557 patients (mean age: 53±10 years; 85%; males) who underwent PCI were included. The majority of patients (84.6%) received ≥6 medications (polypharmacy group) while only 15.4% patients received ≥5 medications (nonpolypharmacy group). The two groups were comparable in term of gender, nationality, socioeconomic status and medical insurance. The non-polypharmacy patients had significantly higher adherence to first refill of DAPT compared with patients in the polypharmacy group (100 vs. 76.9%; p=0.001). Similarly, the non-polypharmacy patients were significantly more adherent to secondary preventive medications (BB, ACEI and statins) than the polypharmacy group. In patients who underwent PCI, polypharmacy at discharge could play a negative role in the adherence to the first refill of EBM. Further studies should investigate other parameters that contribute to long term non-adherence.

Ten years of medical education registrars: Value added?

Science.gov (United States)

Brazil, Victoria; Davin, Lorna

2018-05-22

There is a paucity of any long-term follow up of trainees' career pathways or organisational outcomes from medical education registrar posts in emergency medicine training. We report on the experience of a selected group of medical education trainees during and subsequent to their post and reflect on the value added to emergency medical education at three institutions. We conducted an online survey study, examining quantitative outcomes and qualitative reflections, of emergency physicians who had previously undertaken a medical education registrar post. Descriptive statistics were used to summarise responses to Likert items. The authors independently analysed and interpreted the reflective responses to identify key themes and sub-themes. Nineteen of 21 surveys were completed. Most respondents were in formal educational roles, in addition to clinical practice. The thematic analysis revealed that the medical education registrar experience, and the subsequent contribution of these trainees to medical education, is significantly shaped by external factors. These include the extent of faculty support, and the value placed on medical education by hospitals/departments/leaders. Acquisition of knowledge and skills in medical education was only part of a broader developmental journey and transitioning of identity for the trainees. Our findings suggest that medical education trainees in emergency medicine progress to educational roles, and most respondents attribute their career progression to the medical education training experience. We recommend that medical education registrar programmes need to be valued within the clinical service, supported by faculty and a 'community of practice', to support trainees' transition to clinician educator leadership roles. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Indian medical students in public and private sector medical schools: are motivations and career aspirations different? – studies from Madhya Pradesh, India

Science.gov (United States)

2013-01-01

Background In recent years, there has been a massive growth in the private medical education sector in South Asia. India’s large private medical education sector reflects the market driven growth in private medical education. Admission criteria to public medical schools are based on qualifying examination scores, while admission into private institutions is often dependent on relative academic merit, but also very much on the ability of the student to afford the education. This paper from Madhya Pradesh province in India aims to study and compare between first year medical students in public and private sector medical schools (i) motives for choosing a medical education (ii) career aspirations on completion of a medical degree (iii) willingness to work in a rural area in the short and long terms. Methods Cross sectional survey of 792 first year medical students in 5 public and 4 private medical schools in the province. Results There were no significant differences in the background characteristics of students in public and private medical schools. Reasons for entering medical education included personal ambition (23%), parental desire (23%), prestigious/secure profession (25%) or a service motive (20%). Most students wished to pursue a specialization (91%) and work in urban areas (64%) of the country. A small proportion (7%) wished to work abroad. There were no differences in motives or career aspirations between students of public or private schools. 40% were willing to work in a rural area for 2 years after graduating; public school students were more willing to do so. Conclusion There was little difference in background characteristics, motives for entering medicine or career aspirations between medical students in from public and private sector institutions. PMID:24034988

General Medical Terminology for Vocational Rehabilitation Counselors. "A Guide for the Rehabilitation Practitioner." Final Report.

Science.gov (United States)

Phelps, William R.

This training guide is prepared primarily for the Vocational Rehabilitation practitioner, although academicians may also find it of value. Sixteen specific areas are covered, including common abbreviations, prefixes and suffixes, root words, general terms, operative terminology, special senses and body systems, general medical examination, medical…

Technologies for Medical Sciences

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Tavares, João; Barbosa, Marcos; Slade, AP

2012-01-01

This book presents novel and advanced technologies for medical sciences in order to solidify knowledge in the related fields and define their key stakeholders.   The fifteen papers included in this book were written by invited experts of international stature and address important technologies for medical sciences, including: computational modeling and simulation, image processing and analysis, medical imaging, human motion and posture, tissue engineering, design and development medical devices, and mechanic biology. Different applications are treated in such diverse fields as biomechanical studies, prosthesis and orthosis, medical diagnosis, sport, and virtual reality.   This book is of interest to researchers, students and manufacturers from  a wide range of disciplines related to bioengineering, biomechanics, computational mechanics, computational vision, human motion, mathematics, medical devices, medical image, medicine and physics.

