WorldWideScience

Sample records for underlying medical problem

  1. Sexual dysfunction and the underlying medical problems in post-menopausal women

    Directory of Open Access Journals (Sweden)

    Soheila Nazarpour

    2016-02-01

    Full Text Available Background: Sexual dysfunction could be under the influence of some underlying medical problems. The purpose of this study is to examine the relationship between medical problems and sexual function in post-menopausal women. Methods: This is a community-based, descriptive-correlation study of 405 post-menopausal women residing in Chalus and Nowshahr cities, North of Iran, aged 40 to 65 years old from October 2013 to May 2014. A multistage, randomized sampling was conducted. The data was acquired through interviews using the Female Sexual Function Index (FSFI questionnaire and a researcher-made questionnaire, and was analyzed using descriptive and analytical tests such as multiple linear regression and logistic regression models. Results: 51.4% of the subjects had medical conditions. Cardiovascular disorders were the most common diseases among the subjects. 61% of the women were suffering from female sexual dysfunction (FSD. Sexual dysfunction in patients with medical conditions was significantly higher (P= 0.037. Scores of arousal (P= 0.000, orgasm (P= 0.018, and satisfaction (P= 0.026, as well as the FSFI total score (P= 0.005, were significantly lower in subjects with cardiovascular disorders. Scores of desire (P= 0.001, arousal (P= 0.006, lubrication (P= 0.010, orgasm (P= 0.004, and satisfaction (P= 0.022, as well as the FSFI total score (P= 0.017, were significantly lower in subjects with diabetes. Scores of pain were significantly lower in subjects with musculoskeletal disorders (P= 0.041, they experienced more pain during intercourse. In domains of arousal (P= 0.030, satisfaction (P= 0.040, and pain (P= 0.044, the scores of those taking antihypertensive medications were significantly lower than the scores of the rest of the subjects. Scores of desire (P= 0.001, arousal (P= 0.006, orgasm (P= 0.006, and satisfaction (P= 0.048, as well as the FSFI total score (P= 0.006, were significantly lower in those taking antidiabetic drugs. And lastly

  2. Assisting cytopathology training in medically under-resourced countries: defining the problems and establishing solutions.

    Science.gov (United States)

    Field, A S; Geddie, W; Zarka, M; Sayed, S; Kalebi, A; Wright, C A; Banjo, A; Desai, M; Kaaya, E

    2012-03-01

    Cytology is able to deliver rapid accurate diagnoses with minimal equipment and laboratory infrastructure at minimal cost, and this is especially so for fine needle biopsy (FNB), which is a powerful diagnostic tool in medically resource-poor environments, where histopathology laboratories are small in number and poorly supported financially. The crucial element in the development of cytology services is to train a sufficient number of well trained cytopathologists and cytotechnologists to create a 'critical mass' of personnel who not only provide routine diagnostic services, but also can train an ever expanding number of pathologists, cytotechnologists, and health workers. A review of practical programs to train cytopathologists and cytotechnologists in their own countries will be presented, including a recent series of FNB and cytology tutorials run in sub Saharan Africa. The need for local cytopathology programs and the potential for both local and visiting cytopathologists to provide a faculty will be discussed, as well as a range of possible programs which can bring African pathologists and trainee pathologists to Western institutions for periods of their training. Ideally, the regional Societies of Cytology, including the recently formed West African Society of Cytology, will establish their own diagnostic protocols, training programs, syllabuses, examinations and accreditation and career pathways for both cytopathologists and cytotechnologists, and organize tutorials where they will invite overseas faculty to contribute. Crucially, these new societies will empower cytopathologists and cytotechnologists to approach health services and governments to state the need for cytology services as a cost-effective accurate diagnostic service that enhances patient care. Copyright © 2011 Wiley Periodicals, Inc.

  3. Medical-biological problems

    International Nuclear Information System (INIS)

    1986-01-01

    The report contains data on operational and emergency staff of the Chernobyl nuclear power plant who were exposed to radiation as a consequence of the reactor accident, the size of the doses received and consequences for health. 203 persons were found to have acute radiation sickness. Of the 22 patients suffering from an extremely severe degree of acute radiation sickness, 19 died. Of the 23 patients with severe bone marrow syndrome, 7 died. For the majority of patients, clinical recovery occurred toward the end of the second month following the accident. The main harmful factor for all victims was the relatively uniform gamma- and beta-radiation effect in a dosage exceeding 1 Gy and, in the case of 35 people exceeding 4 Gy. Radiation damage to wide areas of the skin was one of the main factors contributing to the overall severe condition of the patients, and was a determining factor in the main fatal complications. A preliminary evaluation of the use of some biochemical and immunological tests in the event of accidental exposure to radiation and the methods of treatment and preliminary assessment of their effectiveness are presented. Another part of the report contains data on the doses from radiation exposure to the population of the town of Pripyat' until the time of evacuation and to the population in the 30 km zone around Chernobyl' nuclear power plant and radiation consequences of the accident for the population of different regions in the European part of the USSR, especially the problems related to the contamination of food products. The last part of the report gives some data on the organization of medical examinations of the population from the region around the Chernobyl' plant and on the long-term programmes for the medical and biological monitoring of the population and personnel

  4. Medical problems of the developing countries.

    Science.gov (United States)

    Brown, R E

    1966-07-15

    There can be no immediate solution to the medical problems of the developing countries. Priorities are demanded, and it must be acknowledged that in allocation of medical priorities certain compromises are required. It can be hoped that the least detrimental compromises will be selected. Careful planning of health services and also of training programs for various medical personnel must not rely on what exists in developed countries, because those facilities and programs may be completely inappropriate to other situation. At the same time as inroads are made into the preventable conditions which now claim thousands of young lives, programs of birth control and improvement of agricultural methods must be emphasized. The reduced morbidity and mortality which results from immunization against childhood infectious diseases, smallpox, and tuberculosis must be borne in mind in overall planning for schools and general health services. Inexpensive and practical programs that could be managed by medical personnel who are not highly trained should be considered. As the benefits of technical development gradually reach the urbanizing population living under poor social and hygienic conditions, changes in the disease picture must be anticipated. Those involved with planning and training must understand various cultural influences so that the transition period can be made as painless as possible. Certain seemingly attractive Western procedures should be guarded against if they are not practical. For instance, a common tendency is to build large modern hospitals throughout the land with disregard for the fact that these hospitals cannot possibly be staffed, equipped, or maintained because of shortages of trained people and available funds (14). This has been called an "edifice complex" and is unfortunately found in many developing regions, stimulated often by ill-considered advice from overseas experts. At the same time as medical services are being improved, it is extremely

  5. Revisiting the medical diagnosis problem

    DEFF Research Database (Denmark)

    Ejersbo, Lisser Rye; Leron, Uri

    2014-01-01

    psychological research as a theoretical base, we design a new “bridging” task, which is on the one hand formally equivalent to the given “difficult” task, but on the other hand is much more accessible to students’ intuitions. Furthermore, this new task would serve as "stepping stone", enabling students to solve...... of such cognitive challenges? In our view, pointing out the clash is not enough; we'd like to help students build bridges between the intuitive and analytical ways of seeing the problem, thus hopefully creating a peaceful co-existence between these two modes of thought. In this article, we investigate this question...

  6. To the Problem of Medical Term Emotiogenicity

    Directory of Open Access Journals (Sweden)

    Санья Ибрагимовна Маджаева

    2015-12-01

    Full Text Available The article deals with the issue of medical terminology used in the doctor-patient communication. The author aims to prove the emotiogenic potential of medical terms of the deadliest diseases that are directly related to such basic human concepts as life and death . The study object is intricately connected with semantic and pragmatic aspects of a medical term, namely its emotiogenicity. The methodology is based on Russian researchers’ works in the field of emotive linguistics, terminology theory, and medical terminology. The article solves the problem of broadening theoretical conceptions of emotive linguistics in its relation to terminological units. Research material includes the respondents’ answers to the questionnaire and doctor-patient and doctor-relative dialogues. Semantic and contextual analysis and the survey among 200 medical students and patients find that a medical term is emotiogenic (emotionally evocative and provokes emotions dominated by fear, despair, aggression, shame, etc.

  7. The American medical economy: problems and perspectives.

    Science.gov (United States)

    Rice, D P; Wilson, D

    1976-01-01

    Federal initiatives during the last decade have resulted in considerable changes in the American medical economy. Large sums of money have been infused into the system under Medicare and Medicaid, substantially improving access to care for the aged and the poor. At the same time, the improvements in knowledge and medical technology that have occurred have been largely underwritten by the tremendous increases in third-party payment mechanisms. These costly new technologies have contributed significantly to the high cost of hospital care and to the increased specialization of physician's services. The chronic inflation in medical expenditures and the explosive increases in Federal subsidization of medical care have led to questions concerning the efficacy of medical care for improving health status. There is a considerable lack of evidence for a causal relationship between what is done to the patient and the outcome of the medical care process as measured by mortality, disability, and capacity to carry on activities. Various attempts have been made to control the chronic inflation of medical expenditures, but success is uneven and elusive. Alternatives in financing medical care services currently under debate include various provisions to control costs and utilization, but attention should be directed to organizing American medical care services in general, toward the more rational use of our resources.

  8. Abortion as a medical and spiritual problem

    OpenAIRE

    Purgina, A.; Shmakova, V.

    2014-01-01

    The problem of abortion now has adopted a special social significance. Many countries has the laws regulating an abortion. In Russia this law exists in a very liberal state. Statistics of abortions is disappointing. It is not only a medical but also a social problem which roots lies in the moral aspect of society. The Church considers the abortion as a mortal sin since ancient times. We tried to consider the history of the fight against abortion and its appropriateness.

  9. Leximin rules for bankruptcy problems under uncertainty

    Science.gov (United States)

    Hinojosa, M. A.; Mármol, A. M.; Sánchez, F. J.

    2014-01-01

    We model bankruptcy problems under uncertainty under the assumption that there are several possible states of nature, each of which is identified with a different bankruptcy problem. For this multi-dimensional extension of classic bankruptcy problems, we consider situations in which agents exhibit at the same time additive preferences and leximin preferences on their possible results. We propose division rules which combine different rationality principles and guarantee efficiency with respect to leximin preferences.

  10. ADHD Medication and Substance-Related Problems.

    Science.gov (United States)

    Quinn, Patrick D; Chang, Zheng; Hur, Kwan; Gibbons, Robert D; Lahey, Benjamin B; Rickert, Martin E; Sjölander, Arvid; Lichtenstein, Paul; Larsson, Henrik; D'Onofrio, Brian M

    2017-09-01

    Substance use disorders are major contributors to excess mortality among individuals with attention deficit hyperactivity disorder (ADHD), yet associations between pharmacological ADHD treatment and substance-related problems remain unclear. This study investigated concurrent and long-term associations between ADHD medication treatment and substance-related events. The authors analyzed 2005-2014 commercial health care claims from 2,993,887 (47.2% female) adolescent and adult ADHD patients. Within-individual analyses compared the risk of substance-related events (i.e., emergency department visits related to substance use disorders) during months in which patients received prescribed stimulant medication or atomoxetine relative to the risk during months in which they did not. In adjusted within-individual comparisons, relative to periods in which patients did not receive ADHD medication, male patients had 35% lower odds of concurrent substance-related events when receiving medication (odds ratio=0.65, 95% CI=0.64-0.67), and female patients had 31% lower odds of concurrent substance-related events (odds ratio=0.69, 95% CI=0.67-0.71). Moreover, male patients had 19% lower odds of substance-related events 2 years after medication periods (odds ratio=0.81, 95% CI=0.78-0.85), and female patients had 14% lower odds of substance-related events 2 years after medication periods (odds ratio=0.86, 95% CI= 0.82-0.91). Sensitivity analyses supported most findings but were less consistent for long-term associations among women. These results provide evidence that receiving ADHD medication is unlikely to be associated with greater risk of substance-related problems in adolescence or adulthood. Rather, medication was associated with lower concurrent risk of substance-related events and, at least among men, lower long-term risk of future substance-related events.

  11. [The problems of personnel training for military forensic medical expertise under the current reform of the military forces in the Russian Federation].

    Science.gov (United States)

    Tolmachev, I A

    2010-01-01

    The educational sphere is becoming a major priority in the state policy. The Concept of national security for the Russian Federation regards intellectual impairment as a most serious internal threat to the military security. It declares that the operational efficiency of the armed forces should be based on high-quality education of specialists. The current reform of the military forces in the Russian Federation envisages the modification of the forensic medical expertise and the system of training relevant personnel. The post-diploma education of forensic medical experts encounters difficulties at all levels. In all probability, such education will be performed in the near future through the primary retraining mechanism. In the course of the ongoing reform, the Department of Forensic Medicine at the Military Medical Academy remains the sole facility for the post-diploma education of military forensic medical experts. The teaching staff of the department have sufficient qualification and experience for training highly skilled specialists as stipulated by the reform of the military forces in the Russian Federation.

  12. PROBLEMS OF MEDICAL LIBRARIES IN JAPAN.

    Science.gov (United States)

    URATA, T; FUJII, K; TSUDA, Y

    1965-01-01

    Reference service in medical libraries should be considered more seriously by the members of the Japan Medical Library Association, as their interest so far has been focused mainly on interlibrary loan service, compilation of union lists and union catalogs, and the business side of library administration. The Association does not have enough funds to be very active, and its membership is limited to the libraries of medical and of some large dental schools. It should open its membership to other medical libraries, such as those of hospitals and medical laboratories, and eventually to individuals. Many of the member libraries do not have complete control of their own budget, as each department of the school earmarks part of its budget for the library while it still holds the right of deciding which books and journals are to be bought and keeps a large part of them in its departmental library. Lack of proper library school education among the library staff is one of the major problems. There are some training courses for medical librarians in the library schools and also some workshops held by the Association, but they are limited in their usefulness by the fact that there are not enough library school graduates who can take advantage of them.

  13. ACTUAL PROBLEMS OF MEDICAL GAS OXYGEN PRODUCTION

    OpenAIRE

    Подгорный, И. П.

    2014-01-01

    Medical gas oxygen is one of the most popular medicines. Its production is the major branch of the pharmaceutical industry. Provision of its high quality in the process of obtaining is an actual problem for companies of cryogenic oxygen production. For this purpose a concrete enterprise necessary to implement a quality assurance system in the production of medicinal products (QAS). The main component of the QAS is good manufacturing practice (Good Manufacturing Practice, GMP). It is shown how...

  14. Manual for medical problems of radiation protection

    International Nuclear Information System (INIS)

    Anon.

    1979-01-01

    The manual deals comprehensively and topically with the theoretical and practical fundamentals of radiation protection of the population considering the present knowledge in the fields of radiobiology and radiation protection medicine. The subject is covered under the following headings: (1) physics of ionizing radiations, (2) biological radiation effects, (3) the acute radiation syndrome, (4) medical treatment of the acute radiation syndrome, (5) combined radiation injuries, and (6) prophylaxis and therapy of injuries caused by fission products of nuclear explosions. The book is of interest to medical doctors, medical scientists, and students in medicine who have to acquire special knowledge in the field of radiation protection and it is of value as a reference book in daily routine

  15. Medical Treatment and Educational Problems in Children.

    Science.gov (United States)

    Bartel, Nettie R.; Thurman, S. Kenneth

    1992-01-01

    The miracles of modern medical technology are sometimes accompanied by unanticipated costs affecting survivors' quality of life. This article considers the educational implications for three groups of children who could not survive without medical intervention: children treated for cancer, low birth-weight and premature infants, and the medically…

  16. Medical Students' Perception of Problem Areas in Anatomy ...

    African Journals Online (AJOL)

    To determine perceived problem areas in anatomy, determine possible reasons for these problems and propose solutions to the identified areas. Open ended questionnaires were administered to undergraduate medical students of Delta State University, Abraka after obtaining consent from each respondent.

  17. Primary Medical Care and Children's Learning Problems.

    Science.gov (United States)

    McGrath, P J; Feldman, W; Rosser, W

    1989-02-01

    The authors describe the major learning problems that confront the primary-care physician. They discuss why they believe that the primary-care physician has an important role in case finding, referral, case management, and advocacy for the child with learning problems and his or her family.

  18. Problems of medical personnel deontology during radiation emergency response

    International Nuclear Information System (INIS)

    Poplavskij, K.K.; Popov, A.O.

    1990-01-01

    Problems of deontology in the process of liquidation of radiation accident consequences are considered in the article. It is noted, that shortages of ethical nature in the activities of physicians are related to insufficient qualification of medical personnel in the area of radiation medicine. Problems of medical personnel participation in the large scale propaganda activities among various groups of population are considered. 5 refs

  19. INFORMATION SECURITY PROBLEMS OF SUCCESSION OF MEDICAL CARE

    Directory of Open Access Journals (Sweden)

    N. V. Kharyk

    2012-12-01

    Full Text Available The problems of ensuring the succession and continuity of medical care were examined. The information and cyber matters of succession, in particular, information standards, resource management systems of medical institutions were analyzed. The idea of the need to develop standards for succession of medical care is emphasized.

  20. Quality of medical services: problems, evaluation and regulation

    OpenAIRE

    Yerdavletova, Farida; Mukhambetov, Temirkhan

    2015-01-01

    One of the most acute problems in the healthcare industry – the problem of the quality of medical services. In this area, there is no established definition of medical services or approaches to quality management. The aim of the article is to analyze the existing definitions of “quality of medical services,” as well as development approach to managing medical organization. At the same time the management of the medical organization should be focused on ensuring the quality as the most importa...

  1. Problems of postgraduate medical training in Nigeria.

    Science.gov (United States)

    Ike, S O

    2004-01-01

    Postgraduate medical training in Nigeria has been in dire straits for about two decades now. That it has continued to survive, is a tribute to the average resident doctor who has become immunized, and who has grown a thick skin of armour, as well the spirit of altruism of the medical teachers--consultants (young and old), who despite odds, have kept their focus clear, above the murky waters of national distraction and daunting socio economic challenges. A review of relevant literature on medical education in Nigeria was undertaken by manual library search. This paper x-rays the strong points that have still prevailed to hold the rudiments and ideals of postgraduate medical training in a viable position up to date. It discusses the weaknesses and threats--potential and real--to the training programme. This paper attempts to search, and actually hopes, for silver lining in the Nigerian sky as possible solution lifelines that may yet re-engineer the programme.

  2. Medical tourism analysis under the innovation perspective

    Directory of Open Access Journals (Sweden)

    Keline Leão Ferreira

    2016-05-01

    Full Text Available Medical tourism, although being considered a recent phenomenon in Brazil, still represents an important opportunity for institutions that have health facilities, human resources and advanced technological level. This work aims to develop a reflection about this market based under the innovation theoretical perspectives. In order to support this analysis was conducted a multi case study in four health institutions located in the Brazilian south region. Results confirmed that these institutions developed innovations, classified as innovation in product, process, organizational and marketing. Moreover, the evidences indicated that the institution participation on medical tourism market, using innovation as a competitive advantage, helps to promote a new business design and organizational processes, adequate infrastructure, assigning a due importance to the marketing and management sectors, generating an external recognition, a larger network relationships, cooperation among peers, ensuring to these institutions an international standard of service delivery.

  3. Dopaminergic Medication in Parkinson's Disease and Problem Gambling.

    Science.gov (United States)

    Olley, Jacqueline; Blaszczynski, Alex; Lewis, Simon

    2015-09-01

    Studies on Parkinson's disease patients on dopaminergic medication report elevated rates of problem gambling. Results suggest changes in gambling behaviour are associated with the commencement and termination of dopaminergic medication implying a direct causal relationship. However, previous reports have not controlled for possible factors independent of dopamine medication contributing to the onset of problem gambling. This study aimed to explore the temporal relationships between problem gambling and dopamine medication taking into account premorbid gambling risk factors in a sample of Parkinson's disease patients. Twenty patients with Parkinson's disease meeting criteria for moderate risk or problem gambling were compared to twenty patients with Parkinson's disease who did not meet such criteria. The cross-sectional research design compared between group qualitative and quantitative differences. Participants completed an in-depth interview and timeline follow back, and battery of psychometric measures assessing impulsivity, gambling status, affective states, and obsessionality. Results revealed a complex and varied temporal relationship between dopaminergic medication onset and gambling. A small number of participants manifested excessive gambling following dopaminergic medication, with some ceasing on reduction in dosage or change in agonist class. Many demonstrated a range of individual and situational characteristic similar to problem gamblers in the general population, and in older adults with gambling problems. The obtained results provide a better understanding of the role of dopaminergic medication in problem gambling. Such findings have theoretical relevance to the reward deficiency model of gambling and have implications for the treatment of pathological gambling in PD and the general community.

  4. Generalized production planning problem under interval uncertainty

    Directory of Open Access Journals (Sweden)

    Samir A. Abass

    2010-06-01

    Full Text Available Data in many real life engineering and economical problems suffer from inexactness. Herein we assume that we are given some intervals in which the data can simultaneously and independently perturb. We consider the generalized production planning problem with interval data. The interval data are in both of the objective function and constraints. The existing results concerning the qualitative and quantitative analysis of basic notions in parametric production planning problem. These notions are the set of feasible parameters, the solvability set and the stability set of the first kind.

  5. The context of ethical problems in medical volunteer work.

    Science.gov (United States)

    Wall, Anji

    2011-06-01

    Ethical problems are common in clinical medicine, so medical volunteers who practice clinical medicine in developing countries should expect to encounter them just as they would in their practice in the developed world. However, as this article argues, medical volunteers in developing countries should not expect to encounter the same ethical problems as those that dominate Western biomedicine or to address ethical problems in the same way as they do in their practice in developed countries. For example, poor health and advanced disease increase the risks and decrease the potential benefits of some interventions. Consequently, when medical volunteers intervene too readily, without considering the nutritional and general health status of patients, the results can be devastating. Medical volunteers cannot assume that the outcomes of interventions in developing countries will be comparable to the outcomes of the same interventions in developed countries. Rather, they must realistically consider the complex medical conditions of patients when determining whether or not to intervene. Similarly, medical volunteers may face the question of whether to provide a pharmaceutical or perform an intervention that is below the acceptable standard of care versus the alternative of doing nothing. This article critically explores the contextual features of medical volunteer work in developing countries that differentiate it from medical practice in developed countries, arguing that this context contributes to the creation of unique ethical problems and affects the way in which these problems should be analyzed and resolved.

  6. Medical problem and document model for natural language understanding.

    Science.gov (United States)

    Meystre, Stephanie; Haug, Peter J

    2003-01-01

    We are developing tools to help maintain a complete, accurate and timely problem list within a general purpose Electronic Medical Record system. As a part of this project, we have designed a system to automatically retrieve medical problems from free-text documents. Here we describe an information model based on XML (eXtensible Markup Language) and compliant with the CDA (Clinical Document Architecture). This model is used to ease the exchange of clinical data between the Natural Language Understanding application that retrieves potential problems from narrative document, and the problem list management application.

  7. Opinion of medical students regarding problem based learning.

    Science.gov (United States)

    Habib, Farida; Baig, Lubna; Mansuri, Farah Asad

    2006-10-01

    To assess the process of problem-based learning (PBL) as perceived by the medical students and their opinions regarding the process. A cross-sectional study was conducted at Karachi Medical and Dental College. One hundred and four medical students of fourth year MBBS (52 each of batch 2004 and 2005) were selected for their responses and feedback on problem-based learning in small groups. Data was collected through a closed-ended questionnaire. Seventy nine percent (82 out of 104) of medical students liked the PBL sessions. Overall 85% of students were motivated towards self learning while liking for PBL was 82%. Activation of prior knowledge was observed by 83% students. Students supported problem-based learning (PBL) as an effective method of learning. Majority of students were motivated towards self- learning. They were convinced that PBL helped them in building up communication skills, interpersonal relationship and problem solving capacity.