Long-term effect of medical treatment of diarrhoea in 594 patients with SeHCAT scan diagnosed bile acid malabsorption from 2003 to 2016; a retrospective study

DEFF Research Database (Denmark)

Damsgaard, B; Dalby, H R; Krogh, K

2018-01-01

Background Excessive amounts of bile acids entering the colon due to bile acid malabsorption cause chronic bile acid diarrhoea. Diagnosis is possible by measuring the retention fraction of orally ingested 75Selenium homotaurocholic acid (SeHCAT). The knowledge of long-term effects of medical trea...

Contemporary vascular smartphone medical applications.

Science.gov (United States)

Carter, Thomas; O'Neill, Stephen; Johns, Neil; Brady, Richard R W

2013-08-01

Use of smartphones and medical mHealth applications (apps) within the clinical environment provides a potential means for delivering elements of vascular care. This article reviews the contemporary availability of apps specifically themed to major vascular diseases and the opportunities and concerns regarding their integration into practice. Smartphone apps relating to major vascular diseases were identified from the app stores for the 6 most popular smartphone platforms, including iPhone, Android, Blackberry, Nokia, Windows, and Samsung. Search terms included peripheral artery (arterial) disease, varicose veins, aortic aneurysm, carotid artery disease, amputation, ulcers, hyperhydrosis, thoracic outlet syndrome, vascular malformation, and lymphatic disorders. Forty-nine vascular-themed apps were identified. Sixteen (33%) were free of charge. Fifteen apps (31%) had customer satisfaction ratings, but only 3 (6%) had greater than 100. Only 13 apps (27%) had documented medical professional involvement in their design or content. The integration of apps into the delivery of care has the potential to benefit vascular health care workers and patients. However, high-quality apps designed by clinicians with vascular expertise are currently lacking and represent an area of concern in the mHealth market. Improvement in the quality and reliability of these apps will require the development of robust regulation. Copyright © 2013 Elsevier Inc. All rights reserved.

Comparison of indexing times among articles from medical, nursing, and pharmacy journals.

Science.gov (United States)

Rodriguez, Ryan W

2016-04-15

Results of an analysis of the times to indexing of articles published in medical, nursing, and pharmacy journals are reported. MEDLINE data were retrieved for articles published in selected general practice medical, nursing, and pharmacy journals and entered into the PubMed system in 2012 and 2013. Collected data included PubMed entry date, date of indexing with Medical Subject Headings (MeSH) terms, and publication characteristics. Survival analysis was performed to assess the primary outcome of time to indexing. Cox proportional hazards models were developed to assess the effect of healthcare discipline and source journal on the primary outcome. Data were collected for 19,259 articles, of which 78.7%, 12.6%, and 8.7% originated from medical, nursing, and pharmacy journals, respectively. For medical, pharmacy, and nursing journals, 97.8%, 90.8%, and 50.1% of articles, respectively, were indexed within one year of PubMed entry; the corresponding median (interquartile range) times to indexing were 52 (20-68), 186 (150-246), and 252 (168-301) days. Unadjusted hazard ratios derived from Cox models indicated that indexing within one year was significantly less likely for articles published in pharmacy or nursing journals versus medical journals and for articles from all evaluated journals versus a designated reference publication (New England Journal of Medicine). Analysis of major medical, nursing, and pharmacy journals found that articles from nursing and pharmacy journals were indexed with MeSH terms more slowly than articles from medical journals. Journal identity was significantly associated with time to indexing. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Medical physics personnel for medical imaging: requirements, conditions of involvement and staffing levels-French recommendations.