  8. Medical Biotechnology: Problems and Prospects in Bangladesh

    Directory of Open Access Journals (Sweden)

    Shaikh Mizan

    2013-01-01

    Full Text Available Biotechnology is the knowledge and techniques of developing and using biological systems for deriving special products and services. The age-old technology took a new turn with the advent of recombinant DNA techniques, and boosted by the development of other molecular biological techniques, cell culture techniques and bioinformatics. Medical biotechnology is the major thrust area of biotechnology. It has brought revolutions in medicine – quick methods for diagnosing diseases, generation of new drugs and vaccines, completely novel approach of treatment are only a few to mention. The industrial and financial bulk of the industry mushroomed very rapidly in the last three decades, led by the USA and western advanced nations. Asian countries like China, India, South Korea, Taiwan and Singapore joined late, but advancing forward in a big way. In all the Asian countries governments supported the initiatives of the expert and entrepreneur community, and invested heavily in its development. Bangladesh has got great potential in developing biotechnology and reaping its fruits. However, lack of commitment and patriotism, and too much corruption and irresponsibility in political and bureaucratic establishment are the major hindrance to the development of biotechnology in Bangladesh.

  9. medical students perception of problem topics in anatomy

    African Journals Online (AJOL)

    East African Medical Journal Vol. 79 No 8 August 2002. MEDICAL STUDENTS PERCEPTION 0F PROBLEM TOPICS IN ANATOMY. B. Kramer, PhD, School of Anatomical Sciences, University of the Witwatersrand. Johannesburg and IT. Soley, PhD, School of Anatomical Sciences, Faculty of Health Sciences, University of ...

  10. Medical audit on problem analysis and implementing changes at the ...

    African Journals Online (AJOL)

    Infection control and continuing medical education committees were formed where they did not exist. Conclusion/Recommendation: Hospital medical audit on problem analysis and implementation of changes in health units is highly effective in stimulating and empowering health care workers and hospital administrators to ...

  11. Medical Malpractice: No Agreement on the Problems or Solutions.

    Science.gov (United States)

    General Accounting Office, Washington, DC. Div. of Human Resources.

    This report was written to provide current information on the existence of medical malpractice problems and the need for federal involvement and alternatives for resolving malpractice claims. It presents the perceptions of respondents from 37 nationally based organizations representing medical, legal, insurance, and consumer interests who…

  12. Frequency, types and severity of medication use-related problems among medical outpatients in Nigeria.

    Science.gov (United States)

    Yusuff, Kazeem B; Tayo, Fola

    2011-06-01

    To determine the frequency, types and severity of medications use-related problems among medical outpatients in a tertiary care setting in southwestern Nigeria. Medical outpatient clinics of a 900-bed Teaching Hospital located in Ibadan, Southwestern Nigeria. A prospective cross-sectional medication use review was conducted by ten pharmacists for 400 randomly selected medical outpatients over a 4 week period at a 900-bed premier teaching hospital located in Ibadan, Nigeria. Severity assessment of medication use-related problems was done by 3 independent assessors with a modified severity index. Frequency, types and severity of medication use-related problems identified through pharmacist-initiated medication use review. Of the 400 randomly selected patients, 324 (81.0%) consented and were interviewed. One hundred and sixty-three (50.3%) of the cohort were males and 161 (49.7%) were females; with mean ages 51.5 ± 17.6 and 52.1 ± 17.4 years respectively. Median no. of drugs prescribed per patient per day was 4 (Minimum-Maximum, 1-7). About 27.5% were self medicating with orthodox (prescription-only and over-the-counter) and/or herbal medicines; and only 14.6% claimed disclosure to their physicians. The proportion of patients self medicating with orthodox medicines was significantly higher (P medication use-related problems were identified from 58.6% of patients, but the highest number (5) was identified among 2.6% of patients. The frequency of medication use-related problems appear strongly related to the number of medicines prescribed (r = 0.71, P = 0.006). The majority of medication use-related problems were ranked as potentially harmful [Inter-rater reliability coefficient: Gwet AC1: 0.7214 (P ≤ 0.001)]. Non-adherence (43.8%), problems associated with self medication (39.3%) and adverse drug reactions (15.6%) were the most frequent. Unauthorized drug holidays (46.5%) and stoppage of prescribed prescription-only medications for local herbs (29.3%) were the

  13. Social problem solving and coping skills of medical students

    Directory of Open Access Journals (Sweden)

    Emel Yigit

    2016-12-01

    Full Text Available Purpose: The aim of this study was to evaluate medical students' social problem solving and coping skills. Material and Methods: In this correlational descriptive study, data were gathered from 457 medical students. Social Problem Solving Inventory and Social Problem Coping Behaviours Inventory were used. Results: The most preferred activities when the students face a problem were talking with friends (87.1%, talking with special persons (85.4%, sleeping (82.6%, talking with family members (81.6%, and eating (79.8%. The ratio of the behaviors that can be deemed risky were exhibiting aggressive and violent behaviors (18.9%, drinking alcohol (18.7%, smoking (17.6%, playing games of chance (16.9%, and using substance (3.8%. There was a positive relationship between total scores of Social Problem Solving Inventory and Social Problem Coping Behaviours Inventory. It is found that immature social problem solving ability has increased the risk of unfavourable behaviours by 3.1 fold. Conclusion: Social problem solving ability is significantly correlated with coping behaviours and may predict it. Medical students who are the doctors and the role models of the future need to develop their social problem solving skills in addition to clinical problem solving skills. [Cukurova Med J 2016; 41(4.000: 721-731

  14. The Effects of Iliad on Medical Student Problem Solving

    OpenAIRE

    Turner, Charles W.; Williamson, John; Lincoln, Michael J.; Haug, Peter J.; Buchanan, James; Anderson, Curtis; Grant, Morgan; Cundick, Robert; Warner, Homer R.

    1990-01-01

    The present study examined the effects of the Iliad expert system on diagnostic problem solving of third-year (n = 97) medical students. Students used Iliad to work-up simulated cases to supplement the education they received in their medicine clerkship. The results of the research provided evidence that the Iliad expert system did improve student diagnostic problem solving and decision making.

  15. Medical social consequences of the safety problems of oncological radiology

    International Nuclear Information System (INIS)

    Pilipenko, M.Yi.; Stadnik, L.L.; Shal'opa, O.Yu.; Rigan, M.M.; Skalets'kij, Yu.M.

    2015-01-01

    Actuality of the problem of patient safety in oncoradiology in Ukraine is grounded. The results of international audit TLD (IAEA/WHO) quality during dosimetry procedures cobalt-telegamma vehicles in Ukraine are investigated, as well as legal and regulatory framework providing for the safety of radiotherapy care, scientific publications on patient safety. Methods: statistical, analytical, bibliographical, systematic approach. On the example of radiation therapy using the results of the international program of the IAEA/WHO TLD audit quality dosimetry calibration devices for remote gamma therapy in Ukraine from 1998 to 2014 the attempt to assess the extent of medical and social consequences of underestimating of medical errors in oncoradiology is made. The problems of regulatory nature of medical errors in oncoradiology are preliminary identified. The problem of medical errors in the treatment of cancer radiation methods in Ukraine is extremely important. Usually the problems of errors in oncoradiology are considered in organizational, technical, personnel and technical aspects, while medical and social consequences of problem are not covered. About 10 thousand of cancer patients in year may suffer from errors related only to dose calculation according to the optimistic variant, while the number of patients for the same period on the pessimistic case can reach 15 thousand. There are a number of legal character problems in oncoradiology related to patient safety that require clarification. The first priority for improving the safety of patients in oncoradiology is the recording and analysis of radiation therapy defects and their consequences

  16. Medical problems of porters and trekkers in the Nepal Himalaya.

    Science.gov (United States)

    Basnyat, B; Litch, J A

    1997-05-01

    The purpose of this study was to assess the incidence of medical illness among members of trekking groups in the Nepal Himalaya. The design was a cohort study using interview and clinical examination by a single physician. The setting was the Manaslu area in the central Nepal Himalaya along a 22-day trekking route with elevations ranging from 487 m to 5100 m. Subjects were 155 members of commercial trekking groups: 102 Nepali porters, 31 Nepali trek staff, and 22 Western trekkers. We found that medical problems occurred in 45% of party members. The porter cohort contained the highest diversity and severity of illness. The relatively larger porter cohort experienced 77% of the medical problems recorded compared with 17% among Western trekkers and 6% among trek staff. The incidence of medical problems was not significantly different in the porter staff (52%) and Western trekkers (55%) and was significantly lower for the trek staff (13%). High-altitude pharyngitis/bronchitis was the most common illness in the party (12%) followed by acute mountain sickness (8%) and gastroenteritis (6%). Other conditions included anxiety (3%), cellulitis (3%), scabies (3%), snow blindness (3%), acute alcohol intoxication (2%), conjunctivitis (2%), fever (2%), lacerations (2%), and hemorrhoids (1%). Illness with infectious etiologies comprised 33% of the medical problems. The incidence of altitude illness was not significantly less in the Nepali porter staff than in the Western trekkers. Evacuation was required in 5% of party members, all from the porter group. This study should alert expedition medical providers and trip leaders of the need to be observant for and prepared to treat the frequent and diverse medical problems among the porter staff in their party, in addition to the Western members. Medical problems are common in remote mountainous areas, indicating that trip physicians should be experienced in primary care.

  17. Quality of medical services: problems, evaluation and regulation

    Directory of Open Access Journals (Sweden)

    Farida Yerdavletova

    2015-10-01

    Full Text Available One of the most acute problems in the healthcare industry – the problem of the quality of medical services. In this area, there is no established definition of medical services or approaches to quality management. The aim of the article is to analyze the existing definitions of “quality of medical services,” as well as development approach to managing medical organization. At the same time the management of the medical organization should be focused on ensuring the quality as the most important criterion for the organization. Methodology of the study is based on analysis and grouping of existing definitions of medical services, the factorial approach to evaluating the quality and organization of the process approach to management of the medical organization. Noting the versatility and diversity concepts of quality of care the authors suggest grouping of direct and indirect factors affecting the quality of medical services. However, it is important, according to the authors, to move from functional management to management based on the process approach, which provides better control over the processes of customer service. Is given process model of quality management of health services and highlights the main groups of processes in the medical organization.

  18. Underlying substance abuse problems in drunk drivers.

    Science.gov (United States)

    Snenghi, Rossella; Forza, Giovanni; Favretto, Donata; Sartore, Daniela; Rodinis, Silvia; Terranova, Claudio; Nalesso, Alessandro; Montisci, Massimo; Ferrara, Santo Davide

    2015-01-01

    The aim of this study was to investigate polydrug use in drunk drivers. The experimental study was conducted on 2,072 drunk drivers undergoing a driving license reissue protocol at the Department of Legal Medicine of Padova University Hospital in the period between January 2011 and December 2012. The study protocol involved anamnesis, clinical examination, toxicological history, and toxicological analyses on multiple biological samples. One thousand eight hundred seventy-seven subjects (90.6%) were assessed as fit to drive, and 195 (9.5%) were declared unfit. Among those unfit, 32 subjects (1.6%) were declared unfit due to recent use of an illicit drug (time span drive after completeness of the protocol was established in 1.2% of cases for alcohol disorders and in 5.7% of cases for illicit drug abuse; only one subject was included in both subgroups. Cocaine was the most widely used substance, followed by cannabis, opiates, and psychotropic pharmaceutical drugs. The application of the protocol presented in this study allowed the identification of underlying polydrug use in drunk drivers. The study led to the identification of 6.8% unfit subjects on the basis of alcohol disorders and/or drug abuse, compared to 1.2% of identifiable unfitness if the protocol were limited to the mere assessment of alcohol consumption. The frequent association of alcohol and cocaine is different from other patterns of use in North Europe countries.

  19. Counselling problem drinkers in medical wards: a controlled study.

    OpenAIRE

    Chick, J; Lloyd, G; Crombie, E

    1985-01-01

    Seven hundred and thirty one men admitted to medical wards were interviewed to identify problem drinkers who had not received previous treatment for alcoholism and who had some social support. One hundred and sixty one met the diagnostic criteria; 156 agreed to a follow up interview and were allocated to one of two groups. One group received a session of counselling about their drinking habits from a nurse while the other received only routine medical care. Both groups reported a reduction in...

  20. From cases to projects in problem-based medical education

    Directory of Open Access Journals (Sweden)

    Diana Stentoft

    2014-06-01

    Full Text Available Problem-based learning (PBL based on patient cases has become a well-established worldwide educational approach in medical education. Recent studies indicate that case-based PBL when used throughout an entire curriculum may develop into a counter-productive routine for students as well as teachers. Consequently, there is a need to develop PBL approaches further allowing students to work with more ill-defined problems and alternative learning structures. In this paper, we argue that this can be realised by introducing project-PBL into the medical curriculum, as in the medical education at Aalborg University, Denmark. We outline organisations of case- and project- PBL in the medical curriculum and present an explorative study of 116 first and second year students’ experiences working in the two settings of PBL. Results reveal that students generally rate their PBL experiences positively however, project-PBL is rated more positively than case-PBL on all parameters studied. These results invite further consideration of the differences in working with cases and projects. Two central differences are discussed; the nature of the problem as the trigger of learning and students' possibilities for directing their own learning processes. The study demonstrates that introducing project-PBL may contribute significantly in problem-based medical education. However, the need for extensive research into advantages and limitations of the combined use of case- and project-PBL is also emphasised.

  1. Incorporating problem based learning into medical curriculum: An experience from a medical college in Mangalore.

    Science.gov (United States)

    Kumar, Nithin; Kanchan, Tanuj; Unnikrishnan, Bhaskaran; Thapar, Rekha; Mithra, Prasanna; Kulkarni, Vaman; Holla, Ramesh; Bhagwan, Darshan; Radhakrishnan, Yeshwanter

    2017-01-01

    The Medical Council of India (MCI) has envisioned a change in the undergraduate medical curriculum by encouraging integrated teaching and Problem Based Learning (PBL). In this cross-sectional study 110 medical teachers of Kasturba Medical College, Mangalore were assessed regarding their perception on PBL. Independent t -test was applied to find out the difference in the mean perception scores regarding PBL among the teachers in pre/para-clinical and clinical departments and P learning, and apply the learnt concepts of basic specialties to clinical problem solving.

  2. Fragile X syndrome: a review of associated medical problems.

    Science.gov (United States)

    Kidd, Sharon A; Lachiewicz, Ave; Barbouth, Deborah; Blitz, Robin K; Delahunty, Carol; McBrien, Dianne; Visootsak, Jeannie; Berry-Kravis, Elizabeth

    2014-11-01

    Fragile X syndrome (FXS) is the most common known genetic cause of inherited intellectual disability and the most common known single-gene cause of autism spectrum disorder. It has been reported that a spectrum of medical problems are commonly experienced by people with FXS, such as otitis media, seizures, and gastrointestinal problems. Previous studies examining the prevalence of medical problems related to FXS have been challenging to interpret because of their marked differences in population, setting, and sampling. Through this comprehensive review, we update the literature by reviewing studies that have reported on prominent medical problems associated with FXS. We then compare prevalence results from those studies with results from a large cross-sectional database consisting of data collected by fragile X clinics that specialize in the care of children with FXS and are part of the Fragile X Clinical and Research Consortium. It is vital for pediatricians and other clinicians to be familiar with the medical problems related to FXS so that affected patients may receive proper diagnosis and treatment; improved care may lead to better quality of life for these patients and their families. Copyright © 2014 by the American Academy of Pediatrics.

  3. Bounds in the generalized Weber problem under locational uncertainty

    DEFF Research Database (Denmark)

    Juel, Henrik

    1981-01-01

    An existing analysis of the bounds on the Weber problem solution under uncertainty is incorrect. For the generalized problem with arbitrary measures of distance, we give easily computable ranges on the bounds and state the conditions under which the exact values of the bounds can be found...... with little computational effort. Numerical examples illustrate the analysis....

  4. Medical Libraries and Problem Based Learning: New Challenges and Opportunities

    Directory of Open Access Journals (Sweden)

    Kuan-nien Chen

    2004-06-01

    Full Text Available This article explores the changing role of the medical library and librarians in the context of problem-based learning in terms of fives aspects - impacts on medical libraries, library instruction, technology, the collection, and the new role of the librarians. For the libraries, the role change process is ongoing rather than a single event. The medical school and the library must collaborate and interact in the areas of curriculum design, communications, and library user education. In addition, administrative supports such as budgets, staffing, and the building space of the library are always in demand. [Article content in Chinese

  5. [Methods for teaching problem-solving in medical schools].

    Science.gov (United States)

    Shumway, J M; Vargas, M E; Heller, L E

    1984-01-01

    The need to include in the medical curriculum instructional activities to promote the development of problem-solving abilities has been asserted at the national and international levels. In research on the mental process involved in the solution of problems in medicine, problem-solving has been defined as a hypothetical-deductive activity engaged in by experienced physicians, in which the early generation of hypotheses influences the subsequent gathering of information. This article comments briefly on research on the mental process by which medical problems are solved. It describes the methods that research has shown to be most applicable in instruction to develop problem-solving abilities, and presents some educational principles that justify their application. The "trail-following" approach is the method that has been most commonly used to study the physician's problem-solving behavior. The salient conclusions from this research are that in the problem-solving process the diagnostic hypothesis is generated very early on and with limited data; the number of hypotheses is small; the problem-solving approach is specific to the type of medical problem and case in hand; and the accumulation of medical knowledge and experience forms the basis of clinical competence. Four methods for teaching the solution of problems are described: case presentation, the rain of ideas, the nominal groups technique and decision-making consensus, the census and analysis of forces in the field, and the analysis of clinical decisions. These methods are carried out in small groups. The advantages of the small groups are that the students are active participants in the learning process, they receive formative evaluation of their performance in a setting conductive to learning, and are able to interact with their instructor if he makes proper use of the right questioning techniques. While no single problem-solving method can be useful to all students or in all the problems they encounter

  6. Medical-isotope supply hit by production problems

    Science.gov (United States)

    Gould, Paula

    2008-10-01

    A shortfall in the production of medical isotopes in Europe has forced hospitals to delay patient scans or offer alternative diagnostic tests. The problems began in August when all three nuclear reactors used to generate molybdenum-99, which then decays to form the key nuclear-imaging agent technetium-99, had to be unexpectedly shut down at the same time.

  7. Building successful therapeutics into a problem-based medical ...

    African Journals Online (AJOL)

    Building successful therapeutics into a problem-based medical curriculum in Africa. ... Students evaluated the course, rating how they felt key competences changed. Test results averaged 47 per cent. True/false questions ... The student evaluation showed an improvement for all prescribing abilities. South African Journal of ...

  8. Evaluation of problem-based learning in medical students’ education

    Science.gov (United States)

    IMANIEH, MOHAMMAD HADI; DEHGHANI, SEYED MOHSEN; SOBHANI, AHMAD REZA; HAGHIGHAT, MAHMOOD

    2014-01-01

    Introduction: In traditional medical education systems much interest is placed on the cramming of basic and clinical facts without considering their applicability in the future professional career. The aim of this study is to evaluate a novice medical training method (problem-based learning) as compared to the contemporary teacher-based medical education or traditional methods. Methods: Selection of the study subjects was done through simple sampling and according to the division of medical students introduced from Medical Faculty to the Pediatrics Department with no personal involvement. 120 medical students were assigned to 8 groups of 15 students each. For four months, 4 groups were trained with traditional method and 4 other groups underwent problem-based learning method on selected subject materials. In each method, a pre-course test at the beginning and a post-course test at the end of each course were given to each group. The questionnaire used in this study as the instrument was composed of 39 questions, 37 multiple choice questions and two short answer questions. Three professors of pediatric gastroenterologist took part in the training. Two of these professors were responsible for solving task training method. The third professor used traditional teacher-centered methodology to eliminate any possible bias. Scores obtained from these tests were analyzed using paired t-test and independent t-test. P-values of less than 0.05 were considered as significant. Results: The scores of the students undergoing the traditional method were 14.70±3.03 and 21.20±4.07 in the first and second test, respectively. In problem-based learning, the scores were 15.82±3.29 in the first and 27.52±4.72 in the second test. There was a significant difference between the mean scores of post-course exams of the two groups (p=0.001), while no significant difference was observed between the mean scores of pre-course exams of the groups (p=0.550). Conclusion: It may be concluded that

  9. Evaluation of problem-based learning in medical students' education.

    Science.gov (United States)

    Imanieh, Mohammad Hadi; Dehghani, Seyed Mohsen; Sobhani, Ahmad Reza; Haghighat, Mahmood

    2014-01-01

    In traditional medical education systems much interest is placed on the cramming of basic and clinical facts without considering their applicability in the future professional career. The aim of this study is to evaluate a novice medical training method (problem-based learning) as compared to the contemporary teacher-based medical education or traditional methods. Selection of the study subjects was done through simple sampling and according to the division of medical students introduced from Medical Faculty to the Pediatrics Department with no personal involvement. 120 medical students were assigned to 8 groups of 15 students each. For four months, 4 groups were trained with traditional method and 4 other groups underwent problem-based learning method on selected subject materials. In each method, a pre-course test at the beginning and a post-course test at the end of each course were given to each group. The questionnaire used in this study as the instrument was composed of 39 questions, 37 multiple choice questions and two short answer questions. Three professors of pediatric gastroenterologist took part in the training. Two of these professors were responsible for solving task training method. The third professor used traditional teacher-centered methodology to eliminate any possible bias. Scores obtained from these tests were analyzed using paired t-test and independent t-test. P-values of less than 0.05 were considered as significant. The scores of the students undergoing the traditional method were 14.70±3.03 and 21.20±4.07 in the first and second test, respectively. In problem-based learning, the scores were 15.82±3.29 in the first and 27.52±4.72 in the second test. There was a significant difference between the mean scores of post-course exams of the two groups (p=0.001), while no significant difference was observed between the mean scores of pre-course exams of the groups (p=0.550). It may be concluded that problem-based learning method leads to a

  10. Medical Problems in High Mountain Environments. A Handbook for Medical Officers

    Science.gov (United States)

    1994-02-01

    valvular heart disease , unrevascularized coronary artery disease , pulmonary hypertension, anemia and medications that depress respiration. Any blood...induced medical problems: acute moun- tain sickness (AMS), high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE). Secondary...affecting the performance of soldiers at altitude. DT.N QUALMIBER OF dS 14. SUBJECT TERMS Altitude, Acute Mountain Sickness, Pulmonary Edema, 49

  11. Evaluation of problem-based learning in medical students’ education

    Directory of Open Access Journals (Sweden)

    MOHAMMAD HADI IMANIEH

    2014-01-01

    Full Text Available Introduction: In traditional medical education systems much interest is placed on the cramming of basic and clinical facts without considering their applicability in the future professional career. The aim of this study is to evaluate a novice medical training method (problem-based learning as compared to the contemporary teacher-based medical education or traditional methods. Methods: Selection of the study subjects was done through simple sampling and according to the division of medical students introduced from Medical Faculty to the Pediatrics Department with no personal involvement. 120 medical students were assigned to 8 groups of 15 students each. For four months, 4 groups were trained with traditional method and 4 other groups underwent problem-based learning method on selected subject materials. In each method, a pre-course test at the beginning and a post-course test at the end of each course were given to each group. The questionnaire used in this study as the instrument was composed of 39 questions, 37 multiple choice questions and two short answer questions. Three professors of pediatric gastroenterologist took part in the training. Two of these professors were responsible for solving task training method. The third professor used traditional teacher-centered methodology to eliminate any possible bias. Scores obtained from these tests were analyzed using paired t-test and independent t-test. P values of less than 0.05 were considered as significant. Results: The scores of the students undergoing the traditional method were 14.70±3.03 and 21.20±4.07 in the first and second test, respectively. In problembased learning, the scores were 15.82±3.29 in the first and 27.52±4.72 in the second test. There was a significant difference between the mean scores of post-course exams of the two groups (p=0.001, while no significant difference was observed between the mean scores of pre-course exams of the groups (p=0.550. Conclusion: It may be

  12. Self-affirmation improves problem-solving under stress.

    Science.gov (United States)

    Creswell, J David; Dutcher, Janine M; Klein, William M P; Harris, Peter R; Levine, John M

    2013-01-01

    High levels of acute and chronic stress are known to impair problem-solving and creativity on a broad range of tasks. Despite this evidence, we know little about protective factors for mitigating the deleterious effects of stress on problem-solving. Building on previous research showing that self-affirmation can buffer stress, we tested whether an experimental manipulation of self-affirmation improves problem-solving performance in chronically stressed participants. Eighty undergraduates indicated their perceived chronic stress over the previous month and were randomly assigned to either a self-affirmation or control condition. They then completed 30 difficult remote associate problem-solving items under time pressure in front of an evaluator. Results showed that self-affirmation improved problem-solving performance in underperforming chronically stressed individuals. This research suggests a novel means for boosting problem-solving under stress and may have important implications for understanding how self-affirmation boosts academic achievement in school settings.

  13. Proper use of medical language: Main problems and solutions.

    Science.gov (United States)

    Aleixandre-Benavent, R; Valderrama Zurián, J C; Bueno-Cañigral, F J

    2015-10-01

    Medical language should be characterized by its precision, emotional neutrality and stability. The effective communication of results of scientific studies depends on compliance with current standards of drafting and style; texts with defects can hinder interest in the findings. In this study, we discuss some of the most common problems and errors in medical language, including the abuse of abbreviations and foreign words, the use of improper words, syntax errors and solecisms, the most common errors in titles and the abuse of capital letters and the gerund. Investigators have effective tools for dealing with these problems, such as quality texts, critical dictionaries of questions and difficulties with the Spanish language and various drafting and style manuals. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  14. [Allocation problems in organ transplantation: practical medical experience].

    Science.gov (United States)

    Benckert, Christoph; Quante, Markus; Jonas, Sven

    2010-01-01

    Solid organ transplantation is one the most successful medical innovations of the 20th century. Due to an increasing number of patients on the waiting lists for transplantation in the context of persisting organ shortage the aim of optimal allocation policy is the best possible balance between medical urgency and postoperative outcome. Because of scientific evolution and increasing waiting list mortality the allocation system for liver transplantation was altered in December 2006. As intended, the preferential treatment of sicker patients resulted in a reduced waiting list mortality. On the other hand, an unintentional decrease in postoperative survival was observed. This obvious imbalance between medical urgency and postoperative outcome has led to the current allocation problem. Several scientific approaches for optimising allocation policy will be presented and discussed in this paper. Finally, continuous review and adaptation will be a persisting challenge for people working in the field of solid organ transplantation. Copyright © 2010. Published by Elsevier GmbH.

  15. Medical Physics: Forming and testing solutions to clinical problems.

    Science.gov (United States)

    Tsapaki, Virginia; Bayford, Richard

    2015-11-01

    According to the European Federation of Organizations for Medical Physics (EFOMP) policy statement No. 13, "The rapid advance in the use of highly sophisticated equipment and procedures in the medical field increasingly depends on information and communication technology. In spite of the fact that the safety and quality of such technology is vigorously tested before it is placed on the market, it often turns out that the safety and quality is not sufficient when used under hospital working conditions. To improve safety and quality for patient and users, additional safeguards and related monitoring, as well as measures to enhance quality, are required. Furthermore a large number of accidents and incidents happen every year in hospitals and as a consequence a number of patients die or are injured. Medical Physicists are well positioned to contribute towards preventing these kinds of events". The newest developments related to this increasingly important medical speciality were presented during the 8th European Conference of Medical Physics 2014 which was held in Athens, 11-13 September 2014 and hosted by the Hellenic Association of Medical Physicists (HAMP) in collaboration with the EFOMP and are summarized in this issue. Copyright © 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  16. The cost of problem-based vs traditional medical education.

    Science.gov (United States)

    Mennin, S P; Martinez-Burrola, N

    1986-05-01

    It is generally accepted that teachers' salaries are a major factor in the cost of medical education. Little is known about the effects of curriculum on teaching time. A comparison of teaching time devoted to each of two different medical education curricula is presented. In a traditional teacher-centered, subject-oriented curriculum, 61% of the total teaching effort expended by twenty-two teachers took place in the absence of students, i.e. in preparation for student contact. Only 39% of the effort devoted by these teachers to medical education took place in the presence of students. In a problem-based, student-centered curriculum which focuses upon small-group tutorial learning and early extended primary care experience in a rural community setting, 72% of the total teaching effort devoted to medical education was spent with students and only 28% was spent in preparation for student contact. Overall, there were no differences in the total amount of teaching time required by each of the two curricular approaches to medical education. There were, however, major differences in how teachers spent their teaching time.

  17. Communication with patients as a problem in undergraduate medical education.

    Science.gov (United States)

    Mares, J; Tvorogova, N D; Chrobák, L

    1992-01-01

    The work is based on the following concepts: communication with patients ceases being a matter of experience learning only (the trial and error method) and should become a part of systematic training; it should not be included only into continuous education of graduated physicians but must be gradually introduced into undergraduate education as well; it is not an optional activity which may but may not be performed by physicians, but it is a specific component of their clinical competence. Today attempts to instruct medical students in communication with patients and their relatives are being made at many medical schools all over the world. Reports on such instruction are, however, scattered in various journals or in internal publications published by universities, faculties and clinics. Thus they are not available very easily. If there exist some survey works, they are mostly conceived on the national level. The objective of the study presented here is to show a comparatively comprehensive survey dealing with the medical student instruction on the international level, analyze trends in development and identify problems that have not been solved so far. The work consists of five chapters. The first one gives a short survey of current concepts in communication with patients reaching beyond the traditional training in taking medical history. Among others, the following factors are included here: explanation of both diagnostical and therapeutical methods to the patient, informing the patient about results obtained from the examination, telling him or her general conclusions and recommendations, informing patients of social associations of the disease, developing in the patients those attitudes which support their cooperation with physicians and the patient's will to live, ability to treat serious and terminal patients properly, ability to treat patients' relatives and communicate with other members of a medical team. The second chapter shows current attempts to train

  18. Benefits and problems in implementation for integrated medical information system

    International Nuclear Information System (INIS)

    Park, Chang Seo; Kim, Kee Deog; Park, Hyok; Jeong, Ho Gul

    2005-01-01

    Once the decision has been made to adopt an integrated medical information system (IMIS), there are a number of tissues to overcome. Users need to be aware of the impact the change will make on end users and be prepared to address issues that arise before they become problems. The purpose of this study is to investigate the benefits and unexpected problems encountered in the implementation of IMIS and to determine a useful framework for IMIS. The Yonsei University Dental Hospital is steadily constructing an IMIS. The vendor's PACS software, Piview STAR, supports transactions between workstations that are approved to integrating the health care enterprise (IHE) with security function. It is necessary to develop an excellent framework that is good for the patient, health care provider and information system vendors, in an expert, efficient, and cost-effective manner. The problems encountered with IMIS implementation were high initial investments, delay of EMR enforcement, underdevelopment of digital radiographic appliances and software and insufficient educational training for users. The clinical environments of dental IMIS is some different from the medical situation. The best way to overcome these differences is to establish a gold standard of dental IMIS integration, which estimates the cost payback. The IHE and its technical framework are good for the patient, the health care provider and all information systems vendors.

  19. Medical support of children’s sports: Topical problems

    Directory of Open Access Journals (Sweden)

    L. A. Balykova

    2017-01-01

    Full Text Available The paper discusses the most topical issues of medical support of children and adolescents engaged in physical exercises and sports. Much attention is paid to different views on the etiology, pathogenesis, diagnosis, and principles of therapy of pathological transformation of the heart in child athletes. The problem of sudden cardiac death in sports and the possibility of a relationship between connective tissue dysplasia and its development are touched upon. Electrocardiographic and morphological criteria for cardiac maladaptation in athletes are discussed. The problem of early and accessible diagnosis and Russia’s tactics for the diagnosis of health changes in athletes and approaches to their prevention and treatment are covered. Different ways to prevent the pathological transformation of the cardiovascular system in athletes and sudden cardiac death as its extreme manifestation are discussed.

  20. Self-affirmation improves problem-solving under stress.

    Directory of Open Access Journals (Sweden)

    J David Creswell

    Full Text Available High levels of acute and chronic stress are known to impair problem-solving and creativity on a broad range of tasks. Despite this evidence, we know little about protective factors for mitigating the deleterious effects of stress on problem-solving. Building on previous research showing that self-affirmation can buffer stress, we tested whether an experimental manipulation of self-affirmation improves problem-solving performance in chronically stressed participants. Eighty undergraduates indicated their perceived chronic stress over the previous month and were randomly assigned to either a self-affirmation or control condition. They then completed 30 difficult remote associate problem-solving items under time pressure in front of an evaluator. Results showed that self-affirmation improved problem-solving performance in underperforming chronically stressed individuals. This research suggests a novel means for boosting problem-solving under stress and may have important implications for understanding how self-affirmation boosts academic achievement in school settings.

  1. Electrolyte imbalance and sleep problems during anti-retroviral therapy: an under-recognized problem

    Directory of Open Access Journals (Sweden)

    Md Dilshad Manzar

    Full Text Available Human immunodeficiency virus (HIV infection, and the anti-retroviral therapy (ART associated complications necessitate that the medical care system keeps evolving for proper management of this group of patients. Electrolyte imbalance and sleep problems are common in patients on ART. Both of these conditions are associated with increased morbidity (such as acute kidney injury, chronic kidney disease, low CD4 count, non-adherence and depression and mortality. Therefore, screening for both sleep problems and electrolytes imbalance may help to decrease the risk of complications in patients on ART.

  2. Electrolyte imbalance and sleep problems during anti-retroviral therapy: an under-recognized problem.

    Science.gov (United States)

    Manzar, Md Dilshad; Sony, Peter; Salahuddin, Mohammed; Kumalo, Abera; Geneto, Mathewos; Pandi-Perumal, Seithikurippu R; Moscovitch, Adam; BaHammam, Ahmed S

    2017-01-01

    Human immunodeficiency virus (HIV) infection, and the anti-retroviral therapy (ART) associated complications necessitate that the medical care system keeps evolving for proper management of this group of patients. Electrolyte imbalance and sleep problems are common in patients on ART. Both of these conditions are associated with increased morbidity (such as acute kidney injury, chronic kidney disease, low CD4 count, non-adherence and depression) and mortality. Therefore, screening for both sleep problems and electrolytes imbalance may help to decrease the risk of complications in patients on ART.

  3. Sleep Problems Under-Reported by Parents in Iranian Children.

    Science.gov (United States)

    Afsharpaiman, Shahla; Bagheri Hagh, Ali; Kolbadi Nejad, Mohammad; Amirsalari, Susan; Torkaman, Mohammad

    2015-01-01

    Sleep problems are common in childhood, but there are limited studies regarding that in Iranian children and awareness of the sleep problems and their complication in Iranian parents. We arranged this study in which parents of children attending for a sick visit or routine growth control to assess whether sleep problems are under-reported at general pediatric visits. In a cross-sectional study from April 2010 to April 2011 in 301 children aged 2-14 years old attending to pediatric clinics were enrolled. To investigate the general orientation of parents about their child sleep problem we asked them a global question at first regarding sleep of their child. After that, the Persian version of BEARS questionnaire was completed by them. Only 30 (9.9%) parents reported sleep problems in their children in response to primary global question but by collecting the data from BEARS questionnaire it was revealed 45.18% (136/301) of children had one or more of sleep disorders at all. As mentioned 136 (45.18%) children had slept problems of which the most frequent complaint (15.28%) was related to bedtime problems. The second complaint (11.96%) was awakening during the night children. A significant association between sleep problems and child gender was not found. Co-sleeping with parents was found in 55.48% of all children in this study. Despite the high prevalence and adverse effects of sleep disorders, the present study suggests that parents underreport sleep problems at consultation. We suggest children should be assessed for sleep disorders in monitoring and health screening visits.

  4. Psychosomatic problems among medical students: a myth or reality?

    Science.gov (United States)

    Chinawa, J M; Nwokocha, Ada R C; Manyike, Pius C; Chinawa, Awoere Tamunosiki; Aniwada, Elias C; Ndukuba, Appolos Chidi

    2016-01-01

    Medical students are exposed to stress and this can predispose them to psychological and behavioral consequences. Psychosomatic disorders were investigated among 385 medical students from two teaching hospitals using a stratified random sampling. The Enugu somatization Scale (ESS) was used to evaluate for presence of somatization in the participants. Statistical analysis was done with the Statistical Package for Social Sciences (SPPS) version 19 (Chicago IL). A total of 385 medical students with a calculated mean age of 23.55 ± 3.33 years were recruited in this study. The prevalence of psychosomatic disorder was 55 (14.3%) with prevalence among males 33 (14.2%) and among females 22 (14.4%). Based on features, 44 (11.4%) had head features while 30 (7.8%) had body features of psychosomatic disorder respectively. Similar proportion of both males and females (about 14% each) had psychosomatic disorder. There was no statistically significant difference ([Formula: see text] = 0.002, p = 0.966). Students aged 24 years and below had similar proportion of psychosomatic disorder 38 (14.3%) with those aged over 24 years 17 (14.2%). The difference was not statistically significant ([Formula: see text] = 0.002, p = 0.964). Students from lower social class had lower proportion of psychosomatic disorder (10.6%) when compared to middle (17.2%) and upper (15.2%). The difference was equally not statistically significant ([Formula: see text] = 1.759, p = 0.415). Male students had similar likelihood of psychosomatic disorder with females (OR 1.01, 95% CI 0.56-1.82). Those had belong to middle socio-economic class were about 1.2 times (AOR 1.15, 95% CI 0.54-2.45) and lower socio-economic class about 0.6 times (AOR 0.66, 95% CI 0.31-1.37) likely to have psychosomatic disorder than those from upper socio-economic class. Psychosomatic disorders constitute an emerging mental health problem among medical students in Nigerian Universities. This can pose a major mental

  5. Problem-based learning in medical school: A student's perspective

    Directory of Open Access Journals (Sweden)

    Bliss J. Chang

    2016-12-01

    Full Text Available Problem-based learning (PBL has been a concept in existence for decades yet its implementation in medical student education is limited. Considering the nature of a physician's work, PBL is a logical step towards developing students' abilities to synthesize and integrate foundational concepts into clinical medicine. Harvard's recently redesigned Pathways curriculum has shifted almost exclusively towards PBL in its one-year preclinical curriculum. This piece provides my thoughts, both derived from my own reflections as well as conversations and observations of my peers, on the effectiveness, advantages, and disadvantages of a PBL curriculum. All in all, the feelings of my peers and I regarding PBL has been overwhelmingly positive despite potential areas of improvement and continued fine-tuning.

  6. Distributionally Robust Joint Chance Constrained Problem under Moment Uncertainty

    Directory of Open Access Journals (Sweden)

    Ke-wei Ding

    2014-01-01

    Full Text Available We discuss and develop the convex approximation for robust joint chance constraints under uncertainty of first- and second-order moments. Robust chance constraints are approximated by Worst-Case CVaR constraints which can be reformulated by a semidefinite programming. Then the chance constrained problem can be presented as semidefinite programming. We also find that the approximation for robust joint chance constraints has an equivalent individual quadratic approximation form.

  7. Decision making under ambiguity but not under risk is related to problem gambling severity

    NARCIS (Netherlands)

    Brevers, Damien; Cleeremans, Axel; Goudriaan, Anna E.; Bechara, Antoine; Kornreich, Charles; Verbanck, Paul; Noël, Xavier

    2012-01-01

    The aim of the present study was to examine the relationship between problem gambling severity and decision-making situations that vary in two degrees of uncertainty (probability of outcome is known: decision-making under risk; probability of outcome is unknown: decision-making under ambiguity). For

  8. Parent induced self-medication among under five children: an observational cross sectional study

    Directory of Open Access Journals (Sweden)

    Saima Nazir

    2015-04-01

    CONCLUSION: This study identifies the problem of self-medication in the under-five children and highlights the need for urgent educational measures for general public and drug dispensers in particular, to improve their knowledge and practices related to self-treatment of minor ailments. [TAF Prev Med Bull 2015; 14(2.000: 81-86

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

    Science.gov (United States)

    Custers, Eugène J F M

    2013-08-01

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

  10. Stochastic reduced order models for inverse problems under uncertainty.

    Science.gov (United States)

    Warner, James E; Aquino, Wilkins; Grigoriu, Mircea D

    2015-03-01

    This work presents a novel methodology for solving inverse problems under uncertainty using stochastic reduced order models (SROMs). Given statistical information about an observed state variable in a system, unknown parameters are estimated probabilistically through the solution of a model-constrained, stochastic optimization problem. The point of departure and crux of the proposed framework is the representation of a random quantity using a SROM - a low dimensional, discrete approximation to a continuous random element that permits e cient and non-intrusive stochastic computations. Characterizing the uncertainties with SROMs transforms the stochastic optimization problem into a deterministic one. The non-intrusive nature of SROMs facilitates e cient gradient computations for random vector unknowns and relies entirely on calls to existing deterministic solvers. Furthermore, the method is naturally extended to handle multiple sources of uncertainty in cases where state variable data, system parameters, and boundary conditions are all considered random. The new and widely-applicable SROM framework is formulated for a general stochastic optimization problem in terms of an abstract objective function and constraining model. For demonstration purposes, however, we study its performance in the specific case of inverse identification of random material parameters in elastodynamics. We demonstrate the ability to efficiently recover random shear moduli given material displacement statistics as input data. We also show that the approach remains effective for the case where the loading in the problem is random as well.

  11. Medical identity theft: an emerging problem for informatics.

    Science.gov (United States)

    Gillette, William; Patrick, Timothy B

    2007-10-11

    This poster reports a preliminary review of medical identity theft. Financial identity theft has received a great deal of media attention. Medical identity theft is a particular kind of identity theft that has received little attention. There are two main subtypes of medical identity theft. In the first type the stolen medical identity is used to receive medical services, and in the second type the stolen medical identity is used to commit healthcare fraud.

  12. Common statistical and research design problems in manuscripts submitted to high-impact medical journals

    Directory of Open Access Journals (Sweden)

    Harris Alex HS

    2011-08-01

    Full Text Available Abstract Background To assist educators and researchers in improving the quality of medical research, we surveyed the editors and statistical reviewers of high-impact medical journals to ascertain the most frequent and critical statistical errors in submitted manuscripts. Findings The Editors-in-Chief and statistical reviewers of the 38 medical journals with the highest impact factor in the 2007 Science Journal Citation Report and the 2007 Social Science Journal Citation Report were invited to complete an online survey about the statistical and design problems they most frequently found in manuscripts. Content analysis of the responses identified major issues. Editors and statistical reviewers (n = 25 from 20 journals responded. Respondents described problems that we classified into two, broad themes: A. statistical and sampling issues and B. inadequate reporting clarity or completeness. Problems included in the first theme were (1 inappropriate or incomplete analysis, including violations of model assumptions and analysis errors, (2 uninformed use of propensity scores, (3 failing to account for clustering in data analysis, (4 improperly addressing missing data, and (5 power/sample size concerns. Issues subsumed under the second theme were (1 Inadequate description of the methods and analysis and (2 Misstatement of results, including undue emphasis on p-values and incorrect inferences and interpretations. Conclusions The scientific quality of submitted manuscripts would increase if researchers addressed these common design, analytical, and reporting issues. Improving the application and presentation of quantitative methods in scholarly manuscripts is essential to advancing medical research.

  13. Flow-shop scheduling problem under uncertainties: Review and trends

    Directory of Open Access Journals (Sweden)

    Eliana María González-Neira

    2017-03-01

    Full Text Available Among the different tasks in production logistics, job scheduling is one of the most important at the operational decision-making level to enable organizations to achieve competiveness. Scheduling consists in the allocation of limited resources to activities over time in order to achieve one or more optimization objectives. Flow-shop (FS scheduling problems encompass the sequencing processes in environments in which the activities or operations are performed in a serial flow. This type of configuration includes assembly lines and the chemical, electronic, food, and metallurgical industries, among others. Scheduling has been mostly investigated for the deterministic cases, in which all parameters are known in advance and do not vary over time. Nevertheless, in real-world situations, events are frequently subject to uncertainties that can affect the decision-making process. Thus, it is important to study scheduling and sequencing activities under uncertainties since they can cause infeasibilities and disturbances. The purpose of this paper is to provide a general overview of the FS scheduling problem under uncertainties and its role in production logistics and to draw up opportunities for further research. To this end, 100 papers about FS and flexible flow-shop scheduling problems published from 2001 to October 2016 were analyzed and classified. Trends in the reviewed literature are presented and finally some research opportunities in the field are proposed.

  14. Problems in the Study of the Concepts of Underlying Categories

    Directory of Open Access Journals (Sweden)

    Guzel R. Faizova

    2017-10-01

    Full Text Available This paper considers the concepts of underlying categories. The economic good is one of such categories. In this regard, we considered such characteristics of an economic good as utility, value, and cost. The public goods, which are the goods that can benefit society and have two distinctive features, are an important category as well. In this regard, we characterized the characteristics and features of public goods and identified the main problems in this category. At present, the actual problem faced by the state is the production and evaluation of the effectiveness of public goods. The difficulty is that it is impossible to accurately determine the production volume of goods necessary for the society. Assessment of the effectiveness of the state activities requires the development of special tools. The existing legislatively defined methods have a number of shortcomings and do not allow obtaining an objective picture. Financing of most public goods occurs at the expense of the state, so it is very important to ensure and increase the efficiency of their spending at the moment. Public-private partnership is the most promising tool for better satisfying the needs of the population. The main goal of this work is to identify and discuss the main characteristics of the concepts of underlying categories and explain possible problems, issues faced by the state and the society.

  15. The problem of medical dispatchers’ responsibility functioning in the emergency medical services system

    Directory of Open Access Journals (Sweden)

    Czesław Chowaniec

    2014-08-01

    Full Text Available Aim of the study : Deaths due to inappropriate functioning of the emergency medical services system, as recently described by Polish mass media, has drawn the attention of society to the activities of medical dispatchers. Legal regulations impose obligations on those persons associated with receiving phone calls and dispensing appropriate emergency medical teams. In this paper an analysis of chosen medicolegal opinions from the practice of the Department of Forensic Medicine and Forensic Toxicology, Medical University of Silesia in Katowice, towards malpractices committed by dispatchers of EMS, was performed. Material and methods: The authors analysed 12 of medicolegal opinions, issued from 2007 to 2012 by a team of experts. Results : The errors noted in the work of dispatchers consisted of delays in giving appropriate assistance due to the inability to properly converse, a propensity to downplay patients’ symptoms, and dispatchers crossing their own competences. Conclusions : The problem may be resolved by the subsidy of EMS, fine-tuning the algorithms for conduct, and proper education of both staff and public.

  16. Lectures on Inhumanity: Teaching Medical Ethics in German Medical Schools Under Nazism.

    Science.gov (United States)

    Bruns, Florian; Chelouche, Tessa

    2017-04-18

    Nazi medicine and its atrocities have been explored in depth over the past few decades, but scholars have started to examine medical ethics under Nazism only in recent years. Given the medical crimes and immoral conduct of physicians during the Third Reich, it is often assumed that Nazi medical authorities spurned ethics. However, in 1939, Germany introduced mandatory lectures on ethics as part of the medical curriculum. Course catalogs and archival sources show that lectures on ethics were an integral part of the medical curriculum in Germany between 1939 and 1945. Nazi officials established lecturer positions for the new subject area, named Medical Law and Professional Studies, at every medical school. The appointed lecturers were mostly early members of the Nazi Party and imparted Nazi political and moral values in their teaching. These values included the unequal worth of human beings, the moral imperative of preserving a pure Aryan people, the authoritarian role of the physician, the individual's obligation to stay healthy, and the priority of public health over individual-patient care. This article shows that there existed not only a Nazi version of medical ethics but also a systematic teaching of such ethics to students in Nazi Germany. The findings illustrate that, from a historical point of view, the notion of "eternal values" that are inherent to the medical profession is questionable. Rather, the prevailing medical ethos can be strongly determined by politics and the zeitgeist and therefore has to be repeatedly negotiated.