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Isambert, Aurélie; Le Du, Dominique; Valéro, Marc; Guilhem, Marie-Thérèse; Rousse, Carole; Dieudonné, Arnaud; Blanchard, Vincent; Pierrat, Noëlle; Salvat, Cécile

2015-04-01

The French regulations concerning the involvement of medical physicists in medical imaging procedures are relatively vague. In May 2013, the ASN and the SFPM issued recommendations regarding Medical Physics Personnel for Medical Imaging: Requirements, Conditions of Involvement and Staffing Levels. In these recommendations, the various areas of activity of medical physicists in radiology and nuclear medicine have been identified and described, and the time required to perform each task has been evaluated. Criteria for defining medical physics staffing levels are thus proposed. These criteria are defined according to the technical platform, the procedures and techniques practised on it, the number of patients treated and the number of persons in the medical and paramedical teams requiring periodic training. The result of this work is an aid available to each medical establishment to determine their own needs in terms of medical physics. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Organizational intelligence and agility in Shiraz University of Medical Sciences

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Hamid Taboli

2017-07-01

Full Text Available Introduction: Organizational Intelligence is a combination of all skills that organizations need and use; it enables us to make organizational decisions. Organizational Intelligence can increase the effectiveness of the existing informational structures in achieving organizational goals and result in organizational agility. The aim of this study was to investigate the relationship between Organizational Intelligence and organizational agility in Shiraz University of Medical Sciences. Method: This is an applied study in terms of purpose and descriptive in terms of method. The study population consisted of 1200 employees working in Shiraz University of Medical Sciences. The subjects were selected via convenience sampling. Based on Cochran formula, a sample size of 296 was determined with a confidence level of 95%. The measurement tools included the 36-item Organizational Intelligence questionnaire developed by Albrecht (2003 and a researcher-developed organizational agility questionnaire with 30 items. Expert opinion was used to determine the validity of the questionnaires and reliability was confirmed using Cronbach’s alpha coefficient via SPSS, version 19. Results: Tenure employees had the highest frequency among the participants (50%. In terms of education, employees with a bachelor’s degree were the most frequent (58%. Values obtained for all variables showed a significant positive relationship between Organizational Intelligence and Agility. Conclusion: It is recommended that the university officials take measures to include Organizational Intelligence courses in in-service training programs to promote the agility of the university, and improve the service provision process and speed.

In Sickness and in Debt: Do Mounting Medical Bills Predict Payday Loan Debt?

Science.gov (United States)

Bickham, Trey; Lim, Younghee

2015-01-01

Cash-strapped families sometimes turn to small, short-term loans with exorbitant fees—payday loans—to cope with mounting medical bills. Given that about three-fourths of payday loan customers are repeat borrowers, consumer advocates and policymakers have increasingly raised voices of concern about the use of payday loans to finance various household expenses, including, among other things, medical bills. The present study hypothesized that increases in medical debt are associated with increases in payday loan debt among a sample of Chapter 7 bankruptcy filers. The results of a multivariate tobit regression analysis showed that medical debt was associated with increased payday loan debt, controlling for various types of debt and other socioeconomic variables. This article concludes with implications of the results for social work policy- and direct-practice.

Forecasting the need for medical specialists in Spain: application of a system dynamics model

Science.gov (United States)

2010-01-01

Background Spain has gone from a surplus to a shortage of medical doctors in very few years. Medium and long-term planning for health professionals has become a high priority for health authorities. Methods We created a supply and demand/need simulation model for 43 medical specialties using system dynamics. The model includes demographic, education and labour market variables. Several scenarios were defined. Variables controllable by health planners can be set as parameters to simulate different scenarios. The model calculates the supply and the deficit or surplus. Experts set the ratio of specialists needed per 1000 inhabitants with a Delphi method. Results In the scenario of the baseline model with moderate population growth, the deficit of medical specialists will grow from 2% at present (2800 specialists) to 14.3% in 2025 (almost 21 000). The specialties with the greatest medium-term shortages are Anesthesiology, Orthopedic and Traumatic Surgery, Pediatric Surgery, Plastic Aesthetic and Reparatory Surgery, Family and Community Medicine, Pediatrics, Radiology, and Urology. Conclusions The model suggests the need to increase the number of students admitted to medical school. Training itineraries should be redesigned to facilitate mobility among specialties. In the meantime, the need to make more flexible the supply in the short term is being filled by the immigration of physicians from new members of the European Union and from Latin America. PMID:21034458

Medical Student Research: An Integrated Mixed-Methods Systematic Review and Meta-Analysis.