  17. Fiscal Policy Problems Under Conditions Of Financial Liberalization

    Directory of Open Access Journals (Sweden)

    Valentina Urazayeva

    2014-01-01

    Full Text Available The article under the title deals with the difficulties in pursuing national fiscal policy in conditions of international financial liberalization. The author analyzes the nature of liberalization of international capital flows and its positive and negative consequences for the economies of the countries which participate in global capital movement. The author especially highlights the fact that international financial liberalization often leads to economic crises and what is even more important to their rapid spread between countries due to their growing financial interdependence. The author distinguishes two groups of fiscal policy problems in conditions of international financial liberalization. The first group includes problems arising due to quick spread of the crises due to eliminating restrictions on crossborder capital flows. These are reduction in taxes and at the same time increase in budget spending, which often happens unexpectedly and substantially impedes fiscal policy. To illustrate these points the author refers to the statistics on Spain, the USA and the OECD as a whole. Moreover countries face another range of problems regardless of the business cycle phase. In the short term it is the necessity of large scale structural economic reforms to achieve the required level of financial liberalization, which often is a heavy burden on the state budget. In the long term the attention is paid to the problem of tax competition between countries, which affects the instruments of fiscal policy. The author notes that the negative consequences of global financial liberalization are relevant not only for recipient countries but for donor countries as well and emphasizes such a burning issue as "capital flight".

  18. FISCAL POLICY PROBLEMS UNDER CONDITIONS OF FINANCIAL LIBERALIZATION

    Directory of Open Access Journals (Sweden)

    Valentina Urazayeva

    2014-01-01

    Full Text Available The article under the title deals with the difficulties in pursuing national fiscal policy in conditions of international financial liberalization. The author analyzes the nature of liberalization of international capital flows and its positive and negative consequences for the economies of the countries which participate in global capital movement. The author especially highlights the fact that international financial liberalization often leads to economic crises and what is even more important to their rapid spread between countries due to their growing financial interdependence. The author distinguishes two groups of fiscal policy problems in conditions of international financial liberalization. The first group includes problems arising due to quick spread of the crises due to eliminating restrictions on crossborder capital flows. These are reduction in taxes and at the same time increase in budget spending, which often happens unexpectedly and substantially impedes fiscal policy. To illustrate these points the author refers to the statistics on Spain, the USA and the OECD as a whole. Moreover countries face another range of problems regardless of the business cycle phase. In the short term it is the necessity of large scale structural economic reforms to achieve the required level of financial liberalization, which often is a heavy burden on the state budget. In the long term the attention is paid to the problem of tax competition between countries, which affects the instruments of fiscal policy. The author notes that the negative consequences of global financial liberalization are relevant not only for recipient countries but for donor countries as well and emphasizes such a burning issue as "capital flight".

  19. Medical and social problems of patients in an urban Vesico-Vaginal ...

    African Journals Online (AJOL)

    Faecal incontinence, foot drop, peri-natal losses were found to be their main medical problems, while divorce and social out casting were their main social problems. Conclusion: VVF patients experience medical and social problems, and despite improvements in the social acceptance and awareness about VVF patients ...

  20. Symptoms of anxiety and depression in Estonian medical students with sleep problems.

    Science.gov (United States)

    Eller, Triin; Aluoja, Anu; Vasar, Veiko; Veldi, Marlit

    2006-01-01

    High emotional stress in medical students has been observed in many studies. Our aim in this article was to assess the prevalence of symptoms of anxiety and depression among Estonian medical students and to find relationships between sleep complaints and emotional symptoms. The study group consisted of 413 medical students, ages 19-33 years, at the University of Tartu. Each was asked to complete two questionnaires: the Emotional State Questionnaire (EST-Q), containing 28 questions, and the Questionnaire on Sleep and Daytime Habits, with 25 questions. The anxiety and depression subscales from the EST-Q were applied. From the study group, 21.9% students had symptoms of anxiety, and 30.6% had symptoms of depression. The frequency of anxiety and depressive symptoms was higher in females. In regression and multiple regression analysis, we determined which sleep problems were related to emotional symptoms. The associations were different for men and women. In women, anxiety remained significantly related to waking up because of nightmares and feeling tired in the morning; depressive symptoms were related to difficulties in getting to sleep at night, waking up because of nightmares and nocturnal eating habits, daytime sleepiness, and sleepiness during school lessons. In men, significant relations were clear only for depression: difficulties in falling asleep at night before an exam and subjective sleep quality. The study demonstrated that a high percentage of medical students had emotional symptoms. We found that some sleep problems indicated underlying symptoms of anxiety and depression. (c) 2006 Wiley-Liss, Inc.

  1. Decision criteria under uncertainty and the climate problem

    Energy Technology Data Exchange (ETDEWEB)

    Bretteville, Camilla

    1999-11-01

    This working paper examines some of the decision criteria suggested by theories on decision making under uncertainty. This is done by applying the criteria to the problem of global warming. It is shown that even if there was a benevolent planner who is both supranational and supra generational and even if he had a well defined inter generational welfare function, there are still remaining problems. The question asked is: If there were a benevolent planner, would he know the best climate policy for the world today. The main discussion abstracts from all other complications and focuses on the lack of certainty regarding impacts of greenhouse gas emissions and the effectiveness of policy. A very simplified example of a game against nature is constructed. It has two possible policy choices. One can either try to prevent global warming, or one can choose to do nothing. The future state of the world is uncertain and the chosen policy might affect the outcome in each state. The framing of the example is such that one should expect a policy of action to be preferred rather than a no-action policy, however this is not always the case. It is shown that the preferred policy choice is very much dependent on the choice of decision criterion, the magnitude of costs and of the framing. 3 tabs., 23 refs

  2. Beyond fatigue: Assessing variables associated with sleep problems and use of sleep medications in multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Alyssa M Bamer

    2010-05-01

    Full Text Available Alyssa M Bamer, Kurt L Johnson, Dagmar A Amtmann, George H KraftDepartment of Rehabilitation Medicine, University of Washington, Seattle, WA, USABackground: Recent research indicates that sleep disturbances are common in persons with multiple sclerosis (MS, though research to date has primarily focused on the relationship between fatigue and sleep. In order to improve treatment of sleep disorders in MS, a better understanding of other factors that contribute to MS sleep disturbance and use of sleep medications in this population is needed.Methods: Individuals with MS (N = 473 involved in an ongoing self-report survey study were asked to report on use of over-the-counter and prescription sleep medications. Participants completed the Medical Outcomes Study Sleep (MOSS scale and other common self-report symptom measures. Multiple regression was used to evaluate factors associated with sleep problems and descriptive statistics were generated to examine use of sleep medications.Results: The mean score on the MOSS scale was 35.9 (standard deviation, 20.2 and 46.8% of the sample had moderate or severe sleep problems. The majority of participants did not use over-the-counter (78% or prescription (70% sleep medications. In a regression model variables statistically significantly associated with sleep problems included depression, nighttime leg cramps, younger age, pain, female sex, fatigue, shorter duration of MS, and nocturia. The model explained 45% of the variance in sleep problems. Of the variance explained, depression accounted for the majority of variance in sleep problems (33%, with other variables explaining significantly less variance.Conclusions: Regression results indicate that fatigue may play a minor role in sleep disturbance in MS and that clinicians should consider the interrelationship between depression and sleep problems when treating either symptom in this population. More research is needed to explore the possibility of under

  3. Medical student perception of problem topics in anatomy | Kramer ...

    African Journals Online (AJOL)

    Objective: To examine the existence of perceived problem topics/concepts in anatomy, possible reasons for the problems and also student suggestions for alleviating the problems. Design: An open-ended questionnaire. Setting: School of Anatomical Sciences, University of the Witwatersrand, Johannesburg, South Africa.

  4. Problems and Challenges in Medical Education in India

    Science.gov (United States)

    Goswami, Sribas; Sahai, Manjari

    2015-01-01

    As India marches towards an exciting new future of growth and progress, medical education will play a pivotal role in crafting a sustained development agenda. The idea of creating a healthy society is no longer a debatable luxury; its significance has been grasped by policy shapers worldwide. In a developing nation like India, medical services…

  5. Medication errors: problems and recommendations from a consensus meeting.

    NARCIS (Netherlands)

    Agrawal, A.; Aronson, J.K.; Britten, N.; Ferner, R.E.; Smet, P.A.G.M. de; Fialova, D.; Fitzgerald, R.J.; Likic, R.; Maxwell, S.R.; Meyboom, R.H.; Minuz, P.; Onder, G.; Schachter, M.; Velo, G.

    2009-01-01

    Here we discuss 15 recommendations for reducing the risks of medication errors: 1. Provision of sufficient undergraduate learning opportunities to make medical students safe prescribers. 2. Provision of opportunities for students to practise skills that help to reduce errors. 3. Education of

  6. Assessing the problem of counterfeit medications in the United Kingdom.

    Science.gov (United States)

    Jackson, G; Patel, S; Khan, S

    2012-03-01

    Counterfeit medicines pose an ever-increasing threat to public health, although precise tracking of illegal counterfeit prescription drug activity is difficult. Available data indicate that all types of medications have been targeted. Adverse health effects, including death, have resulted from using counterfeit medications; consumers who self-medicate without appropriate interactions with the healthcare system rarely receive adequate healthcare. The Internet provides a large, convenient route for counterfeiters to reach potential buyers with unregulated, often dangerous, products. The majority of medicines purchased via unverified Internet sites are counterfeit; often, these products lack the purported drug compound or have variable concentrations of active ingredients and sometimes contain dangerous toxins. Although many consumers acknowledge some degree of risk with purchasing medications via the Internet, speed, convenience and cost often prompt these purchases. Counterfeit medications also have been detected in the legitimate supply chain, but represent a significantly smaller proportion of sales than those purchased via the Internet. Pilot programmes in Europe have demonstrated that product verification systems prevent penetration of counterfeit products into the legitimate supply chain. Significant EU legislation, including stronger penalties for counterfeiting, is in development. In the United Kingdom, the Medicines and Healthcare Products Regulatory Agency (MHRA) launched an initiative against counterfeit medication. Healthcare professionals should report suspected cases of counterfeit medication to the MHRA, be alert to threats to the medicine supply, and provide practical advice to patients about ordering medications online, including avoiding unregulated Internet pharmacies, and being suspicious of sites offering substantial discounts and prescription-only medication without a prescription. © 2011 Blackwell Publishing Ltd.

  7. Pain relief for headaches. Is self-medication a problem?

    Science.gov (United States)

    Robinson, R. G.

    1993-01-01

    Recent survey results show that 3.2 million Canadians suffer from migraine attacks. Among those responding to the survey, 36% were currently consulting physicians for their headaches, 45% had discontinued consulting physicians, and 19% had never sought medical help. About 90% of these migraine sufferers used over-the-counter drugs. Risks associated with improper use of OTC medications include addiction, gastric irritation, liver toxicity, and rebound headache syndrome. PMID:8495144

  8. FDA Experience with Medical Countermeasures under the Animal Rule

    Directory of Open Access Journals (Sweden)

    Paul Aebersold

    2012-01-01

    Full Text Available The Food and Drug Administration issued a final rule in May 2002 to permit the Agency to approve drugs or license biological products on the basis of animal efficacy studies for use in ameliorating or preventing serious or life-threatening conditions caused by exposure to lethal or permanently disabling toxic biological, chemical, radiological, or nuclear substances. Only two drugs were approved in the first nine years of the “Animal Rule” despite massive investment by the federal government since 2001 to stimulate development of medical countermeasures to biological threats. This article therefore examines the Food and Drug Administration reviews made public after approval of those two drugs and the public discussion at the Agency's Anti-Infective Drugs Advisory Committee of one biological product under development under the Animal Rule. Despite the paucity of approved drugs or licensed biological products as medical countermeasures, several investigational drugs have been placed in the National Strategic Stockpile for use as medical countermeasures, if needed.

  9. Cybersecurity vulnerabilities in medical devices: a complex environment and multifaceted problem

    Science.gov (United States)

    Williams, Patricia AH; Woodward, Andrew J

    2015-01-01

    The increased connectivity to existing computer networks has exposed medical devices to cybersecurity vulnerabilities from which they were previously shielded. For the prevention of cybersecurity incidents, it is important to recognize the complexity of the operational environment as well as to catalog the technical vulnerabilities. Cybersecurity protection is not just a technical issue; it is a richer and more intricate problem to solve. A review of the factors that contribute to such a potentially insecure environment, together with the identification of the vulnerabilities, is important for understanding why these vulnerabilities persist and what the solution space should look like. This multifaceted problem must be viewed from a systemic perspective if adequate protection is to be put in place and patient safety concerns addressed. This requires technical controls, governance, resilience measures, consolidated reporting, context expertise, regulation, and standards. It is evident that a coordinated, proactive approach to address this complex challenge is essential. In the interim, patient safety is under threat. PMID:26229513

  10. Cybersecurity vulnerabilities in medical devices: a complex environment and multifaceted problem.

    Science.gov (United States)

    Williams, Patricia Ah; Woodward, Andrew J

    2015-01-01

    The increased connectivity to existing computer networks has exposed medical devices to cybersecurity vulnerabilities from which they were previously shielded. For the prevention of cybersecurity incidents, it is important to recognize the complexity of the operational environment as well as to catalog the technical vulnerabilities. Cybersecurity protection is not just a technical issue; it is a richer and more intricate problem to solve. A review of the factors that contribute to such a potentially insecure environment, together with the identification of the vulnerabilities, is important for understanding why these vulnerabilities persist and what the solution space should look like. This multifaceted problem must be viewed from a systemic perspective if adequate protection is to be put in place and patient safety concerns addressed. This requires technical controls, governance, resilience measures, consolidated reporting, context expertise, regulation, and standards. It is evident that a coordinated, proactive approach to address this complex challenge is essential. In the interim, patient safety is under threat.

  11. [Development of medical tourism in Georgia. Problems and prospectiv (review)].

    Science.gov (United States)

    Gerzmava, O; Lomtadze, L; Kitovani, D; Kadjrishvili, M

    2011-10-01

    Medical tourism is the movement of patients through a global network of health services. Medical tourists seek affordable healthcare on a timely basis in a variety of destination nations. The expansion of global medical services has sparked immense economic growth in developing nations and has created a new market for advertising access to care. Beyond offering a unique untapped market of services, medical tourism has invited a host of liability, malpractice and ethical concerns. The explosion of off-shore "mini-surgical" vacations will surely incite global unification and increased access, quality and affordability of care. Medical tourism is a dynamic subset of global health care that incorporates a variety of services, procedures and venues of care. Health insurance coverage, the impact on domestic and global markets, and the use of international standards of care will be examined in combination with quality, access and cost parameters. The global nature of medical tourism invites a variety of legal and ethical issues and calls for an organizational body to monitor this new phenomenon. Finally, the future implications of the globalization of health services and systems will be discussed.

  12. Study of Sleep Habits and Sleep Problems Among Medical Students ...

    African Journals Online (AJOL)

    Background: Good quality sleep and adequate amount of sleep are important in order to have better cognitive performance and avoid health problems and psychiatric disorders. Aim: The aim of this study was to describe sleep habits and sleep problems in a population of undergraduates, interns and postgraduate students ...

  13. An optimal multiple switching problem under weak assumptions

    Directory of Open Access Journals (Sweden)

    Imen Hassairi

    2017-10-01

    Full Text Available This work studies the problem of optimal multiple switching in finite horizon, when the switching costs functions are continous and belong to class D. This problem is solved by means of the Snell envelope of processes.

  14. Development and application of measurement methods focusing on medication related problems in elderly hospitalised patients

    NARCIS (Netherlands)

    Wierenga, P.C.

    2013-01-01

    In conclusion, elderly hospitalised patients form a patient group that is at higher risk for medication related problems compared to younger patients. In order to measure medication related problems in hospitalised elderly and to ultimately improve their pharmaceutical care we examined three

  15. PROBLEMS OF QUALITY OF SERVICES PROVIDED BY MEDICAL AND ACCESSIBLE TOURISM IN CRIMEA

    Directory of Open Access Journals (Sweden)

    Marina Ryndach

    2015-09-01

    Full Text Available The article discusses the possibilities and problems of development of medical tourism in the Crimea. The problems of the existing infrastructure in order to attract new tourist flow to the Crimea — people with disabilities. The measures aimed at improving the quality of services in the field of medical and accessible tourism.

  16. Problem based learning in continuing medical education: a review of controlled evaluation studies

    NARCIS (Netherlands)

    Smits, P. B. A.; Verbeek, J. H. A. M.; de Buisonjé, C. D.

    2002-01-01

    Reviews of undergraduate medical education cautiously support the short term and long term outcomes of problem based learning compared with traditional learning. The effectiveness of problem based learning in continuing medical education, however, has not been reviewed. This review of controlled

  17. Bringing science to medicine: an interview with Larry Weed, inventor of the problem-oriented medical record.

    Science.gov (United States)

    Wright, Adam; Sittig, Dean F; McGowan, Julie; Ash, Joan S; Weed, Lawrence L

    2014-01-01

    Larry Weed, MD is widely known as the father of the problem-oriented medical record and inventor of the now-ubiquitous SOAP (subjective/objective/assessment/plan) note, for developing an electronic health record system (Problem-Oriented Medical Information System, PROMIS), and for founding a company (since acquired), which developed problem-knowledge couplers. However, Dr Weed's vision for medicine goes far beyond software--over the course of his storied career, he has relentlessly sought to bring the scientific method to medical practice and, where necessary, to point out shortcomings in the system and advocate for change. In this oral history, Dr Weed describes, in his own words, the arcs of his long career and the work that remains to be done. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. Ruralising Medical Curricula: The Importance of Context in Problem Design.

    Science.gov (United States)

    Hays, Richard; Sen Gupta, Tarun

    2003-01-01

    Clinical scenarios used in rural medical education often convey inappropriate stereotypes that undermine the intent of the curriculum. Case writers should be clear about the learning or assessment objectives in each case, have access to people with appropriate expertise and understanding of the issues, and ensure that contextual and cultural…

  19. Learning processes and learning problems in German postgraduate medical education.

    Science.gov (United States)

    van den Bussche, Hendrik; Krause-Solberg, Lea; Scherer, Martin; Ziegler, Stine

    2017-01-01

    Objective: In order to evaluate the quality of postgraduate medical education in Germany, we examined how the learning of theoretical and practical competencies is conceptualized and how the learning process takes place in real terms. The training conditions, as perceived by medical residents, are compared with the learning objectives, as stated by the Federal Chamber of Physicians in its regulation on postgraduate education. The analysis is based on the data of the "KarMed" study (abbreviation of "career progression and career breaks among physicians during postgraduate education"), a multicentre cohort study of medical school graduates from seven universities who arre followed until they receive their licenses as specialist physicians. The study was conducted by the Institute of Primary Medical Care of the University Medical Center Hamburg-Eppendorf starting in 2008. Methodology: The KarMed study is based on annual, standardized surveys of the population described above. 48% responded in the initial survey (n=1012) and 85% or more in each of the following surveys. Descriptive statistics and logistical regressions were used for analysis. Gender-specific analyses were performed where possible in order to highlight the differences in the professional objectives and workloads between female and male physicians. Results: The study shows that both the practical and the theoretical components of postgraduate medical education in Germany are insufficient. There is a lack of a curriculum with precise learning objectives and descriptions of the corresponding educational settings. In fact, the act of learning is identical to daily clinical work. There is no structuring of the work process with regard to learning; for example, documentation procedures and feedback discussions are prescribed but largely omitted. Evidence-based medicine is not a systematic part of the training, nor is the evaluation of residents' progress. The summative final oral examination pretends that the

  20. Problems in classical and quantum mechanics extracting the underlying concepts

    CERN Document Server

    Kelley, J Daniel

    2017-01-01

    This book is a collection of problems intended to aid students in their graduate courses in physics and in preparing for the PhD qualifying exam. Thus, the included problems are of the type that could be on a qualifying exam or are problems that are meant to elucidate a principle that is important for the exam. Unlike other compilations of problems, the problems in this text are placed in the broader context of the subject. The goal of the book is to develop the problem solving skills of the reader to insure a complete understanding of the physics. Problems and solutions are presented in detail, and, additionally, their significance is discussed within the context of the physical principle(s) that they illustrate. The solution of the problem is only the beginning of the learning process--it is in manipulating the solution and changing the parameters that a great deal of insight can be gleaned. This technique is referred to by the authors as "massaging the problem," and it is a technique that the authors have ...

  1. Underlying construct of empathy, optimism, and burnout in medical students.

    Science.gov (United States)

    Hojat, Mohammadreza; Vergare, Michael; Isenberg, Gerald; Cohen, Mitchell; Spandorfer, John

    2015-01-29

    This study was designed to explore the underlying construct of measures of empathy, optimism, and burnout in medical students. Three instruments for measuring empathy (Jefferson Scale of Empathy, JSE); Optimism (the Life Orientation Test-Revised, LOT-R); and burnout (the Maslach Burnout Inventory, MBI, which includes three scales of Emotional Exhaustion, Depersonalization, and Personal Accomplishment) were administered to 265 third-year students at Sidney Kimmel (formerly Jefferson) Medical College at Thomas Jefferson University. Data were subjected to factor analysis to examine relationships among measures of empathy, optimism, and burnout in a multivariate statistical model. Factor analysis (principal component with oblique rotation) resulted in two underlying constructs, each with an eigenvalue greater than one. The first factor involved "positive personality attributes" (factor coefficients greater than .58 for measures of empathy, optimism, and personal accomplishment). The second factor involved "negative personality attributes" (factor coefficients greater than .78 for measures of emotional exhaustion, and depersonalization). Results confirmed that an association exists between empathy in the context of patient care and personality characteristics that are conducive to relationship building, and considered to be "positive personality attributes," as opposed to personality characteristics that are considered as "negative personality attributes" that are detrimental to interpersonal relationships. Implications for the professional development of physicians-in-training and in-practice are discussed.

  2. [The Actual Legal and Organizational Problems of Licensing of Military Medical Expertise].

    Science.gov (United States)

    Sogiiainen, A A; Schepin, V O; Telnova, E A; Chicherin, L P

    2017-09-01

    The article presents analysis of problems of organization of functioning of military medical commissions in the light of implementation of complex of activities related to licensing of military medical expertise as a type of medical activity. The conceptual definitions and main legislative acts regulating procedures of licensing of the given type of expertise are considered. The characteristics of functioning of military medical expertise in actual conditions of Russia, including experience of Moscow and the Moskovskaia oblast are established.

  3. [The topical problems of forensic medical expertise of the child injury].

    Science.gov (United States)

    Kovalev, A V; Kozlova, T P

    2013-01-01

    The objective of the present study was to analyse the current state of forensic medical expertise of the child injury. The relevant medical documents were used to estimate the quality of forensic medical examinations (surveys) of selected cases of child injuries and the related organizational, strategic, and methodological errors. The most challenging problems facing forensic medical expertise of the child injury are identified and the ways to address them are proposed.

  4. The Liner Shipping Routing and Scheduling Problem Under Environmental Considerations

    DEFF Research Database (Denmark)

    Dithmer, Philip; Reinhardt, Line Blander; Kontovas, Christos

    2017-01-01

    This paper deals with the Liner Shipping Routing and Scheduling Problem (LSRSP), which consists of designing the time schedule for a vessel to visit a fixed set of ports while minimizing costs. We extend the classical problem to include the external cost of ship air emissions and we present some ...

  5. Effects of asymmetric medical insurance subsidy on hospitals competition under non-price regulation.

    Science.gov (United States)

    Wang, Chan; Nie, Pu-Yan

    2016-11-15

    Poor medical care and high fees are two major problems in the world health care system. As a result, health care insurance system reform is a major issue in developing countries, such as China. Governments should take the effect of health care insurance system reform on the competition of hospitals into account when they practice a reform. This article aims to capture the influences of asymmetric medical insurance subsidy and the importance of medical quality to patients on hospitals competition under non-price regulation. We establish a three-stage duopoly model with quantity and quality competition. In the model, qualitative difference and asymmetric medical insurance subsidy among hospitals are considered. The government decides subsidy (or reimbursement) ratios in the first stage. Hospitals choose the quality in the second stage and then support the quantity in the third stage. We obtain our conclusions by mathematical model analyses and all the results are achieved by backward induction. The importance of medical quality to patients has stronger influence on the small hospital, while subsidy has greater effect on the large hospital. Meanwhile, the importance of medical quality to patients strengthens competition, but subsidy effect weakens it. Besides, subsidy ratios difference affects the relationship between subsidy and hospital competition. Furthermore, we capture the optimal reimbursement ratio based on social welfare maximization. More importantly, this paper finds that the higher management efficiency of the medical insurance investment funds is, the higher the best subsidy ratio is. This paper states that subsidy is a two-edged sword. On one hand, subsidy stimulates medical demand. On the other hand, subsidy raises price and inhibits hospital competition. Therefore, government must set an appropriate subsidy ratio difference between large and small hospitals to maximize the total social welfare. For a developing country with limited medical resources

  6. Who was Akilaos? A problem in medical historiography.

    Science.gov (United States)

    Irvine, Judith T; Temkin, Owsei

    2003-01-01

    In the years before the conquest of Alexandria by the Arabs in 642, Alexandrian scholars produced compendia, summaries, and commentaries on Galen's writings and other works in the Hippocratic medical tradition. This paper concerns the identities of those Alexandrian commentators-two in particular, whose names are reported in Arabic texts, but about whom little else is known-and the routes by which Galenic medicine was transmitted to other parts of the Mediterranean world after Alexandria's fall. We review debates over the identity of "Akilaos" and "Anqilaos," and argue that "Akilaos" is not merely a scribal duplication, as some have supposed. Instead, we suggest a connection with the city of Aquileia in northern Italy, as a source for the name "Akilaos" and as a route by which Alexandrian medical texts reached northern Italy (where their Latin versions subsequently were associated with a "Ravenna school" of medicine).

  7. Multistage problem-based case discussion for medical students

    Directory of Open Access Journals (Sweden)

    Dadgostarnia, M

    2003-10-01

    Full Text Available Purpose: Students are presented with a variety of case formulas to promote the development of clinical reasoning. Methods: 120 third-year medical students at our medical university were randomly assigned to 18 small groups. After each ICM (Introduction to clinical Medicine course, they were given a paper case. A few days later small group sessions were formed and students asked tutors some questions to have more history and physical examination data and discussed and developed a differential diagnosis list. Then, all small groups met in a large group session for further discussion. After that, back to small groups, students ordered paraclinical tests and they were given the results by tutor. At this stage, each group tried to further narrow the differential diagnosis list and to determine the most probable diagnosis. Finally, in the large group session a consensus diagnosis was reached after reflective observation. A questionnaire was used before and after intervention. The small group tutor rated student’s abilities at the end of first day and last day. Results: The attitude of students about the positive effects of MPCD increased significantly from the first day to the last day (P<0.05. the progress checklist of the student’s abilities showed a statistically significant improvement post intervention. Conclusion: Our study suggests that using MPCD method is an effective way to increase clinical reasoning skills of medical students.

  8. Medical student's perspective of problem based learning (PBL ...

    African Journals Online (AJOL)

    The Faculty of Health Sciences at the University of Transkei has completed the first 5 years of its problem-based community oriented teaching curriculum. The use of SWOT analysis to evaluate current and future directions can lead to the successful evolution of any organization. The aim of this study was to obtain a students' ...

  9. Medical Students' Knowledge about Alcohol and Drug Problems: Results of the Medical Council of Canada Examination

    Science.gov (United States)

    Kahan, Meldon; Midmer, Deana; Wilson, Lynn; Borsoi, Diane

    2006-01-01

    Purpose: To determine knowledge of a national sample of medical students about substance withdrawal, screening and early intervention, medical and psychiatric complications of addiction, and treatment options. Methods: Based on learning objectives developed by medical faculty, twenty-two questions on addictions were included in the 1998 Canadian…

  10. Production and application of medical radionuclide: status and urgent problems to be resolved in China

    International Nuclear Information System (INIS)

    Li Mingqi; Deng Qimin; Cheng Zuoyong; Li Maoliang

    2013-01-01

    Radionuclide is the basic of nuclear technology application, it's widely used in manufacturing, medical and other industry area. The status and the problems in radionuclide production and application was introduced, problems in radionuclide production and application of China were also analyzed. The advice was suggested to resolve these problems to promote development of Chinese radionuclide production and application. (authors)

  11. Cybersecurity vulnerabilities in medical devices: a complex environment and multifaceted problem

    Directory of Open Access Journals (Sweden)

    Williams PAH

    2015-07-01

    Full Text Available Patricia AH Williams, Andrew J Woodward eHealth Research Group and Security Research Institute, Edith Cowan University, Perth, WA, Australia Abstract: The increased connectivity to existing computer networks has exposed medical devices to cybersecurity vulnerabilities from which they were previously shielded. For the prevention of cybersecurity incidents, it is important to recognize the complexity of the operational environment as well as to catalog the technical vulnerabilities. Cybersecurity protection is not just a technical issue; it is a richer and more intricate problem to solve. A review of the factors that contribute to such a potentially insecure environment, together with the identification of the vulnerabilities, is important for understanding why these vulnerabilities persist and what the solution space should look like. This multifaceted problem must be viewed from a systemic perspective if adequate protection is to be put in place and patient safety concerns addressed. This requires technical controls, governance, resilience measures, consolidated reporting, context expertise, regulation, and standards. It is evident that a coordinated, proactive approach to address this complex challenge is essential. In the interim, patient safety is under threat. Keywords: cybersecurity, security, safety, wireless, risk, medical devices

  12. The Role of Parents' Medication Beliefs, Religious Problem-Solving, and Risks for Treatment Nonadherence in Urban Families with Asthma

    Directory of Open Access Journals (Sweden)

    Sue K. Adams

    2011-01-01

    Full Text Available Childhood asthma is highly prevalent, affecting approximately nine million children in the United States. Negative effects of pediatric asthma are disproportionately experienced by ethnic minorities living in low-income, urban settings. Given the great diversity in families' ways of addressing children's asthma symptoms, sociocultural factors underlying asthma disparities must be examined. The current study investigated associations among parents' beliefs about conventional and holistic/alternative medications, parents' religious problem-solving strategies and childrens' risks for asthma treatment nonadherence. The sample included 66 parents of ethnically diverse children with asthma living in urban settings. Factor analysis of the Religious Problem Solving Questionnaire yielded two factors, self-directed (ie, solving problems independently of God and God-involved problem solving. Parents' strong positive beliefs about conventional and alternative medications were associated with greater self-directed problem solving and with more risks for nonadherence. Higher levels of self-directed problem solving also were associated with more risks for nonadherence. Self-directed problem solving mediated the associations of conventional and alternative medication beliefs with risks for nonadherence. Possible explanations for these findings are discussed.

  13. Educational Problems of Kermanshah Medical School: View Points of Students, Graduates and Faculty Members

    Directory of Open Access Journals (Sweden)

    soraia Siabani

    2009-07-01

    Full Text Available Background and purpose: In recent years although the number of students registering for medicines has decreased in Kermanshah University of Medical sciences parallel to other universities of medical sciences the quality of educational services has not improved the informal reports suggests that the competency of medical graduates is not satisfactory Since any intervention needs situation analysis this study was conducted to obtain viewpoints of three main groups of stockholders including faculty members, students and graduates on medical school problems and insufficiencies.Methods: In this qualitative study faculty members of medical schools, medical graduated of 2005-6, and medical students of different phases participated. With participation of these subjects Focus Group Discussion (FGD sessions were carried out. The goals of the projects were first explained for participants. In the end of each discussion session the discussions were careful transcribed. The sessions continued till the sessions get saturated. The transcript of discussion was thoroughly reviewed by researchers and codified. The problems were classified in 7 areas of management, planning, education goals, evaluation, ethics, teaching, and students.Results: The subjects believed that the most important problems in Kermanshah medical school include neglecting the student evaluation, no educational objectives or being inattentive to them, unwanted effects of pay for service plan, too much duties for interns (students, overload of medical duties and insufficiency in the number of faculty members, no rewarding system for teachers, inattention to needed outcomes, shortage of facilities for student in hospital and being negligent about mutual respect between students and teachers.Conclusion: some of the problems such as the effects of pay for service plan and insufficiency in the number of faculty members have solutions stemming beyond the university at Ministry of Health level

  14. Optimal infrastructure maintenance scheduling problem under budget uncertainty.

    Science.gov (United States)

    2010-05-01

    This research addresses a general class of infrastructure asset management problems. Infrastructure : agencies usually face budget uncertainties that will eventually lead to suboptimal planning if : maintenance decisions are made without taking the u...

  15. An analytic approach to resolving problems in medical ethics.

    OpenAIRE

    Candee, D; Puka, B

    1984-01-01

    Education in ethics among practising professionals should provide a systematic procedure for resolving moral problems. A method for such decision-making is outlined using the two classical orientations in moral philosophy, teleology and deontology. Teleological views such as utilitarianism resolve moral dilemmas by calculating the excess of good over harm expected to be produced by each feasible alternative for action. The deontological view focuses on rights, duties, and principles of justic...

  16. Problems associated with the organization and planning of medical aid for radiation accident casualties

    International Nuclear Information System (INIS)

    Jammet, H.P.

    1977-01-01

    Problems associated with the organization and planning of medical treatment for radiation accident casualties are considered for different types of radiation accident: whole-body or partial irradiation, external or internal contamination and small or large numbers of cases. The problems posed are ones of competence, urgency and capacity; on the diagnostic side there is the problem of evaluating the exposure or contamination and assessing the resultant damage, while on the treatment side the questions of first aid, conventional treatment and specialized treatment have to be considered. The solutions envisaged involve organization at the local and national levels and planning of medical treatment by skilled, multidisciplinary medical teams. (author)

  17. Renewed roles for librarians in problem-based learning in the medical curriculum.

    Science.gov (United States)

    Mi, Misa

    2011-01-01

    Problem-based learning (PBL) is a teaching-learning process or method of instruction that is widely used in medical education curricula. Librarians play important roles as facilitators for PBL as well as guides for information resources. Involvement in PBL activities presents unique opportunities to incorporate library resources and instruction into the medical curriculum. This article reviews the problem-based learning method within the conceptual framework of the learning theory of constructivism. It describes how a medical librarian at a U.S. medical school used emerging technologies to facilitate PBL small group case discussions, guide students to quality information resources, and enhance the learning environment for the PBL process.

  18. Drug-related problems identified in medication reviews by Australian pharmacists

    DEFF Research Database (Denmark)

    Stafford, Andrew C; Tenni, Peter C; Peterson, Gregory M

    2009-01-01

    OBJECTIVE: In Australia, accredited pharmacists perform medication reviews for patients to identify and resolve drug-related problems. We analysed the drug-related problems identified in reviews for both home-dwelling and residential care-facility patients. The objective of this study was to exam......OBJECTIVE: In Australia, accredited pharmacists perform medication reviews for patients to identify and resolve drug-related problems. We analysed the drug-related problems identified in reviews for both home-dwelling and residential care-facility patients. The objective of this study....... These reviews had been self-selected by pharmacists and submitted as part of the reaccreditation process to the primary body responsible for accrediting Australian pharmacists to perform medication reviews. The drug-related problems identified in each review were classified by type and drugs involved. MAIN...... OUTCOME MEASURE: The number and nature of drug-related problems identified in pharmacist-conducted medication reviews. RESULTS: There were 1,038 drug-related problems identified in 234 medication reviews (mean 4.6 (+/-2.2) problems per review). The number of problems was higher (4.9 +/- 2.0 vs. 3.9 +/- 2...

  19. An analytic approach to resolving problems in medical ethics.

    Science.gov (United States)

    Candee, D; Puka, B

    1984-01-01

    Education in ethics among practising professionals should provide a systematic procedure for resolving moral problems. A method for such decision-making is outlined using the two classical orientations in moral philosophy, teleology and deontology. Teleological views such as utilitarianism resolve moral dilemmas by calculating the excess of good over harm expected to be produced by each feasible alternative for action. The deontological view focuses on rights, duties, and principles of justice. Both methods are used to resolve the 1971 Johns Hopkins case of a baby born with Down's syndrome and duodenal atresia. PMID:6234395

  20. An analytic approach to resolving problems in medical ethics.

    Science.gov (United States)

    Candee, D; Puka, B

    1984-06-01

    Education in ethics among practising professionals should provide a systematic procedure for resolving moral problems. A method for such decision-making is outlined using the two classical orientations in moral philosophy, teleology and deontology. Teleological views such as utilitarianism resolve moral dilemmas by calculating the excess of good over harm expected to be produced by each feasible alternative for action. The deontological view focuses on rights, duties, and principles of justice. Both methods are used to resolve the 1971 Johns Hopkins case of a baby born with Down's syndrome and duodenal atresia.

  1. Study of sleep habits and sleep problems among medical students of pravara institute of medical sciences loni, Western maharashtra, India.

    Science.gov (United States)

    Giri, Pa; Baviskar, Mp; Phalke, Db

    2013-01-01

    Good quality sleep and adequate amount of sleep are important in order to have better cognitive performance and avoid health problems and psychiatric disorders. The aim of this study was to describe sleep habits and sleep problems in a population of undergraduates, interns and postgraduate students of Pravara Institute of Medical Sciences (Deemed University), Loni, Maharashtra, India. Sleep habits and problems were investigated using a convenience sample of students from Pravara Institute of Medical Sciences (Deemed University), Loni, Maharashtra, India. The study was carried out during Oct. to Dec. 2011 with population consisted of total 150 medical students. A self-administered questionnaire developed based on Epworth Daytime Sleepiness Scale and Pittsburgh Sleep Quality Index was used. Data was analyzed by using Statistical Package of Social Sciences (SPSS) version 16.0. In this study, out of 150 medical students, 26/150 (17.3%) students had abnormal levels of daytime sleepiness while 20/150 (13.3%) were border line. Sleep quality in females was better than the male. Disorders related to poor sleep qualities are significant problems among medical students in our institution. Caffeine and alcohol ingestion affected sleep and there was high level of daytime sleepiness. Sleep difficulties resulted in irritability and affected lifestyle and interpersonal relationships.

  2. Newsvendor problem with random shortage cost under a risk criterion

    NARCIS (Netherlands)

    Wu, Meng; Zhu, Stuart X.; Teunter, Ruud H.

    2013-01-01

    We study profit maximization vs risk approaches for the standard newsvendor problem with uncertainty in demand as well as a generalized version with uncertainty in the shortage cost (as often applies in practice). We consider two well-known risk approaches: Value-at-Risk (VaR) included as a

  3. Problems of elderly patients on inhalation therapy: Difference in problem recognition between patients and medical professionals

    Directory of Open Access Journals (Sweden)

    Daiki Hira

    2016-10-01

    Conclusions: Elderly patients are apt to assume that they “understand well”, therefore, in order to recognize and close the perception gap between elderly patients and medical professionals, it is necessary to provide them with more aggressive (frequent instructions on inhalation therapy.

  4. Development of countermeasures for medical problems encountered in space flight

    Science.gov (United States)

    Nicogossian, Arnauld E.; Rummel, John D.; Leveton, Lauren; Teeter, Ron

    1992-08-01

    By the turn of this century, long-duration space missions, either in low Earth orbit or for got early planetary missions, will become commonplace. From the physiological standpoint, exposure to the weightless environment results in changes in body function, some of which are adaptive in nature and some of which can be life threatening. Important issues such as environmental health, radiation protection, physical deconditioning, and bone and muscle loss are of concern to life scientists and mission designers. Physical conditioning techniques such as exercise are not sufficient to protect future space travellers. A review of past experience with piloted missions has shown that gradual breakdown in bone and muscle tissue, together with fluid losses, despite a vigorous exercise regimen can ultimately lead to increased evidence of renal stones, musculoskeletal injuries, and bone fractures. Biological effects of radiation can, over long periods of time increase the risk of cancer development. Today, a vigorous program of study on the means to provide a complex exercise regimen to the antigravity muscles and skeleton is under study. Additional evaluation of artificial gravity as a mechanism to counteract bone and muscle deconditioning and cardiovascular asthenia is under study. New radiation methods are being developed. This paper will deal with the results of these studies.

  5. Alcohol-related problems of future physicians prior to medical training.

    Science.gov (United States)

    Richman, J A; Flaherty, J A

    1990-07-01

    Time 1 data are presented from an ongoing longitudinal study of drinking patterns and problems of future physicians from medical school entrance through 2.5 years of training. The data in this report address the prevalence and psychosocial correlates of alcohol-related problems experienced prior to medical school training. A group of 167 students (91% of the cohort) was surveyed. Self-report questionnaires included: alcohol-related problems (the MAST), earlier parent-child relationships, personality characteristics (external locus of control, self-esteem, dependency, masculinity-femininity), life events, social supports, motivations for drinking and symptomatic distress. The male students manifested a higher mean level of alcohol problems, and the sexes differed at the trend level when the MAST was scored to distinguish "problem" from "nonproblem" drinkers (with 18.4% of the students reporting 5 or more problem points and 7.4% reporting 4 problem points). The significant correlates of alcohol problems included: perceived lack of earlier maternal affectivity (for men) and perceived lack of earlier paternal affectivity (for women), and lack of emotional support (for men). Moreover, escape motives for men were the motives most highly correlated with alcohol problems. Symptomatic distress (anxiety and hostility) was significantly correlated with alcohol-related problems in men but not women. Future reports will depict the psychosocial experiences and alcohol-related problems manifested by this cohort during medical training.

  6. [Certain theoretical-methodological problems of forensic medical expertise of the blast injury].

    Science.gov (United States)

    Popov, V L

    2015-01-01

    This article is devoted to the analysis of the theoretical problems facing forensic medical expertise of the blast injury. The original notions of the blast, injurious blast factors, and their traumatic consequences are proposed together with the classification of the blasts and their injurious factors. The principal lines of the further research on the forensic medical aspects of the blast injury are formulated.

  7. Environmental problems indicator under environmental modeling toward sustainable development

    OpenAIRE

    P. Sutthichaimethee; W. Tanoamchard; P. Sawangwong; P Pachana; N. Witit-Anun

    2015-01-01

    This research aims to apply a model to the study and analysis of environmental and natural resource costs created in supply chains of goods and services produced in Thailand, and propose indicators for environmental problem management, caused by goods and services production, based on concepts of sustainable production and consumer behavior. The research showed that the highest environmental cost in terms of Natural Resource Materials was from pipelines and gas distribution, while the lowest ...

  8. 34 CFR 356.11 - What types of problems may be researched under the fellowship program?

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false What types of problems may be researched under the... (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION DISABILITY AND... Program? § 356.11 What types of problems may be researched under the fellowship program? Problems...

  9. The problem of «medical inertia» in the practice of an ophthalmologist

    Directory of Open Access Journals (Sweden)

    A. L. Onischenko

    2015-01-01

    Full Text Available The authors study the problem of inertia in the medical practice of ophthalmology, which implies the absence of any modification of the treatment in the presence of objective necessity or clinical indications. The treatment of multifactorial diseases, including primary glaucoma is particularly critical. An anonymous survey of 147 ophthalmologists from different regions of Western Siberia — Altai Territory, Kemerovo Region and the Republic of Khakassia, has been conducted. Most of the surveyed doctors believed that their treatment was successful in 40‑80 % of patients. According to literature data, ithe target value of IOP level is achieved in practice in under half of the patients receiving regular therapy. Another reason of medical inertia was the fear of polypragmasy. Almost 54 % of doctors said they are afraid to prescribe several medications, which limits their desire to intensify therapy. The results of our study suggest that the cost of glaucoma treatment, i.e. the fear to prescribe an expensive treatment for patients does not significantly determine the doctors’activity. Doctors often exaggerate the fear of patients for the treatment, believing that a particular medical drugwill not be taken by the patient, without trying to figure out the patient’s intention. The economic barrier has become an essential factor for our doctors, as 35 % ophthalmologists believe that 300‑500 Rubles for the therapy per month is expencive for a patient. Over 30 % respondents discussed with the patient the prescribed treatment with cost about 700‑900 Rubles. This could potentially lead to the fact, that the second and third medical drugs would be less likely prescribed due to the increased cost of treatment. Thus, we have set up the structure of the causes of medical inertia — a psychological unwillingness to achieve target values of IOP, overestimation of the therapy success. Less important reasons were the lack of doctor

  10. Historicising the budgetary problems of Ghana and Nigeria under ...

    African Journals Online (AJOL)

    The 1990s were periods in the history of Africa that many states on the continent which had hitherto been governed by military dictatorships began to embrace democracy. Under the military dictatorship and their similar civilian variants, the economies of these states had witnessed utter ruination partly as a result of IMF or ...

  11. Drug-related problems associated with self-medication and medication guided by prescription: A pharmacy-based survey.

    Science.gov (United States)

    Panda, Abinash; Pradhan, Supriya; Mohapatra, Gurukrushna; Mohapatra, Jigyansa

    2016-01-01

    The objective of this study is to identify and compare the nature of the drug-related problems (DRPs) associated with self-medication and non-self-medication (drug use guided by a prescription). The cross-sectional, observational study was conducted on 1100 adult participants at a convenience sample of six retail private pharmacy counters. The data collection form was based on the Pharmaceutical Care Network Europe version 6.2 classification for DRPs. Descriptive statistics was used to represent the prevalence of DRPs. Chi-square test was used to find out the association between the type of medication and DRPs. Odds ratio (OR) with confidence interval (CI) was computed to find the factors determining the occurrence of DRPs. P self-medication was 18.72%. The prevalence of DRPs was 17.36%. In the self-medication group, the prevalence of DRPs was high (40.78%) as compared to the non-self-medication group (11.97%). DRP related to inappropriate drug dosing was observed in 44.83% and 40.45% subjects in self-medication and non-self-medication group, respectively ( P self-medication group were about 5 times likely to have a DRP (OR: 5.06, CI: 3.59-7.14, P Self-medication is associated with a higher risk of various DRPs. Since retail pharmacy outlet is often the first point of contact between the patient and the health care system in a developing country, interventions like drug information activities at the retail pharmacy is likely to bring down the DRPs associated with self-medication.

  12. Problem-based learning versus lecture-based learning in postgraduate medical education

    NARCIS (Netherlands)

    Smits, Paul B.; de Buisonjé, Cathelijn D.; Verbeek, Jos H.; Van Dijk, Frank J.; Metz, Jaap C.; ten Cate, Olle J.

    2003-01-01

    Objectives. The objective of this study was to investigate the effectiveness of problem-based learning in comparison with lecture-based learning in a postgraduate medical training program concerning the management of mental health problems for occupational health physicians. Methods. A randomized

  13. Mediators for internalizing problems in adolescents of parents with chronic medical condition

    NARCIS (Netherlands)

    Sieh, D.S.; Oort, F.J.; Visser-Meily, J.M.A.; Meijer, A.M.

    2014-01-01

    Parents’ chronic medical condition (CMC) is related to internalizing problem behavior in adolescents. Following the transactional stress and coping (TSC) model of Hocking and Lochman, our study examines whether the effect of illness and demographic parameters on the child’s internalizing problems is

  14. EFFECTIVENESS OF PROBLEM BASED LEARNING AS A STRATEGY TO FOSTER PROBLEM SOLVING AND CRITICAL REASONING SKILLS AMONG MEDICAL STUDENTS.

    Science.gov (United States)

    Asad, Munazza; Iqbal, Khadija; Sabir, Mohammad

    2015-01-01

    Problem based learning (PBL) is an instructional approach that utilizes problems or cases as a context for students to acquire problem solving skills. It promotes communication skills, active learning, and critical thinking skills. It encourages peer teaching and active participation in a group. It was a cross-sectional study conducted at Al Nafees Medical College, Isra University, Islamabad, in one month duration. This study was conducted on 193 students of both 1st and 2nd year MBBS. Each PBL consists of three sessions, spaced by 2-3 days. In the first session students were provided a PBL case developed by both basic and clinical science faculty. In Session 2 (group discussion), they share, integrate their knowledge with the group and Wrap up (third session), was concluded at the end. A questionnaire based survey was conducted to find out overall effectiveness of PBL sessions. Teaching through PBLs greatly improved the problem solving and critical reasoning skills with 60% students of first year and 71% of 2nd year agreeing that the acquisition of knowledge and its application in solving multiple choice questions (MCQs) was greatly improved by these sessions. They observed that their self-directed learning, intrinsic motivation and skills to relate basic concepts with clinical reasoning which involves higher order thinking have greatly enhanced. Students found PBLs as an effective strategy to promote teamwork and critical thinking skills. PBL is an effective method to improve critical thinking and problem solving skills among medical students.