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Mohamed Amgad

Full Text Available Despite the rapidly declining number of physician-investigators, there is no consistent structure within medical education so far for involving medical students in research.To conduct an integrated mixed-methods systematic review and meta-analysis of published studies about medical students' participation in research, and to evaluate the evidence in order to guide policy decision-making regarding this issue.We followed the PRISMA statement guidelines during the preparation of this review and meta-analysis. We searched various databases as well as the bibliographies of the included studies between March 2012 and September 2013. We identified all relevant quantitative and qualitative studies assessing the effect of medical student participation in research, without restrictions regarding study design or publication date. Prespecified outcome-specific quality criteria were used to judge the admission of each quantitative outcome into the meta-analysis. Initial screening of titles and abstracts resulted in the retrieval of 256 articles for full-text assessment. Eventually, 79 articles were included in our study, including eight qualitative studies. An integrated approach was used to combine quantitative and qualitative studies into a single synthesis. Once all included studies were identified, a data-driven thematic analysis was performed.Medical student participation in research is associated with improved short- and long- term scientific productivity, more informed career choices and improved knowledge about-, interest in- and attitudes towards research. Financial worries, gender, having a higher degree (MSc or PhD before matriculation and perceived competitiveness of the residency of choice are among the factors that affect the engagement of medical students in research and/or their scientific productivity. Intercalated BSc degrees, mandatory graduation theses and curricular research components may help in standardizing research education during

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

Science.gov (United States)

Taylor, H G

1998-01-01

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

Barriers and solutions to online learning in medical education - an integrative review.

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O'Doherty, Diane; Dromey, Marie; Lougheed, Justan; Hannigan, Ailish; Last, Jason; McGrath, Deirdre

2018-06-07

The aim of this study is to review the literature on known barriers and solutions that face educators when developing and implementing online learning programs for medical students and postgraduate trainees. An integrative review was conducted over a three-month period by an inter-institutional research team. The search included ScienceDirect, Scopus, BioMedical, PubMed, Medline (EBSCO & Ovid), ERIC, LISA, EBSCO, Google Scholar, ProQuest A&I, ProQuest UK & Ireland, UL Institutional Repository (IR), UCDIR and the All Aboard Report. Search terms included online learning, medical educators, development, barriers, solutions and digital literacy. The search was carried out by two reviewers. Titles and abstracts were screened independently and reviewed with inclusion/exclusion criteria. A consensus was drawn on which articles were included. Data appraisal was performed using the Critical Appraisal Skills Programme (CASP) Qualitative Research Checklist and NHMRC Appraisal Evidence Matrix. Data extraction was completed using the Cochrane Data Extraction Form and a modified extraction tool. Of the 3101 abstracts identified from the search, ten full-text papers met the inclusion criteria. Data extraction was completed on seven papers of high methodological quality and on three lower quality papers. Findings suggest that the key barriers which affect the development and implementation of online learning in medical education include time constraints, poor technical skills, inadequate infrastructure, absence of institutional strategies and support and negative attitudes of all involved. Solutions to these include improved educator skills, incentives and reward for the time involved with development and delivery of online content, improved institutional strategies and support and positive attitude amongst all those involved in the development and delivery of online content. This review has identified barriers and solutions amongst medical educators to the implementation of

Influencing factors of mental health of medical students in China.

Science.gov (United States)

Yang, Fan; Meng, Heng; Chen, Hui; Xu, Xin-hao; Liu, Zhuo; Luo, Ai; Feng, Zhan-chun

2014-06-01

This study investigated the mental health status of medical students in China, and analyzed the influencing factors in order to provide evidence for mental health education for medical students. A stratified cluster sampling method was used to recruit medical students from Huazhong University of Science and Technology, China. The questionnaire survey on general information and Symptom Checklist 90 (SCL-90) were used for investigation and analysis. The results showed among the 1137 valid questionnaires, 278 (24.45%) participants had SCL-90 score ≥ 160. The top three mental problems of medical students were obsessive-compulsive disorder, interpersonal sensitivity and depression in terms of the factor score ≥ 2.5 and the number of participants who reflected on the diseases. The third-year medical students had the worst mental health status, and fifth-year medical students had the best mental health status. Students from rural area had more psychological problems than those from urban area; furthermore, students with high professional satisfaction, those who were the single child of the family, non-poor students, and those whose parents had high education level had better mental health status. It was concluded that the mental health of medical students is not optimistic in China. Medical students have some mental health problems of different degrees. Factors that influence the mental health of medical students include academic pressure, professional satisfaction level and family environment.