  15. Post-traumatic stress disorder and health problems among medically ill Canadian peacekeeping veterans.

    Science.gov (United States)

    Richardson, J Don; Pekevski, Jordan; Elhai, Jon D

    2009-04-01

    The aim of the present study was to examine the relationship between post-traumatic stress disorder (PTSD) symptom severity and four significant health conditions (gastrointestinal disorders, musculoskeletal problems, headaches, and cardiovascular problems). Participants included 707 Canadian peacekeeping veterans with service-related disabilities, from a random, national Canadian survey, who had been deployed overseas. PTSD severity was significantly related to gastrointestinal disorders, musculoskeletal problems, and headaches, but not to cardiovascular problems. Controlling for demographic factors did not affect PTSD's relationships with the three significant health conditions. The present study supports previous work in finding consistent relations between PTSD severity and specific types of medical problems.

  16. New fuzzy support vector machine for the class imbalance problem in medical datasets classification.

    Science.gov (United States)

    Gu, Xiaoqing; Ni, Tongguang; Wang, Hongyuan

    2014-01-01

    In medical datasets classification, support vector machine (SVM) is considered to be one of the most successful methods. However, most of the real-world medical datasets usually contain some outliers/noise and data often have class imbalance problems. In this paper, a fuzzy support machine (FSVM) for the class imbalance problem (called FSVM-CIP) is presented, which can be seen as a modified class of FSVM by extending manifold regularization and assigning two misclassification costs for two classes. The proposed FSVM-CIP can be used to handle the class imbalance problem in the presence of outliers/noise, and enhance the locality maximum margin. Five real-world medical datasets, breast, heart, hepatitis, BUPA liver, and pima diabetes, from the UCI medical database are employed to illustrate the method presented in this paper. Experimental results on these datasets show the outperformed or comparable effectiveness of FSVM-CIP.

  17. New Fuzzy Support Vector Machine for the Class Imbalance Problem in Medical Datasets Classification

    Directory of Open Access Journals (Sweden)

    Xiaoqing Gu

    2014-01-01

    Full Text Available In medical datasets classification, support vector machine (SVM is considered to be one of the most successful methods. However, most of the real-world medical datasets usually contain some outliers/noise and data often have class imbalance problems. In this paper, a fuzzy support machine (FSVM for the class imbalance problem (called FSVM-CIP is presented, which can be seen as a modified class of FSVM by extending manifold regularization and assigning two misclassification costs for two classes. The proposed FSVM-CIP can be used to handle the class imbalance problem in the presence of outliers/noise, and enhance the locality maximum margin. Five real-world medical datasets, breast, heart, hepatitis, BUPA liver, and pima diabetes, from the UCI medical database are employed to illustrate the method presented in this paper. Experimental results on these datasets show the outperformed or comparable effectiveness of FSVM-CIP.

  18. From poor performance to success under stress: working memory, strategy selection, and mathematical problem solving under pressure.

    Science.gov (United States)

    Beilock, Sian L; Decaro, Marci S

    2007-11-01

    Two experiments demonstrate how individual differences in working memory (WM) impact the strategies used to solve complex math problems and how consequential testing situations alter strategy use. In Experiment 1, individuals performed multistep math problems under low- or high-pressure conditions and reported their problem-solving strategies. Under low-pressure conditions, the higher individuals' WM, the more likely they were to use computationally demanding algorithms (vs. simpler shortcuts) to solve the problems, and the more accurate their math performance. Under high-pressure conditions, higher WM individuals used simpler (and less efficacious) problem-solving strategies, and their performance accuracy suffered. Experiment 2 turned the tables by using a math task for which a simpler strategy was optimal (produced accurate performance in few problem steps). Now, under low-pressure conditions, the lower individuals' WM, the better their performance (the more likely they relied on a simple, but accurate, problem strategy). And, under pressure, higher WM individuals performed optimally by using the simpler strategies lower WM individuals employed. WM availability influences how individuals approach math problems, with the nature of the task performed and the performance environment dictating skill success or failure. PsycINFO Database Record (c) 2007 APA, all rights reserved.

  19. Effective chronic disease management: patients' perspectives on medication-related problems.

    Science.gov (United States)

    Gordon, Karen; Smith, Felicity; Dhillon, Soraya

    2007-03-01

    To examine medication-related problems from the perspective of patients with a chronic condition and to identify how they may be supported in managing their medication. Patients prescribed medication for cardiovascular disease were recruited through five general medical surgeries and four community pharmacies in south London. Data were collected in 98 face-to-face interviews in participants' own homes. Interviews were designed to enable a detailed and holistic exploration of medication-related problems from participants' perspectives. Data were audio-recorded and transcribed verbatim to allow qualitative analysis. Five broad categories of medication-related problem emerged which were examined in the context of patients' perspectives on, and experiences of, the use of medicines and health services. These were concerns about and management of side effects; differing views regarding the use of medicines; cognitive, practical and sensory problems; lack of information or understanding; and problems with access to, and organisation of, services. All categories of problem had potential implications for the success of therapy in that they created barriers to adherence, access to medication or informed decision-making. The study demonstrated how patients actively engage in decision-making about their medicines in the home, if not in the consultation. The five categories of problem provide a focus for interventions by health professionals to support patients in achieving optimal theory outcomes. They demonstrate the need for a comprehensive approach, spanning patient education to the systems of delivery of care. Within the NHS in Britain, policy and practice initiatives are being designed to achieve this end. Further research should focus on the evaluation of professional practices and service developments in supporting patients in the self-management of their medicines.

  20. [Existant quality problems and suggestions for quality control of medical absorbent cotton].

    Science.gov (United States)

    Jiang, De-long; Chi, An-zheng; Zhang, Qi-hua

    2005-07-01

    In the process of acid hydrolysis of medical absorbent cotton, we have discovered that some of the domestic manufactured medical absorbent cotton is mixed with wasted non-cotton chemical fiber. If the cotton is used in medical treatments, the chemical fiber will cause irritation, allergy and inflammation, so it's very harmful. But the non-cotton fiber content is not stipulated in the standard of YY0330-2002, and no testing method for it is available. In this paper we discuss the existent quality problems, the control and the test method for non-cotton chemical fiber in medical absorbent cotton.

  1. Can Friedberg's Triad Solve Persistent Anesthesia Problems? Over-Medication, Pain Management, Postoperative Nausea and Vomiting.

    Science.gov (United States)

    Friedberg, Barry L

    2017-10-01

    Friedberg's Triad is (1) measure the brain; (2) preempt the pain; (3) emetic drugs abstain. Persistent anesthesia problems include over- and under-medication, postoperative pain management, and postoperative nausea and vomiting. Inspired by Vinnik's diazepam-ketamine paradigm, Friedberg's propofol ketamine paradigm was first published in 1993. The 1997 addition of the bispectral (BIS) index brain monitor made the propofol ketamine paradigm numerically reproducible. The 1998 addition of the frontalis electromyogram (EMG) as a secondary trend to the BIS transformed the time-delayed BIS monitor into a real-time, extremely useful device. Before BIS monitoring, anesthesiologists only had heart rate (HR) and blood pressure (BP) changes to guide depth of anesthesia. Not surprisingly, the American Society of Anesthesiologists' Awareness study showed no HR or BP changes in half of the patients experiencing awareness with recall. HR and BP changes may only reflect brain stem signs while consciousness and pain are processed at higher, cortical brain levels. BIS/electromyogram measurement can accurately reflect propofol effect on the cerebral cortex in real time. Although propofol requirements can vary as much as a hundred-fold, titrating propofol to 60 < BIS < 75 with baseline electromyogram assures every patient will be anesthetized to the same degree and allows more scientific analysis of outcomes. Numerous publications are cited to support the author's 25-year clinical experience. Over that period, no office-based, cosmetic surgery patients were admitted to the hospital for unmanageable pain or postoperative nausea and vomiting. Friedberg's Triad appears to solve persistent anesthesia problems.

  2. [The contamination under polymerase chain reaction studies: problems and solutions].

    Science.gov (United States)

    Titov, V N; Ameliushkina, V A; Rozhkova, T A

    2015-01-01

    The study was carried out to determine risk factors of false positive and false negative results under polymerase chain reaction-analysis of clinical material. The samples with high viral load can be the source of false positive results. The contamination with nucleic acids can occur at any section of polymerase chain reaction analysis. The study data permitted to establish that the most sensitive stage is isolation and purification of nucleic acids especially under manual mode of operation. The detection of positive signal in most samples of one setting indicates total contamination. The cases when only several samples are polluted are special challenge. The presence of sample with high concentration of viral nucleic acid and several samples with low concentration in one setting means necessity of repeated analysis beginning with stage of isolation of nucleic acid. The analysis of curves of accumulation of products of amplification, their forms and positioning on chart is the obligatory stage of polymerase chain reaction study in real time regimen. These actions permit to exclude the readouts of false negative testing results to departments. The study conclusions are equipotent for polymerase chain reaction testing of any nucleic acid targets.

  3. Incidence of and sequels to medical problems discovered in medical students during study-related activities

    NARCIS (Netherlands)

    Pols, J; Boendermaker, PM; Muntinghe, H

    2003-01-01

    Purpose Students often act as subjects during practical and clinical skills training sessions. This routine seems to be quite acceptable for them but may present side-effects. Disorders, sometimes of a serious nature, have been discovered in medical students during clinical skills training. Because

  4. Child and caregiver reported problems in using asthma medications and question-asking during paediatric asthma visits.

    Science.gov (United States)

    Sleath, Betsy; Carpenter, Delesha M; Beard, Ashley; Gillette, Christopher; Williams, Dennis; Tudor, Gail; Ayala, Guadalupe X

    2014-02-01

    The objectives of the study were to describe the extent to which lay caregivers and children who reported asthma medication problems asked medication questions during their medical visits. Children with asthma ages 8 through 16 years and their caregivers were recruited at five paediatric practices and their medical visits were audiotape recorded. Children were interviewed after their medical visits and caregivers completed questionnaires. A home visit was conducted 1 month later. Generalized estimating equations were used to analyse the data. Two hundred and ninety six families participated. Among those caregivers who reported asthma medication problems, only 35% had asked at least one medication question during the visit. Among children who reported asthma medication problems, only 11% had asked at least one medication question during their consultation. Caregivers and children who reported a problem with their asthma medications were significantly more likely to have asked medication questions if providers had asked more questions about control medications. Children who reported higher asthma management self-efficacy were significantly more likely to have asked an asthma medication question. Only one in three caregivers and one in 10 children who reported an asthma medication problem asked a question during their medical visits and many still reported these problems 1 month later. Pharmacists should encourage caregivers and children to report problems they may be having using their asthma medications. © 2013 Royal Pharmaceutical Society.

  5. Geriatric oncology: problems with under-treatment within this population.

    Science.gov (United States)

    Swaminathan, Divya; Swaminathan, Vikram

    2015-12-01

    We are currently faced with an aging population, which is rapidly growing worldwide. Two thirds of cancer occurs in the over 65-year age group. Societal conceptions from the past have created ageist stereotypes; old age is associated with frailty and the elderly are perceived to be destined for deterioration and loss of independence. Cancer within the elderly is also subject to these stereotypes, with elderly cancer patients considered by some not as likely to recover as younger patients with cancer. We summarise and review the current concerns regarding elderly management and treatments utilised for the management of oncological disease in the elderly, and discuss the impact of under-treatment within this population.

  6. 76 FR 31684 - Agency Information Collection (Medical Expense Report) Activity Under OMB Review

    Science.gov (United States)

    2011-06-01

    ... AFFAIRS Agency Information Collection (Medical Expense Report) Activity Under OMB Review AGENCY: Veterans...: Medical Expense Report, VA Form 21-8416. OMB Control Number: 2900-0161. Type of Review: Extension of a... income-based benefits to report medical expenses paid. Unreimbursed medical expenses may be excluded as...

  7. Distribution of Problems, Medications and Lab Results in Electronic Health Records: The Pareto Principle at Work.

    Science.gov (United States)

    Wright, Adam; Bates, David W

    2010-01-01

    BACKGROUND: Many natural phenomena demonstrate power-law distributions, where very common items predominate. Problems, medications and lab results represent some of the most important data elements in medicine, but their overall distribution has not been reported. OBJECTIVE: Our objective is to determine whether problems, medications and lab results demonstrate a power law distribution. METHODS: Retrospective review of electronic medical record data for 100,000 randomly selected patients seen at least twice in 2006 and 2007 at the Brigham and Women's Hospital in Boston and its affiliated medical practices. RESULTS: All three data types exhibited a power law distribution. The 12.5% most frequently used problems account for 80% of all patient problems, the top 11.8% of medications account for 80% of all medication orders and the top 4.5% of lab result types account for all lab results. CONCLUSION: These three data elements exhibited power law distributions with a small number of common items representing a substantial proportion of all orders and observations, which has implications for electronic health record design.

  8. Validation of a Crowdsourcing Methodology for Developing a Knowledge Base of Related Problem-Medication Pairs.

    Science.gov (United States)

    McCoy, A B; Wright, A; Krousel-Wood, M; Thomas, E J; McCoy, J A; Sittig, D F

    2015-01-01

    Clinical knowledge bases of problem-medication pairs are necessary for many informatics solutions that improve patient safety, such as clinical summarization. However, developing these knowledge bases can be challenging. We sought to validate a previously developed crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large, non-university health care system with a widely used, commercially available electronic health record. We first retrieved medications and problems entered in the electronic health record by clinicians during routine care during a six month study period. Following the previously published approach, we calculated the link frequency and link ratio for each pair then identified a threshold cutoff for estimated problem-medication pair appropriateness through clinician review; problem-medication pairs meeting the threshold were included in the resulting knowledge base. We selected 50 medications and their gold standard indications to compare the resulting knowledge base to the pilot knowledge base developed previously and determine its recall and precision. The resulting knowledge base contained 26,912 pairs, had a recall of 62.3% and a precision of 87.5%, and outperformed the pilot knowledge base containing 11,167 pairs from the previous study, which had a recall of 46.9% and a precision of 83.3%. We validated the crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large non-university health care system with a widely used, commercially available electronic health record, indicating that the approach may be generalizable across healthcare settings and clinical systems. Further research is necessary to better evaluate the knowledge, to compare crowdsourcing with other approaches, and to evaluate if incorporating the knowledge into electronic health records improves patient outcomes.

  9. Problems presented by medical students seeking support: a possible intervention framework.

    Science.gov (United States)

    Hays, Richard B; Lawson, Mary; Gray, Carol

    2011-01-01

    Academically bright and ambitious medical students must cope with a combination of curriculum, assessment, career choice, personal, family and social pressures. Many seek support, and some present complex problems that consume substantial resources. A few continue unresolved into postgraduate life and may affect future professional performance. Early intervention may be helpful in minimising the impact on both individual students and school resources. To develop a broad classification framework for personal problems presented by medical students to student support services. We report a study of more complex student problems presenting to student support services. A three stage iterative process, involving student support faculty from several international medical schools, discussed case scenarios based on pooled experience and developed a framework for categorising and considering management. Seven profiles of student problems were developed, based on composites of unidentified cases drawn from participants' experiences, reflecting: immaturity; learning skills; organisational skills; health or personal issues and poor insight. Broad characteristics and brief prognostic comments are provided for each profile. While profiles may overlap and each student may have a unique set of issues, there appears to be similarities that allow some categorisation for management strategies and prognostic features in both undergraduate and postgraduate medical education. Further work is needed to develop 'diagnostic' assessments that might guide intervention. This classification may assist early intervention into personal problems presented by medical students to student support services.

  10. KnowBaSICS-M: an ontology-based system for semantic management of medical problems and computerised algorithmic solutions.

    Science.gov (United States)

    Bratsas, Charalampos; Koutkias, Vassilis; Kaimakamis, Evangelos; Bamidis, Panagiotis D; Pangalos, George I; Maglaveras, Nicos

    2007-10-01

    In this paper, an ontology-based system (KnowBaSICS-M) is presented for the semantic management of Medical Computational Problems (MCPs), i.e., medical problems and computerised algorithmic solutions. The system provides an open environment, which: (1) allows clinicians and researchers to retrieve potential algorithmic solutions pertinent to a medical problem and (2) enables incorporation of new MCPs into its underlying Knowledge Base (KB). KnowBaSICS-M is a modular system for MCP acquisition and discovery that relies on an innovative ontology-based model incorporating concepts from the Unified Medical Language System (UMLS). Information retrieval (IR) is based on an ontology-based Vector Space Model (VSM) that estimates the similarity among user-defined MCP search criteria and registered MCP solutions in the KB. The results of a preliminary evaluation and specific examples of use are presented to illustrate the benefits of the system. KnowBaSICS-M constitutes an approach towards the construction of an integrated and manageable MCP repository for the biomedical research community.

  11. Agreement between questionnaire and medical records on some health and socioeconomic problems among poisoning cases

    Directory of Open Access Journals (Sweden)

    Fathelrahman Ahmed I

    2009-09-01

    Full Text Available Abstract Background The main objective of the present study was to evaluate the agreement between questionnaire and medical records on some health and socioeconomic problems among poisoning cases. Methods Cross-sectional sample of 100 poisoning cases consecutively admitted to the Hospital Pulau Pinang, Malaysia during the period from September 2003 to February 2004 were studied. Data on health and socioeconomic problems were collected both by self-administered questionnaire and from medical records. Agreement between the two sets of data was assessed by calculating the concordance rate, Kappa (k and PABAK. McNemar statistic was used to test differences between categories. Results Data collected by questionnaire and medical records showed excellent agreement on the "marital status"; good agreements on "chronic illness", "psychiatric illness", and "previous history of poisoning"; and fair agreements on "at least one health problem", and "boy-girl friends problem". PABAK values suggest better agreements' measures. Conclusion There were excellent to good agreements between questionnaire and medical records on the marital status and most of the health problems and fair to poor agreements on the majority of socioeconomic problems. The implications of those findings were discussed.

  12. Problem-based learning in undergraduate medical education in Saudi Arabia: time has come to reflect on the experience.

    Science.gov (United States)

    AlHaqwi, Ali Ibrahim; Mohamed, Tariq Awad; Al Kabba, Abdulaziz F; Alotaibi, Sultan S; Al Shehri, Ali M; Abdulghani, Hamza M; Badri, Motasim

    2015-04-01

    Problem-based learning (PBL) is being increasingly used in many undergraduate medical schools worldwide due to its recognized advantages. To explore views of medical students in the Kingdom of Saudi Arabia (KSA) about the appropriateness of the PBL concepts and process. Differences in students' views were examined as well. This is a cross-sectional, questionnaire-based study conducted in two medical colleges in Riyadh, Saudi Arabia, during the period from April to June 2012. One hundred seventy four undergraduate medical students participated in the study. Majority of the participants supported the concept of PBL and thought it is a beneficial learning strategy. However, only about half of them consider the problems used in tutorials are relevant for the local setting. Significant differences have been identified between the gender, schools, and study level of participants and their views on the process of PBL tutorials. About 35% of participants either undecided or will not recommend medical schools that adopt PBL curriculums for their friends. The majority of participants were satisfied with PBL approach and valued its importance in their learning process. Specific concerns have been expressed about relevance of some aspects of PBL. Underlying factors should be further explored in order to improve the outcomes of PBL curriculum in the local Saudi setting.

  13. Practical Problems with Medication Use that Older People Experience: A Qualitative Study

    Science.gov (United States)

    Notenboom, Kim; Beers, Erna; van Riet-Nales, Diana A; Egberts, Toine C G; Leufkens, Hubert G M; Jansen, Paul A F; Bouvy, Marcel L

    2014-01-01

    Objectives To identify the practical problems that older people experience with the daily use of their medicines and their management strategies to address these problems and to determine the potential clinical relevance thereof. Design Qualitative study with semistructured face-to-face interviews. Setting A community pharmacy and a geriatric outpatient ward. Participants Community-dwelling people aged 70 and older (N = 59). Measurements Participants were interviewed at home. Two researchers coded the reported problems and management strategies independently according to a coding scheme. An expert panel classified the potential clinical relevance of every identified practical problem and associated management strategy using a 3-point scale. Results Two hundred eleven practical problems and 184 management strategies were identified. Ninety-five percent of the participants experienced one or more practical problems with the use of their medicines: problems reading and understanding the instructions for use, handling the outer packaging, handling the immediate packaging, completing preparation before use, and taking the medicine. For 10 participants, at least one of their problems, in combination with the applied management strategy, had potential clinical consequences and 11 cases (5% of the problems) had the potential to cause moderate or severe clinical deterioration. Conclusion Older people experience a number of practical problems using their medicines, and their strategies to manage these problems are sometimes suboptimal. These problems can lead to incorrect medication use with clinically relevant consequences. The findings pose a challenge for healthcare professionals, drug developers, and regulators to diminish these problems. PMID:25516030

  14. Mental problems among first-year conservatory students compared with medical students.

    Science.gov (United States)

    van Fenema, E M; van Geel, C C J

    2014-06-01

    Musical education and the musical profession can be stressful, which may make musicians vulnerable for stress-related disorders. To determine if music students are particularly at risk for mental problems, we used the Standardised Assessment of Personality-Abbreviated Scale (SAPAS) and the Symptom Questionnaire (SQ48S) to compare symptoms in first-year conservatory students (n=33) and first-year medical students (n=43). On the SAPAS, we found that medical students have significantly more difficulty making and keeping friends (p=0.015). Also, we observed a trend that conservatory students lose their temper more easily (p=0.040). Both student groups showed high scores for the personality trait "perfectionism." On the SQ48, we observed a trend that both conservatory and medical students experience more psychological problems than the general population, but there were no significant differences between conservatory students and medical students in the total scores of both questionnaires.

  15. [Recommendations for overcoming interface problems in medical rehabilitation of federal pension funds and statutory health insurance].

    Science.gov (United States)

    Pohontsch, N; Träder, J-M; Scherer, M; Deck, R

    2013-10-01

    Interface problems in medical rehabilitation are a consequence of problems with communication and cooperation, lack of information and transparency. Different stakeholders are trying to solve these problems since many years or decades respectively. Following a series of deficit-oriented studies we tried to develop recommendations for possible solutions of important interface problems together with affected people based on a qualitative analysis of main problem areas. 10 separate group discussions with rehabilitation patients, general practitioners and specialists in private practices, representatives of the federal pension fund and statutory health insurance as well as clinicians from rehabilitation clinics and 3 mixed group discussions (all before mentioned groups excluding rehabilitation patients) were conducted. These group discussions served to prepare a semidiurnal final conference. All meetings were recorded and content analyzed or summarized in protocols respectively. Results are recommendations on strategies to reduce interface problems in medical rehabilitation. Those are: development of a rehabilitation-information-website for insurees and general practitioners and specialists in private practices; changes in forms, applications, notifications; advanced training for general practitioners and specialists in private practices und support in detecting rehabilitation need. Due to divided structures of care provision and increasing specialization, overcoming interface problems is one of the main challenges in the provision of medical rehabilitation. It can be met if different stakeholder approach each other without prejudices, share instead of demarcate competencies and are willing to strike new paths. Our recommendations represent the first step to reaching this goal. © Georg Thieme Verlag KG Stuttgart · New York.

  16. MOBILE PHONE USE PATTERN AND SELF REPORTED HEALTH PROBLEMS AMONG MEDICAL STUDENTS

    OpenAIRE

    Sumit; Vincy; Sony

    2016-01-01

    Pattern of mobile phone use and self-reported health problems related to over use of the mobile phones are assessed among the medical students of Travancore Medical College, Kollam. MATERIALS AND METHODS Study design: Cross-sectional study. Sample size: 200 students; Sampling technique: Convenient sampling; Data analysis: Data was entered in MS Excel and analysed by SPSS 20. RESULTS A total of 200 students and interns participated in the study and among them ...

  17. More on the fragility of performance: choking under pressure in mathematical problem solving.

    Science.gov (United States)

    Beilock, Sian L; Kulp, Catherine A; Holt, Lauren E; Carr, Thomas H

    2004-12-01

    In 3 experiments, the authors examined mathematical problem solving performance under pressure. In Experiment 1, pressure harmed performance on only unpracticed problems with heavy working memory demands. In Experiment 2, such high-demand problems were practiced until their answers were directly retrieved from memory. This eliminated choking under pressure. Experiment 3 dissociated practice on particular problems from practice on the solution algorithm by imposing a high-pressure test on problems practiced 1, 2, or 50 times each. Infrequently practiced high-demand problems were still performed poorly under pressure, whereas problems practiced 50 times each were not. These findings support distraction theories of choking in math, which contrasts with considerable evidence for explicit monitoring theories of choking in sensorimotor skills. This contrast suggests a skill taxonomy based on real-time control structures. (c) 2004 APA

  18. Compendium to radiation physics for medical physicists. 300 problems and solutions

    International Nuclear Information System (INIS)

    Podgorsak, Ervin B.

    2014-01-01

    Can be used in combination with other textbooks. Exercise book for graduate and undergraduate students of medical physics and engineering. Well chosen and didactically presented problems. Perfect set for learning in connection with the textbook by Podgorsak and others. Detailed derivation of results with many detailed illustrations. Fully worked-out solutions to exercises/questions. Combines exercises in radiation physics and medical physics. This exercise book contains 300 typical problems and exercises in modern physics and radiation physics with complete solutions, detailed equations and graphs. This textbook is linked directly with the textbook ''Radiation Physics for Medical Physicists'', Springer (2010) but can also be used in combination with other related textbooks. For ease of use, this textbook has exactly the same organizational layout (14 chapters, 128 sections) as the ''Radiation Physics for Medical Physicists'' textbook and each section is covered by at least one problem with solution given. Equations, figures and tables are cross-referenced between the two books. It is the only large compilation of textbook material and associated solved problems in medical physics, radiation physics, and biophysics.

  19. [Medical education under the Revolution and the Empire].

    Science.gov (United States)

    Legaye, Jean

    2014-01-01

    After the suppression of medical education during the French revolution in 1793, the lack of caregivers is dramatic, especially in the army. The medical education is therefore rehabilitated in 1794 in 3 (then 6) Health Schools, which will become Schools of Medicine and Faculties of Medicine, incorporated in 1808 into then Imperial University. During 3 years, the courses are theoretical and also based on a practical teaching on the patient. The defense of a thesis provides access to the title of doctor in medicine or surgery and allows practicing for all the pathologies on the entire territory of the Empire. Meanwhile, medical courses are given in military hospitals to train officers of health. They are dedicated for the service of the army and for minor diseases in rural areas. They are authorized to practice only in the department in which they were received. The inspectors general provide medical education directly in the military medical structures and conduct examinations about medical care. This type of career is illustrated by the biography of Surgeon Major François Augustin Legaÿ.

  20. Dynamic composition of semantic pathways for medical computational problem solving by means of semantic rules.

    Science.gov (United States)

    Bratsas, Charalampos; Bamidis, Panagiotis; Kehagias, Dionisis D; Kaimakamis, Evangelos; Maglaveras, Nicos

    2011-03-01

    This paper presents a semantic rule-based system for the composition of successful algorithmic pathways capable of solving medical computational problems (MCPs). A subset of medical algorithms referring to MCP solving concerns well-known medical problems and their computational algorithmic solutions. These solutions result from computations within mathematical models aiming to enhance healthcare quality via support for diagnosis and treatment automation, especially useful for educational purposes. Currently, there is a plethora of computational algorithms on the web, which pertain to MCPs and provide all computational facilities required to solve a medical problem. An inherent requirement for the successful construction of algorithmic pathways for managing real medical cases is the composition of a sequence of computational algorithms. The aim of this paper is to approach the composition of such pathways via the design of appropriate finite-state machines (FSMs), the use of ontologies, and SWRL semantic rules. The goal of semantic rules is to automatically associate different algorithms that are represented as different states of the FSM in order to result in a successful pathway. The rule-based approach is herein implemented on top of Knowledge-Based System for Intelligent Computational Search in Medicine (KnowBaSICS-M), an ontology-based system for MCP semantic management. Preliminary results have shown that the proposed system adequately produces algorithmic pathways in agreement with current international medical guidelines.

  1. 29 CFR 1904.9 - Recording criteria for cases involving medical removal under OSHA standards.

    Science.gov (United States)

    2010-07-01

    ... under OSHA standards. 1904.9 Section 1904.9 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL... removal under OSHA standards. (a) Basic requirement. If an employee is medically removed under the medical surveillance requirements of an OSHA standard, you must record the case on the OSHA 300 Log. (b) Implementation...

  2. Writing Problems in Developmental Dyslexia: Under-Recognized and Under-Treated2,3

    OpenAIRE

    Berninger, Virginia W.; Nielsen, Kathleen H.; Abbott, Robert D.; Wijsman, Ellen; Raskind, Wendy

    2008-01-01

    The International Dyslexia Association defines dyslexia as unexpected problems of neurobiological origin in accuracy and rate of oral reading of single real words, single pseudowords, or text or of written spelling. However, prior research has focused more on the reading than the spelling problems of students with dyslexia. A test battery was administered to 122 children who met inclusion criteria for dyslexia and qualified their families for participation in a family genetics study that has ...

  3. Natural language processing to extract medical problems from electronic clinical documents: performance evaluation.

    Science.gov (United States)

    Meystre, Stéphane; Haug, Peter J

    2006-12-01

    In this study, we evaluate the performance of a Natural Language Processing (NLP) application designed to extract medical problems from narrative text clinical documents. The documents come from a patient's electronic medical record and medical problems are proposed for inclusion in the patient's electronic problem list. This application has been developed to help maintain the problem list and make it more accurate, complete, and up-to-date. The NLP part of this system-analyzed in this study-uses the UMLS MetaMap Transfer (MMTx) application and a negation detection algorithm called NegEx to extract 80 different medical problems selected for their frequency of use in our institution. When using MMTx with its default data set, we measured a recall of 0.74 and a precision of 0.756. A custom data subset for MMTx was created, making it faster and significantly improving the recall to 0.896 with a non-significant reduction in precision.

  4. Medical examination of school entrants: later school problems and absenteeism of attenders and non-attenders.

    Science.gov (United States)

    Mowat, D L; White, C

    1985-01-01

    Children who were scheduled for medical examination before entering school were followed in school one or two years later. Non-attenders had a two-fold risk of repeating grades, special class placement, referral for speech/language problems, teacher-reported learning or behavior problems, failure of vision or hearing screening, and transfer between schools. Absenteeism was also significantly more common. Children not brought in for preventive health care are at greater risk than others for difficulties in school. PMID:3976966

  5. [Current situations and problems of quality control for medical imaging display systems].

    Science.gov (United States)

    Shibutani, Takayuki; Setojima, Tsuyoshi; Ueda, Katsumi; Takada, Katsumi; Okuno, Teiichi; Onoguchi, Masahisa; Nakajima, Tadashi; Fujisawa, Ichiro

    2015-04-01

    Diagnostic imaging has been shifted rapidly from film to monitor diagnostic. Consequently, Japan medical imaging and radiological systems industries association (JIRA) have recommended methods of quality control (QC) for medical imaging display systems. However, in spite of its need by majority of people, executing rate is low. The purpose of this study was to validate the problem including check items about QC for medical imaging display systems. We performed acceptance test of medical imaging display monitors based on Japanese engineering standards of radiological apparatus (JESRA) X-0093*A-2005 to 2009, and performed constancy test based on JESRA X-0093*A-2010 from 2010 to 2012. Furthermore, we investigated the cause of trouble and repaired number. Medical imaging display monitors had 23 inappropriate monitors about visual estimation, and all these monitors were not criteria of JESRA about luminance uniformity. Max luminance was significantly lower year-by-year about measurement estimation, and the 29 monitors did not meet the criteria of JESRA about luminance deviation. Repaired number of medical imaging display monitors had 25, and the cause was failure liquid crystal panel. We suggested the problems about medical imaging display systems.

  6. Effects of problem-based discussion on studying a subsequent text: A randomized trial among first year medical students

    NARCIS (Netherlands)

    W.S. de Grave; H.G. Schmidt (Henk); H.P.A. Boshuizen (Henny)

    2001-01-01

    textabstractThe Purpose of this study was to examine effects of group discussion of a medical problem on the comprehension of a subsequent problem-relevant text by first year medical students. Forty-eight first-year medical students were randomly assigned to one of two conditions: The experimental

  7. Evaluation of disposable medical device packaging materials under ozone sterilization

    Directory of Open Access Journals (Sweden)

    Gerson Roberto Luqueta

    Full Text Available Abstract Introduction Ozonization is an alternative sterilization process for heat-sensitive medical devices. However, the side effects of this process on packaging materials should be verified. Methods Four types of commercial disposable packaging for medical devices were evaluated after undergoing ozone sterilization: crepe paper sheet, non-woven fabric sheet (SMS, medical grade paper-plastic pouch and Tyvec©-plastic pouch. For each material, the gas penetration through the microbiological barrier was measured. Other packaging properties, such as chemical composition, color, tactile and mechanical resistance, were also evaluated after sterilization, by using characterization techniques, namely microbiological indicators, infrared spectroscopy, tensile test and optical microscopy. Results All commercial disposable packaging showed good ozone penetration. Crepe paper and SMS were chemically and mechanically modified by ozone, while Tyvec© only suffered mechanical modification. Paper-plastic pouch was the packaging material which just experienced an acceptable reduction in tensile resistance, showing no variations on chemical or visual properties. Conclusion The results suggest that medical grade paper-plastic pouch is the most appropriate disposable medical device packaging to be sterilized by ozone when compared to other materials.

  8. Evaluation of Medical Problem Extraction from Electronic Clinical Documents Using MetaMap Transfer (MMTx).

    Science.gov (United States)

    Meystre, Stéphane; Haug, Peter J

    2005-01-01

    To improve the use and quality of the electronic Problem List, which is at the heart of the problem-oriented medical record in development in our institution (Intermountain Health Care, Utah, U.S.), we developed an Automated Problem List system using Natural Language Processing (NLP) technologies. A key part of this system is a module that automatically extracts potential medical problems from free-text clinical documents. The NLP module uses MMTx, developed at the U.S. National Library of Medicine. Negation detection was added to this application by adapting a negation detection algorithm called NegEx. To evaluate the adequacy of the performance of the NLP module for our Automated Problem List system, we evaluated it with 160 electronic clinical documents of different types. Two different data sets for MMTx were used: the default full UMLS data set and a customised subset adapted to detect the set of 80 medical problems we are interested in. With the default data set, we measured a recall of 0.74 (95% CI 0.68-0.8) and a precision of 0.76 (0.69-0.82). The customised subset had a significantly better recall of 0.9 (0.85-0.94), and a non-significantly different precision of 0.69 (0.63-0.75).

  9. Writing problems in developmental dyslexia: under-recognized and under-treated.

    Science.gov (United States)

    Berninger, Virginia W; Nielsen, Kathleen H; Abbott, Robert D; Wijsman, Ellen; Raskind, Wendy

    2008-02-01

    The International Dyslexia Association defines dyslexia as unexpected problems of neurobiological origin in accuracy and rate of oral reading of single real words, single pseudowords, or text or of written spelling. However, prior research has focused more on the reading than the spelling problems of students with dyslexia. A test battery was administered to 122 children who met inclusion criteria for dyslexia and qualified their families for participation in a family genetics study that has been ongoing for over a decade. Their parents completed the same test battery. Although a past structural equation modeling study of typically developing children identified a significant path from handwriting to composition quality, the current structural equation modeling study identified a significant path from spelling to composition for children and their parents with dyslexia. Grapho-motor planning did not contribute uniquely to their composition, showing that writing is not just a motor skill. Students with dyslexia do have a problem in automatic letter writing and naming, which was related to impaired inhibition and verbal fluency, and may explain their spelling problems. Results are discussed in reference to the importance of providing explicit instruction in the phonological, orthographic, and morphological processes of spelling and in composition to students with dyslexia and not only offering accommodation for their writing problems.

  10. Transplant ethics under scrutiny – responsibilities of all medical professionals

    Science.gov (United States)

    Trey, Torsten; Caplan, Arthur L.; Lavee, Jacob

    2013-01-01

    In this text, we present and elaborate ethical challenges in transplant medicine related to organ procurement and organ distribution, together with measures to solve such challenges. Based on internationally acknowledged ethical standards, we looked at cases of organ procurement and distribution practices that deviated from such ethical standards. One form of organ procurement is known as commercial organ trafficking, while in China the organ procurement is mostly based on executing prisoners, including killing of detained Falun Gong practitioners for their organs. Efforts from within the medical community as well as from governments have contributed to provide solutions to uphold ethical standards in medicine. The medical profession has the responsibility to actively promote ethical guidelines in medicine to prevent a decay of ethical standards and to ensure best medical practices. PMID:23444249

  11. Medication-related problem type and appearance rate in ambulatory hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Drayer Debra K

    2003-12-01

    Full Text Available Abstract Background Hemodialysis (HD patients are at risk for medication-related problems (MRP. The MRP number, type, and appearance rate over time in ambulatory HD patients has not been investigated. Methods Randomly selected HD patients were enrolled to receive monthly pharmaceutical care visits. At each visit, MRP were identified through review of the patient chart, electronic medical record, patient interview, and communications with other healthcare disciplines. All MRP were categorized by type and medication class. MRP appearance rate was determined as the number of MRP identified per month/number of months in study. The number of MRP per patient-drug exposures were determined using: {[(number of patients × (mean number of medications]/(number of months of study} /number of MRP identified. Results were expressed as mean ± standard deviation or percentages. Results Patients were 62.6 ± 15.9 years old, had 6.4 ± 2.0 comorbid conditions, were taking 12.5 ± 4.2 medications, and 15.7 ± 7.2 doses per day at baseline. Medication-dosing problems (33.5%, adverse drug reactions (20.7%, and an indication that was not currently being treated (13.5% were the most common MRP. 5,373 medication orders were reviewed and a MRP was identified every 15.2 medication exposures. Overall MRP appearance rate was 0.68 ± 0.46 per patient per month. Conclusion MRP continue to occur at a high rate in ambulatory HD patients. Healthcare providers taking care of HD patients should be aware of this problem and efforts to avoid or resolve MRP should be undertaken at all HD clinics.

  12. Medication management and practices in prison for people with mental health problems: a qualitative study

    Directory of Open Access Journals (Sweden)

    Rogers Anne

    2009-10-01

    Full Text Available Abstract Background Common mental health problems are prevalent in prison and the quality of prison health care provision for prisoners with mental health problems has been a focus of critical scrutiny. Currently, health policy aims to align and integrate prison health services and practices with those of the National Health Service (NHS. Medication management is a key aspect of treatment for patients with a mental health problem. The medication practices of patients and staff are therefore a key marker of the extent to which the health practices in prison settings equate with those of the NHS. The research reported here considers the influences on medication management during the early stages of custody and the impact it has on prisoners. Methods The study employed a qualitative design incorporating semi-structured interviews with 39 prisoners and 71 staff at 4 prisons. Participant observation was carried out in key internal prison locations relevant to the management of vulnerable prisoners to support and inform the interview process. Thematic analysis of the interview data and interpretation of the observational field-notes were undertaken manually. Emergent themes included the impact that delays, changes to or the removal of medication have on prisoners on entry to prison, and the reasons that such events take place. Results and Discussion Inmates accounts suggested that psychotropic medication was found a key and valued form of support for people with mental health problems entering custody. Existing regimes of medication and the autonomy to self-medicate established in the community are disrupted and curtailed by the dominant practices and prison routines for the taking of prescribed medication. The continuity of mental health care is undermined by the removal or alteration of existing medication practice and changes on entry to prison which exacerbate prisoners' anxiety and sense of helplessness. Prisoners with a dual diagnosis are likely

  13. Development of a new diabetes medication self-efficacy scale and its association with both reported problems in using diabetes medications and self-reported adherence

    Science.gov (United States)

    Sleath, Betsy; Carpenter, Delesha M; Blalock, Susan J; Davis, Scott A; Hickson, Ryan P; Lee, Charles; Ferreri, Stefanie P; Scott, Jennifer E; Rodebaugh, Lisa B; Cummings, Doyle M

    2016-01-01

    Background Although there are several different general diabetes self-efficacy scales, there is a need to develop a self-efficacy scale that providers can use to assess patient’s self-efficacy regarding medication use. The purpose of this study was to: 1) develop a new diabetes medication self-efficacy scale and 2) examine how diabetes medication self-efficacy is associated with patient-reported problems in using diabetes medications and self-reported adherence. Patients and methods Adult English-speaking patients with type 2 diabetes were recruited from a family medicine clinic and a pharmacy in Eastern North Carolina, USA. The patients were eligible if they reported being nonadherent to their diabetes medicines on a visual analog scale. Multivariable regression was used to examine the relationship between self-efficacy and the number of reported diabetes medication problems and adherence. Results The diabetes medication self-efficacy scale had strong reliability (Cronbach’s alpha =0.86). Among a sample (N=51) of mostly African-American female patients, diabetes medication problems were common (6.1±3.1) and a greater number of diabetes medications were associated with lower medication adherence (odds ratio: 0.35; 95% confidence interval: 0.13, 0.89). Higher medication self-efficacy was significantly related to medication adherence (odds ratio: 1.17; 95% confidence interval: 1.05, 1.30) and inversely related to the number of self-reported medication problems (β=−0.13; P=0.006). Conclusion Higher diabetes medication self-efficacy was associated with fewer patient-reported medication problems and better medication adherence. Assessing medication-specific self-efficacy may help to identify medication-related problems that providers can help the patients address, potentially improving adherence and patient outcomes. PMID:27354769

  14. On Management Problem of Energy Use at Medical Institutions in Morocco

    Directory of Open Access Journals (Sweden)

    М. Ait Bahajou

    2012-01-01

    Full Text Available The paper considers problems of rational energy use at  medical institutions inMoroccowithin the context of general energy policy and promotion of the ISO 50001:2011 “Energy management systems – Requirements with guidance for use” requirements in one of the largest hospitals of the country.

  15. A Test of Problem Behavior and Self-Medication Theories in Incarcerated Adolescent Males

    Science.gov (United States)

    Esposito-Smythers, Christianne; Penn, Joseph V.; Stein, L. A. R.; Lacher-Katz, Molly; Spirito, Anthony

    2008-01-01

    The purpose of this study is to examine the problem behavior and self-medication models of alcohol abuse in incarcerated male adolescents. Male adolescents (N = 56) incarcerated in a juvenile correction facility were administered a battery of psychological measures. Approximately 84% of adolescents with clinically significant alcohol-related…

  16. Structured Medication Review to Improve Pharmacotherapy in People with Intellectual Disability and Behavioural Problems.

    Science.gov (United States)

    Scheifes, Arlette; Egberts, Toine C G; Stolker, Joost Jan; Nijman, Henk L I; Heerdink, Eibert R

    2016-07-01

    Polypharmacy and chronic drug use are common in people with intellectual disability and behavioural problems, although evidence of effectiveness and safety in this population is lacking. This study examined the effects of a structured medication review and aimed to improve pharmacotherapy in inpatients with intellectual disability. In a treatment facility for people with mild to borderline intellectual disability and severe behavioural problems, a structured medication review was performed. Prevalence and type of drug-related problems (DRPs) and of the recommended and executed actions were calculated. In a total of 55 patients with intellectual disability and behavioural problems, 284 medications were prescribed, in which a DRP was seen in 106 (34%). No indication/unclear indication was the most prevalent DRP (70). Almost 60% of the recommended actions were also executed. This high prevalence of DRPs is worrying. The structured medication review is a valuable instrument to optimize pharmacotherapy and to support psychiatrists in adequate prescribing of both psychotropic and somatic drugs. © 2015 John Wiley & Sons Ltd.

  17. Structured Medication Review to Improve Pharmacotherapy in People with Intellectual Disability and Behavioural Problems

    Science.gov (United States)

    Scheifes, Arlette; Egberts, Toine C. G.; Stolker, Joost Jan; Nijman, Henk. L. I.; Heerdink, Eibert R.

    2016-01-01

    Background: Polypharmacy and chronic drug use are common in people with intellectual disability and behavioural problems, although evidence of effectiveness and safety in this population is lacking. This study examined the effects of a structured medication review and aimed to improve pharmacotherapy in inpatients with intellectual disability.…

  18. Investigation of medical board reports of disability due to mental health problems

    Directory of Open Access Journals (Sweden)

    Mesut Yildiz

    2016-06-01

    Conclusion: We think that this report might be helpful for regulations related to disabled people, and might guide adult psychiatric services for patients who present to medical boards for disability due to mental health problems. [Cukurova Med J 2016; 41(2.000: 253-258

  19. Problem Based Learning (PBL) - An Effective Approach to Improve Learning Outcomes in Medical Teaching.

    Science.gov (United States)

    Preeti, Bajaj; Ashish, Ahuja; Shriram, Gosavi

    2013-12-01

    As the "Science of Medicine" is getting advanced day-by-day, need for better pedagogies & learning techniques are imperative. Problem Based Learning (PBL) is an effective way of delivering medical education in a coherent, integrated & focused manner. It has several advantages over conventional and age-old teaching methods of routine. It is based on principles of adult learning theory, including student's motivation, encouragement to set goals, think critically about decision making in day-to-day operations. Above all these, it stimulates challenge acceptance and learning curiosity among students and creates pragmatic educational program. To measure the effectiveness of the "Problem Based Learning" as compared to conventional theory/didactic lectures based learning. The study was conducted on 72 medical students from Dayanand Medical College & Hospital, Ludhiana. Two modules of problem based sessions designed and delivered. Pre & Post-test score's scientific statistical analysis was done. Student feed-back received based on questionnaire in the five-point Likert scale format. Significant improvement in overall performance observed. Feedback revealed majority agreement that "Problem-based learning" helped them create interest (88.8 %), better understanding (86%) & promotes self-directed subject learning (91.6 %). Substantial improvement in the post-test scores clearly reveals acceptance of PBL over conventional learning. PBL ensures better practical learning, ability to create interest, subject understanding. It is a modern-day educational strategy, an effective tool to objectively improve the knowledge acquisition in Medical Teaching.

  20. Tracks to a Medical Diagnosis: Expertise Differences in Visual Problem Solving

    NARCIS (Netherlands)

    Jaarsma, Thomas; Boshuizen, Els; Jarodzka, Halszka; Nap, Marius; Verboon, Peter; Van Merriënboer, Jeroen

    2018-01-01

    This study focuses on the visual problem-solving process of clinical pathologists. Its aim is to find expertise-related differences in the temporal arrangement of this process, with a special focus on the orientation phase. A theoretical model of the visual diagnostic process of medical specialists

  1. Motivational Influences of Using Peer Evaluation in Problem-Based Learning in Medical Education

    Science.gov (United States)

    Abercrombie, Sara; Parkes, Jay; McCarty, Teresita

    2015-01-01

    This study investigates the ways in which medical students' achievement goal orientations (AGO) affect their perceptions of learning and actual learning from an online problem-based learning environment, Calibrated Peer Review™. First, the tenability of a four-factor model (Elliot & McGregor, 2001) of AGO was tested with data collected from…

  2. Implementation of problem-based learning in medical education in Korea

    Directory of Open Access Journals (Sweden)

    Sanghee Yeo

    2017-12-01

    Full Text Available Purpose This study aims to identify how problem-based learning (PBL has been implemented in Korean medical education, and how it is evaluated by each medical school. Methods For this study, a total of 40 medical schools in Korea were surveyed via e-mail. The survey tool was a questionnaire consisting of 22 questions which was developed independently by the researchers. Results Of the 40 medical schools, 35 schools were implementing PBL programs in their medical curriculum, while five were found not currently to be running the program. A large number of the schools which introduced PBL (30 schools, 85.7% used a hybrid PBL model. In over 70% of the medical schools surveyed, professors evaluated the effects of PBL as positive. Most medical schools (85.7% stated they would maintain or expand their use of PBL. However, the lack of understanding and skeptical attitude of the faculty on PBL, the lack of self-study time and passive attitude of students, insufficiency of good PBL cases, and the perfunctory PBL introduction for school accreditation interfere with the successful PBL. Conclusion PBL has been incorporated in Korean medical curriculum as hybrid PBL type. It is analyzed that intensive tutor training and good PBL case development are necessary for the success and effective operation of PBL.