An analysis of medical students’ reflective essays in problem-based learning

Directory of Open Access Journals (Sweden)

Jihyun Si

2018-03-01

Full Text Available Purpose This study aimed to explore students’ learning experience in problem-based learning (PBL particularly in terms of what they learned and how they learned in one Korean medical school by analyzing their reflective essays with qualitative research methods. Methods This study included 44 first-year medical students. They took three consecutive PBL courses and wrote reflective essays 3 times anonymously on the last day of each course. Their reflective essays were analyzed using an inductive content analysis method. Results The coding process yielded 16 sub-categories and these categories were grouped into six categories according to the distinctive characteristics of PBL learning experience: integrated knowledge base, clinical problem solving, collaboration, intrinsic motivation, self-directed learning, and professional attitude. Among these categories, integrated knowledge base (34.68% and professional attitude (2.31% were the categories mentioned most and least frequently. Conclusion The findings of this study provide an overall understanding of the learning experience of Korean medical students during PBL in terms of what they learned and how they learned with rich descriptive commentaries from their perspectives as well as several thoughtful insights to help develop instructional strategies to enhance the effectiveness of PBL.

Short-term to Long-term Results of Ahmed Glaucoma Valve Implantation for Uveitic Glaucoma Secondary to Behçet Disease.

Science.gov (United States)

Yakin, Mehmet; Eksioglu, Umit; Sungur, Gulten; Satana, Banu; Demirok, Gulizar; Ornek, Firdevs

2017-01-01

To evaluate short-term to long-term outcomes of Ahmed glaucoma valve (AGV) implantation in the management of uveitic glaucoma (UG) secondary to Behçet disease (BD). A retrospective chart review of 47 eyes of 35 patients with UG secondary to BD who underwent AGV implantation was conducted. Success was defined as having an intraocular pressure (IOP) between 6 and 21 mm Hg with (qualified success) or without (complete success) antiglaucomatous medications and without need for further glaucoma surgery. Mean postoperative follow-up was 57.72±26.13 months. Mean preoperative IOP was 35.40±8.33 mm Hg versus 12.28±2.90 mm Hg at the last follow-up visit (P<0.001). Mean number of preoperative topical antiglaucomatous medications was 2.96±0.29 versus 0.68±1.12 at the last follow-up visit (P<0.001). In all eyes, IOP could be maintained between 6 and 21 mm Hg with or without antiglaucomatous medications during follow-up. The cumulative probability of complete success was 46.8% at 6 months, 40.4% at 12 months, and 35.9% at 36 months, and the cumulative probability of eyes without complication was 53.2% at 6 months, 46.5% at 12 months, and 39.6% at 24 months postoperatively based on Kaplan-Meier survival analysis. No persistent or irreparable complications were observed. This study includes one of the largest series of AGV implantation in the management of UG with the longest follow-up reported. AGV implantation can be considered as a primary surgical option in the management of UG secondary to BD with 100% total success rate (with or without medications).

Economic evaluation of pharmacist-led medication reviews in residential aged care facilities.

Science.gov (United States)

Hasan, Syed Shahzad; Thiruchelvam, Kaeshaelya; Kow, Chia Siang; Ghori, Muhammad Usman; Babar, Zaheer-Ud-Din

2017-10-01

Medication reviews is a widely accepted approach known to have a substantial impact on patients' pharmacotherapy and safety. Numerous options to optimise pharmacotherapy in older people have been reported in literature and they include medication reviews, computerised decision support systems, management teams, and educational approaches. Pharmacist-led medication reviews are increasingly being conducted, aimed at attaining patient safety and medication optimisation. Cost effectiveness is an essential aspect of a medication review evaluation. Areas covered: A systematic searching of articles that examined the cost-effectiveness of medication reviews conducted in aged care facilities was performed using the relevant databases. Pharmacist-led medication reviews confer many benefits such as attainment of biomarker targets for improved clinical outcomes, and other clinical parameters, as well as depict concrete financial advantages in terms of decrement in total medication costs and associated cost savings. Expert commentary: The cost-effectiveness of medication reviews are more consequential than ever before. A critical evaluation of pharmacist-led medication reviews in residential aged care facilities from an economical aspect is crucial in determining if the time, effort, and direct and indirect costs involved in the review rationalise the significance of conducting medication reviews for older people in aged care facilities.

Development of X-ray protective clothes for medical treatments

International Nuclear Information System (INIS)

Nagai, M.; Koike, K.; Fujinuma, T.; Aso, T.; Konba, T.

1991-01-01

As various medical treatments using X-ray irradiation are getting more important in modern medicine, effective, excellent X-ray protective clothes have been required. Elastomeric or PVC sheets containing powdery lead are usually employed as conventional X-ray protective clothes. In this case, enhancement of X-ray shielding efficiency increases the weight because the efficiency depends on the amount of lead incorporated. Such heavy clothes give significant fatigue and inconvenience during long term use. Consequently, lightweight and comfortable X-ray protective clothes have been eagerly desired in the medical field. The authors have improved these defects in the conventional clothes by means of elastomeric blending technologies and successfully developed new, lightweight and comfortable X-ray shielding clothes. The new clothes consist of lead-containing rubber sheet in which lead is homogeneously incorporated and lightweight PVC laminated with fabrics. They achieved favorable sense of touch, comfortable wearing and long-term durability. Furthermore, the clothes satisfy all requirements including X-ray shielding efficiency defined in JIS specifications. This article introduces the development of the new clothes and their properties in detail. (author)

Pediatric сlinic of Odessa National Medical University: the quality of emergency medical care for children

Directory of Open Access Journals (Sweden)

E.A. Starets

2017-04-01

guidelines of the United States, Great Britain, Canada, Australia; Ukrainian National Formulary; British National Formulary for Children. All medicines included in these local guidelines are presented in the WHO Model List of Essential Medicines (April 2015. In the Pediatric Clinic the medical care is patient-centred, responsive to and respectful of the patient’s values and choices to promote patient satisfaction and fulfillment of human rights. We use the patient-centred technologies: mothers and infants to remain together 24 hours a day; the preference is given to oral rehydration, rather than intravenous fluid administration; the minimization of pain for all manipulations, to refuse any intramuscular injections; to usage of screening test systems for the diagnosis of Beta-hemolytic streptococcus, rotavirus, influenza, bacteriuria; the humidification of air around the patient. The average period of staying in the ICU is 2 days. The culture of patient safety is a priority in the Pediatric Clinic. The culture of patient’s safety includes: the changing of the attitudes of medical staffs towards the safety of medical care; the identification of triggers and risks of medical care; the identification of all medi-cal errors/“no harm events”/“near miss events”; the implementation of safe technologies, simple algorithms; learning of medical staff. There were more than 40 lectures and practices for medical staff of the Pediatric Clinic, including the training courses CODE BLUE. Conclusions. The measures aimed at improving the quality of emergency medical care for children in the Pediatric Clinic of the Odessa National Medical University are: 1 the organization of ICU and equipping it with mo-dern equipment for diagnose and treatment of children; 2 the triage of patients according to the condition severity by the objective criteria; 3 the reducing of terms of hospitalization due to optimization of treatment in ICU; 4 standardization of medical care by developing local

MEDication reminder APPs to improve medication adherence in Coronary Heart Disease (MedApp-CHD) Study: a randomised controlled trial protocol.

Science.gov (United States)

Santo, Karla; Chow, Clara K; Thiagalingam, Aravinda; Rogers, Kris; Chalmers, John; Redfern, Julie

2017-10-08

The growing number of smartphone health applications available in the app stores makes these apps a promising tool to help reduce the global problem of non-adherence to long-term medications. However, to date, there is limited evidence that available medication reminder apps are effective. This study aims to determine the impact of medication reminder apps on adherence to cardiovascular medication when compared with usual care for people with coronary heart disease (CHD) and to determine whether an advanced app compared with a basic app is associated with higher adherence. Randomised controlled trial with follow-up at 3 months to evaluate the feasibility and effectiveness of medication reminder apps on medication adherence compared with usual care. An estimated sample size of 156 patients with CHD will be randomised to one of three groups (usual care group, basic medication reminder app group and advanced medication reminder app group). The usual care group will receive standard care for CHD with no access to a medication reminder app. The basic medication reminder app group will have access to a medication reminder app with a basic feature of providing simple daily reminders with no interactivity. The advanced medication reminder app group will have access to a medication reminder app with additional interactive and customisable features. The primary outcome is medication adherence measured by the eight-item Morisky Medication Adherence Scale at 3 months. Secondary outcomes include clinical measurements of blood pressure and cholesterol levels, and medication knowledge. A process evaluation will also be performed to assess the feasibility of the intervention by evaluating the acceptability, utility and engagement with the apps. Ethical approval has been obtained from the Western Sydney Local Health Network Human Research Ethics Committee (AU/RED/HREC/1/WMEAD/3). Study findings will be disseminated via usual scientific forums. ACTRN12616000661471; Pre-results. �

Medication effects on sleep and breathing.

Science.gov (United States)

Seda, Gilbert; Tsai, Sheila; Lee-Chiong, Teofilo

2014-09-01

Sleep respiration is regulated by circadian, endocrine, mechanical and chemical factors, and characterized by diminished ventilatory drive and changes in Pao2 and Paco2 thresholds. Hypoxemia and hypercapnia are more pronounced during rapid eye movement. Breathing is influenced by sleep stage and airway muscle tone. Patient factors include medical comorbidities and body habitus. Medications partially improve obstructive sleep apnea and stabilize periodic breathing at altitude. Potential adverse consequences of medications include precipitation or worsening of disorders. Risk factors for adverse medication effects include aging, medical disorders, and use of multiple medications that affect respiration. Published by Elsevier Inc.

Prevalence of inappropriate medication using Beers criteria in Japanese long-term care facilities

DEFF Research Database (Denmark)

Niwata, Satoko; Yamada, Yukari; Ikegami, Naoki

2006-01-01

dependent on the disease or condition was found in patients with chronic constipation. Multiple logistic regression analysis revealed psychotropic drug use (OR = 1.511), medication cost of per day (OR = 1.173), number of medications (OR = 1.140), and age (OR = 0.981) as factors related to inappropriate...

The relevance and role of homestays in medical education: a scoping study.

Science.gov (United States)

Hughes, Bonnie Olivia; Moshabela, Mosa; Owen, Jenni; Gaede, Bernhard

2017-01-01

The community-based medical education curriculum is growing in popularity as a strategy to bring universal health coverage to underserved communities by providing medical students with hands-on training in primary health care. Accommodation and immersion of medical students within the community will become increasingly important to the success of community-based curricula. In the context of tourism, homestays, where local families host guests, have shown to provide an immersive accommodation experience. By exploring homestays in the educational context, this scoping study investigates their role in providing an immersive pedagogical experience for medical students. A scoping review was performed using the online databases ScienceDirect and the Duke University Library Database, which searches Academic Search Complete, JSTOR, LexisNexis Academic, Web of Science, Proquest, PubMed and WorldCat. Using the inclusion term 'homestays' and excluding the term 'tourism', 181 results were returned. AClose assessment using inclusion criteria narrowed this to 14 relevant articles. There is very little published research specific to the experience of medical students in community homestays, indicating a gap in the literature. However, the existing educational outcomes suggest homestays may have the potential to serve a significant role in medical education, especially as a component of decentralised or community-based programmes. The literature reveals that educational homestays influence language learning, cultural immersion, and the development of professional skills for health science careers. These outcomes relate to the level of engagement between students and hosts, including the catalytic role of community liaisons. Homestays offer a unique depth of experience that has the potential to enrich the education of participating students, and require further research, particularly in the context of distributed and decentralised training platforms for medical and health sciences

Current trends in medical ethics education in Japanese medical schools.

Science.gov (United States)

Kurosu, Mitsuyasu

2012-09-01

The Japanese medical education program has radically improved during the last 10 years. In 1999, the Task Force Committee on Innovation of Medical Education for the 21st Century proposed a tutorial education system, a core curriculum, and a medical student evaluation system for clinical clerkship. In 2001, the Model Core Curriculum of medical education was instituted, in which medical ethics became part of the core material. Since 2005, a nationwide medical student evaluation system has been applied for entrance to clinical clerkship. Within the Japan Society for Medical Education, the Working Group of Medical Ethics proposed a medical ethics education curriculum in 2001. In line with this, the Japanese Association for Philosophical and Ethical Research in Medicine has begun to address the standardization of the curriculum of medical ethics. A medical philosophy curriculum should also be included in considering illness, health, life, death, the body, and human welfare.

A study on the long term effect of biofilm produced by biosurfactant producing microbe on medical implant