  3. Implementation of problem-based learning in medical education in Korea.

    Science.gov (United States)

    Yeo, Sanghee; Chang, Bong Hyun

    2017-12-01

    This study aims to identify how problem-based learning (PBL) has been implemented in Korean medical education, and how it is evaluated by each medical school. For this study, a total of 40 medical schools in Korea were surveyed via e-mail. The survey tool was a questionnaire consisting of 22 questions which was developed independently by the researchers. Of the 40 medical schools, 35 schools were implementing PBL programs in their medical curriculum, while five were found not currently to be running the program. A large number of the schools which introduced PBL (30 schools, 85.7%) used a hybrid PBL model. In over 70% of the medical schools surveyed, professors evaluated the effects of PBL as positive. Most medical schools (85.7%) stated they would maintain or expand their use of PBL. However, the lack of understanding and skeptical attitude of the faculty on PBL, the lack of self-study time and passive attitude of students, insufficiency of good PBL cases, and the perfunctory PBL introduction for school accreditation interfere with the successful PBL. PBL has been incorporated in Korean medical curriculum as hybrid PBL type. It is analyzed that intensive tutor training and good PBL case development are necessary for the success and effective operation of PBL.

  4. Update on research and application of problem-based learning in medical science education.

    Science.gov (United States)

    Fan, Chuifeng; Jiang, Biying; Shi, Xiuying; Wang, Enhua; Li, Qingchang

    2017-12-29

    Problem-based learning (PBL) is a unique form of pedagogy dedicated to developing students' self-learning and clinical practice skills. After several decades of development, although applications vary, PBL has been recognized all over the world and implemented by many medical schools. This review summarizes and updates the application and study of PBL in medical education through the literature published between 1993 and early 2017. It focuses on understanding real medical PBL courses and ways to improve PBL to achieve better learning outcomes. PBL aims to develop lifelong skills to solve practical problems rather than limiting learning to theoretical knowledge. To achieve this goal, strict and reasonable procedures need to be designed and implemented. Rigorous monitoring and timely feedback and evaluation are indispensable to constant improvements and perfecting of the process. © 2017 by The International Union of Biochemistry and Molecular Biology, 2017. © 2018 The International Union of Biochemistry and Molecular Biology.

  5. Problems of overcoming medical consequences of nuclear tests at the former Semipalatinsk test site (STS)

    International Nuclear Information System (INIS)

    Devyatko, V.N.

    1997-01-01

    Tests conducted for many years resulted in large radioactive contamination of Semipalatinsk, East Kazakhstan, Pavlodar and Karaganda regions. About 1,5 million people underwent multiple acute and chronic influence of small ionizing radiation doses basically.In this connection Ministry of Heals Protection and Social Protection Organizations are worried about the problem of recovering and rehabilitating the population of the above regions. to solve these problems Ministry of Health Protection Republic of Kazakhstan established Scientific Research Institutes of Medicine and Ecology in Semipalatinsk and regional Medical and Diagnostic Center in Kurchatov. With the help of regional Administrations there were created medical centers: diagnostic, children's, recovering, ophthalmological, of motherhood and childhood protection. Work on creating State National Medical Registration for people who underwent influence of ionizing radiation is being performed

  6. Problem based learning as a curricular strategy for medical undergraduates: a tutor's experience.

    Science.gov (United States)

    Luthra, K; Das, N

    1998-12-01

    This article focuses on the experiences and role of a tutor while conducting a problem based learning (PBL) exercise to facilitate the learning of biochemistry and molecular biology. A case presentation of sickle cell anemia was used to frame a module. The objective of this experimental exercise was to assess the suitability and effectiveness of problem based learning in the first year of undergraduate medical course and to practice self-assessment by tutors in this new role of a facilitator of learning through small group discussion. A tutor during such a learning session encouraged the students to apply their reasoning to analyze the problem and to develop self-directed learning skills in acquiring the knowledge appropriate to their perceived needs to work on a problem. The tutors ensured that they apply this knowledge in their work with other similar problems that they would encounter later in life.

  7. Prevalence and correlates of sleep-related problems in adults receiving medical cannabis for chronic pain.

    Science.gov (United States)

    Cranford, James A; Arnedt, J Todd; Conroy, Deirdre A; Bohnert, Kipling M; Bourque, Carrie; Blow, Frederic C; Ilgen, Mark

    2017-11-01

    To examine the prevalence and correlates of sleep problems in a sample of medical cannabis patients. Adults ages 21 and older (N=801,M age=45.8) who were seeking medical cannabis certification (either for the first time or as a renewal) for chronic pain at medical cannabis clinics in southern Michigan completed baseline measures of cannabis use, sleep, pain, and other related constructs. Over half of the sample (59%) met criteria for past 1-month sleep disturbance, defined as at least one sleep problem occurring on 15 or more nights in the past month. Most participants (86%) reported that sleep problems were due to their current pain. Approximately 80% of participants reported using cannabis in the past 6 months to improve sleep and, among these participants, cannabis was rated as helpful for improving sleep. Sleep-related cannabis side effects were rare (35%), but sleep-related cannabis withdrawal symptoms were relatively common (65%). Statistically significant correlates of past 1-month sleep disturbance included a) being female, b) being white, c) being on disability, d) not having a medical cannabis card, and e) frequency of using cannabis to help sleep. Sleep problems are highly prevalent and frequent in medical cannabis patients and are closely tied to pain. Sleep-related cannabis withdrawal symptoms are relatively common but their clinical relevance is unknown. The association between frequency of cannabis use to help sleep with higher odds of sleep problems will need to be clarified by longitudinal studies. Copyright © 2017 Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

    Baig, Lubna A

    2006-09-01

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

  9. Innovation under Regulatory Uncertainty: Evidence from Medical Technology.

    Science.gov (United States)

    Stern, Ariel Dora

    2017-01-01

    This paper explores how the regulatory approval process affects innovation incentives in medical technologies. Prior studies have found early mover regulatory advantages for drugs. I find the opposite for medical devices, where pioneer entrants spend 34 percent (7.2 months) longer than follow-on entrants in regulatory approval. Back-of-the- envelope calculations suggest that the cost of a delay of this length is upwards of 7 percent of the total cost of bringing a new high-risk device to market. Considering potential explanations, I find that approval times are largely unrelated to technological novelty, but are meaningfully reduced by the publication of objective regulatory guidelines. Finally, I consider how the regulatory process affects small firms' market entry patterns and find that small firms are less likely to be pioneers in new device markets, a fact consistent with relatively higher costs of doing so for more financially constrained firms.

  10. Preparing foundation-year students for medical studies in a problem-based learning environment

    DEFF Research Database (Denmark)

    Du, Xiangyun; Massoud, Walid; Al-Banna, Nadia Ali

    2016-01-01

    students with these skills. Methods: A 10-point scale online questionnaire consisting of 20 questions was used for data collection. 50 out of the 59 (19 males and 31 females) students responded and self-evaluated a list of learning skills according to the course objectives before and after the course......Purpose: To contribute to the field of preparing new students for their medical studies and to investigate how foundation-year medical students perceive the progression of appropriate learning skills for studying in a PBL medical curriculum via the support of a course aiming at facilitating......- and post-test was high (2.38). Paired t-tests showed significant improvements (po.001) for each of the 4 factors. The four factors together explained 60.7% percent of variance in the data. Discussion: Students reported large improvements among learning skills required in a problem-based medical curriculum...

  11. Severe childhood obesity: an under-recognised and growing health problem.

    Science.gov (United States)

    Bass, Rosara; Eneli, Ihuoma

    2015-11-01

    Childhood obesity is a serious and urgent public health problem. In the last 10 years, there has been a concerted effort in the USA and globally to develop and implement educational, medical and public health interventions designed to attenuate its growth. The success of these efforts was probably responsible for the plateau in the prevalence rate of childhood obesity noted in the last two years. While the attenuation of the overall prevalence of childhood obesity is promising, data from the same cohort reveal a concerning upward trend in the number of children with severe obesity. The consequences of severe childhood obesity can be devastating. When compared to their moderately obese peers, children with severe obesity are at greater risk for adult obesity, early atherosclerosis, hypertension, type 2 diabetes, metabolic syndrome, fatty liver disease and premature death. The determinants for severe obesity include the same lifestyle, environmental, familial and societal risk factors reported for overweight or obesity. While all these risk factors must be screened for, genetic influences are distinct considerations that may have greater bearing especially with early-onset obesity. Treatments for severe childhood obesity include lifestyle intervention, specialised low-calorie diets and bariatric surgery. Outcomes of these treatments vary, with bariatric surgery clearly the most successful of the three for both short-term and long-term weight loss. Severe obesity in children and adolescents remains a challenging health condition. The enormous medical, emotional and financial burden these children and their families endure signals an urgent need to further investigate and standardise treatment modalities and improve outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  12. Practical problems with medication use that older people experience: a qualitative study.

    Science.gov (United States)

    Notenboom, Kim; Beers, Erna; van Riet-Nales, Diana A; Egberts, Toine C G; Leufkens, Hubert G M; Jansen, Paul A F; Bouvy, Marcel L

    2014-12-01

    To identify the practical problems that older people experience with the daily use of their medicines and their management strategies to address these problems and to determine the potential clinical relevance thereof. Qualitative study with semistructured face-to-face interviews. A community pharmacy and a geriatric outpatient ward. Community-dwelling people aged 70 and older (N = 59). Participants were interviewed at home. Two researchers coded the reported problems and management strategies independently according to a coding scheme. An expert panel classified the potential clinical relevance of every identified practical problem and associated management strategy using a 3-point scale. Two hundred eleven practical problems and 184 management strategies were identified. Ninety-five percent of the participants experienced one or more practical problems with the use of their medicines: problems reading and understanding the instructions for use, handling the outer packaging, handling the immediate packaging, completing preparation before use, and taking the medicine. For 10 participants, at least one of their problems, in combination with the applied management strategy, had potential clinical consequences and 11 cases (5% of the problems) had the potential to cause moderate or severe clinical deterioration. Older people experience a number of practical problems using their medicines, and their strategies to manage these problems are sometimes suboptimal. These problems can lead to incorrect medication use with clinically relevant consequences. The findings pose a challenge for healthcare professionals, drug developers, and regulators to diminish these problems. © 2014 The Authors.The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

  13. Creating a virtual pharmacology curriculum in a problem-based learning environment: one medical school's experience.

    Science.gov (United States)

    Karpa, Kelly Dowhower; Vrana, Kent E

    2013-02-01

    Integrating pharmacology education into a problem-based learning (PBL) curriculum has proven challenging for many medical schools, including the Pennsylvania State University College of Medicine (Penn State COM). In response to pharmacology content gaps in its PBL-intensive curriculum, Penn State COM in 2003 hired a director of medical pharmacology instruction to oversee efforts to improve the structure of pharmacology education in the absence of a stand-alone course. In this article, the authors describe the ongoing development of the virtual pharmacology curriculum, which weaves pharmacology instruction through the entire medical school curriculum with particular emphasis on the organ-based second year. Pharmacology is taught in a spiraling manner designed to add to and build upon students' knowledge and competency. Key aspects of the virtual curriculum (as of 2011) include clearly stated and behaviorally oriented pharmacology learning objectives, pharmacology study guides that correspond to each PBL case, pharmacology review sessions that feature discussions of United States Medical Licensing Examination (USMLE)-type questions, and pharmacology questions for each PBL case on course examinations to increase student accountability. The authors report a trend toward improved USMLE Step 1 scores since these initiatives were introduced. Furthermore, graduates' ratings of their pharmacology education have improved on the Medical School Graduation Questionnaire. The authors suggest that the initiatives they describe for enhancing pharmacology medical education are relevant to other medical schools that are also seeking ways to better integrate pharmacology into PBL-based curricula.

  14. Evaluating learning among undergraduate medical students in schools with traditional and problem-based curricula.

    Science.gov (United States)

    Meo, Sultan Ayoub

    2013-09-01

    This study aimed to assess knowledge and skills in a respiratory physiology course in traditional versus problem-based learning (PBL) groups in two different medical schools. Two different undergraduate medical schools were selected for this study. The first medical school followed the traditional [lecture-based learning (LBL)] curriculum, and the second medical school followed the PBL curriculum. Sixty first-year male medical students (30 students from each medical school) volunteered; they were apparently healthy and of the same age, sex, nationality, and regional and cultural background. Students were taught respiratory physiology according to their curriculum for a period of 2 wk. At the completion of the study period, knowledge was measured based on a single best multiple-choice question examination, and skill was measured based on the objective structured practical examination in the lung function laboratory (respiratory physiology). A Student's t-test was applied for the analysis of the data, and the level of significance was set at P < 0.05. Students belonging to the PBL curriculum obtained a higher score in the multiple-choice question examination (P = 0.001) and objective structured practical examination (P = 0.0001) compared with traditional (LBL) students. Students in the PBL group obtained significantly higher knowledge and skill scores in the respiratory physiology course compared with students in the traditional (LBL) style of medical schools.

  15. Medical and psychological problems faced by young Australian gap year travellers.

    Science.gov (United States)

    Furuya-Kanamori, Luis; Mills, Deborah; Sheridan, Sarah; Lau, Colleen

    2017-09-01

    Gap year travellers can potentially be exposed to many infectious diseases and other travel-related health problems including injuries and psychological problems. Currently, there is little information on health and wellbeing of this particular group of travellers. Participants were recruited from an organization that specialized in organising international gap year placements. Gap year travellers were asked to complete a pre-departure survey on demographics, placement destination and duration, previous travel experience, hobbies, risk taking behaviour, anticipated problems during the placement, and pre-travel preparations. After the placement, participants were asked to complete a post-trip survey on their experiences, problems, health issues, and medical treatment required. The 88 and 34 gap year travellers aged 17-23 years completed pre- and post-placement surveys respectively. The duration of placements ranged from 3 to 12 months. Psychological stressors were frequently reported [ n = 26 (76.5%) felt home sick; n = 18 (52.9%) experienced culture shock; n = 17 (50.0%) had difficulty communicating with the locals]. The majority of participants (91.2%) tried to work out a solution for the stressor on their own. Twenty-eight (82.4%) participants reported medical problems during their placement; the most common problems were sunburn ( n = 19; 55.9%), respiratory infections ( n = 15; 44.1%), weight change ( n = 14; 41.2%), and diarrhoea/food poisoning ( n = 13; 38.2%). Three participants (3.4%) were admitted to hospital; for a muscle injury, head injury and skin infection after getting a tribal tattoo. Psychological stressors were common, but most did not seek help. Some medical problems encountered during their placement may have been preventable with improved pre-departure preparation. Gap year, pre-departure, preparation. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e

  16. Skin problems in children under five years old at a rural hospital in Southern Ethiopia

    Directory of Open Access Journals (Sweden)

    José Manuel Ramos

    2016-07-01

    Conclusions: Skin problems, mainly scabies, impetigo, and eczema were common in young children attended at a rural hospital in Southern Ethiopia. Children under 5 years should be examined thoroughly to rule out skin diseases, especially scabies.

  17. Incidence of academic failure and its underlying factors in Lorestan university of medical sciences

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    Farzad Ebrahimzadeh

    2016-02-01

    Full Text Available Background: Academic failure, conceived of as lack of success in one’s education, is of paramount importance for students of medical sciences and it might lead to more acute problems. The present study set out to investigate the prevalence and underlying reasons of academic failure in Lorestan University of medical sciences.  Materials and Methods: In this cohort study, academic records of all students of Lorestan University of Medical Sciences during the academic years of 2006-2011 were collected from education and student affair center and also, demographic and educational records were entered into a checklist. Inappropriate grade point average, being a provisional student, prolonged graduation, expulsion and dropout were taken into account as academic failure. To model the related effective factors, logistic regression was adopted and significance level was set at 0.05. Results: The cumulative incidence of academic failure was about 25.1%. Factors such as department, being self-funded or government-funded student, academic grade students are pursuing, the elapsed time between academic grades, gender and location of residence were related to academic failure (P<0.05. It is worth mentioning that no relationship was observed between the academic failure and being accepted based on quota system. Conclusion: The most important at risk groups were students of department of medicine and health, associate or medical doctoral students, self-funded students, students with a considerable time elapsed between their academic grades, male students and students living in dormitory. It is suggested that these students refer to consulting centers of university or educational supervisors and receive particular attention.

  18. Absenteeism and under-achievement in final year medical students.

    Science.gov (United States)

    Dhaliwal, Upreet

    2003-01-01

    Absenteeism among medical students has received little attention in the literature. The aim of this study was to determine the causes of absenteeism from didactic lectures in ophthalmology and its correlation with performance in formative assessment. The attendance of 101 final year medical students for lectures in ophthalmology was studied in three parts: terms 1, 2 and 3. Based on the attendance in all three terms, students were divided into groups I to V, where group I students had good attendance in all three terms down to group V, with very poor attendance in one or more terms. The marks scored in the first, second and third terminal theory tests were tabulated separately. Results of the second and final professional examinations were assessed for the five groups of students. Students were asked to list the causes of absenteeism in a proforma. Data were analysed by regression analysis and Chi-square test. Significance was obtained at 5% level. In each formative assessment, higher attendance was associated with better marks (p absenteeism in 62.6% of instances. Six of the 10 students who failed the ophthalmology professional examination were in groups IV and V and had failed the second professional examination as well. They were designated low achievers, as were 3 students who made several attempts to pass the second professional examination and failed in ophthalmology despite a fair-good attendance. Learner absenteeism may contribute to low achievement. However, absenteeism may be symptomatic of low achievers. Low achievers or students with learning handicaps must be identified before admission or early in the medical course and encouraged to improve their performance and thereby enhance their self-esteem. A support group of family, peers, faculty and psychologists could help.

  19. Professional or administrative value patterns? Clinical pathways in medical problem-solving processes.

    Science.gov (United States)

    Holmberg, Leif

    2007-11-01

    A health-care organization simultaneously belongs to two different institutional value patterns: a professional and an administrative value pattern. At the administrative level, medical problem-solving processes are generally perceived as the efficient application of familiar chains of activities to well-defined problems; and a low task uncertainty is therefore assumed at the work-floor level. This assumption is further reinforced through clinical pathways and other administrative guidelines. However, studies have shown that in clinical practice such administrative guidelines are often considered inadequate and difficult to implement mainly because physicians generally perceive task uncertainty to be high and that the guidelines do not cover the scope of encountered deviations. The current administrative level guidelines impose uniform structural features that meet the requirement for low task uncertainty. Within these structural constraints, physicians must organize medical problem-solving processes to meet any task uncertainty that may be encountered. Medical problem-solving processes with low task uncertainty need to be organized independently of processes with high task uncertainty. Each process must be evaluated according to different performance standards and needs to have autonomous administrative guideline models. Although clinical pathways seem appropriate when there is low task uncertainty, other kinds of guidelines are required when the task uncertainty is high.

  20. Documenting clinical performance problems among medical students: feedback for learner remediation and curriculum enhancement

    Directory of Open Access Journals (Sweden)

    Brian E. Mavis

    2013-07-01

    Full Text Available Introduction: We operationalized the taxonomy developed by Hauer and colleagues describing common clinical performance problems. Faculty raters pilot tested the resulting worksheet by observing recordings of problematic simulated clinical encounters involving third-year medical students. This approach provided a framework for structured feedback to guide learner improvement and curricular enhancement. Methods: Eighty-two problematic clinical encounters from M3 students who failed their clinical competency examination were independently rated by paired clinical faculty members to identify common problems related to the medical interview, physical examination, and professionalism. Results: Eleven out of 26 target performance problems were present in 25% or more encounters. Overall, 37% had unsatisfactory medical interviews, with ‘inadequate history to rule out other diagnoses’ most prevalent (60%. Seventy percent failed because of physical examination deficiencies, with missing elements (69% and inadequate data gathering (69% most common. One-third of the students did not introduce themselves to their patients. Among students failing based on standardized patient (SP ratings, 93% also failed to demonstrate competency based on the faculty ratings. Conclusions: Our review form allowed clinical faculty to validate pass/fail decisions based on standardized patient ratings. Detailed information about performance problems contributes to learner feedback and curricular enhancement to guide remediation planning and faculty development.

  1. Problem-based learning in comparison with lecture-based learning among medical students.

    Science.gov (United States)

    Faisal, Rizwan; Bahadur, Sher; Shinwari, Laiyla

    2016-06-01

    To compare performance of medical students exposed to problem-based learning and lecture-based learning. The descriptive study was conducted at Rehman Medical College, Peshawar, Pakistan from May 20 to September 20, 2014, and comprised 146 students of 3rd year MBBS who were randomised into two equal groups. One group was taught by the traditional lecture based learning, while problem-based learning was conducted for the other group on the same topic. At the end of sessions, the performance of the two groups was evaluated by one-best type of 50 multiple choice questions. Total marks were 100, with each question carrying 2 marks. SPSS 15 was used for statistical analysis. There were 146 students who were divided into two equal groups of 73(50%) each. The mean score in the group exposed to problem-based learning was 3.2 ± 0.8 while those attending lecture-based learning was 2.7±0.8 (p= 0.0001). Problem-based learning was more effective than lecture based learning in the academic performance of medical students.

  2. The Orienteering Problem under Uncertainty Stochastic Programming and Robust Optimization compared

    NARCIS (Netherlands)

    Evers, L.; Glorie, K.; Ster, S. van der; Barros, A.I.; Monsuur, H.

    2012-01-01

    The Orienteering Problem (OP) is a generalization of the well-known traveling salesman problem and has many interesting applications in logistics, tourism and defense. To reflect real-life situations, we focus on an uncertain variant of the OP. Two main approaches that deal with optimization under

  3. Contraception choices in women with underlying medical conditions.

    Science.gov (United States)

    Bonnema, Rachel A; McNamara, Megan C; Spencer, Abby L

    2010-09-15

    Primary care physicians often prescribe contraceptives to women of reproductive age with comorbidities. Novel delivery systems (e.g., contraceptive patch, contraceptive ring, single-rod implantable device) may change traditional risk and benefit profiles in women with comorbidities. Effective contraceptive counseling requires an understanding of a woman's preferences and medical history, as well as the risks, benefits, adverse effects, and contraindications of each method. Noncontraceptive benefits of combined hormonal contraceptives, such as oral contraceptive pills, include regulated menses, decreased dysmenorrhea, and diminished premenstrual dysphoric disorder. Oral contraceptive pills may be used safely in women with a range of medical conditions, including well-controlled hypertension, uncomplicated diabetes mellitus, depression, and uncomplicated valvular heart disease. However, women older than 35 years who smoke should avoid oral contraceptive pills. Contraceptives containing estrogen, which can increase thrombotic risk, should be avoided in women with a history of venous thromboembolism, stroke, cardiovascular disease, or peripheral vascular disease. Progestin-only contraceptives are recommended for women with contraindications to estrogen. Depo-Provera, a long-acting injectable contraceptive, may be preferred in women with sickle cell disease because it reduces the frequency of painful crises. Because of the interaction between antiepileptics and oral contraceptive pills, Depo-Provera may also be considered in women with epilepsy. Implanon, the single-rod implantable contraceptive device, may reduce symptoms of dysmenorrhea. Mirena, the levonorgestrel-containing intrauterine contraceptive system, is an option for women with menorrhagia, endometriosis, or chronic pelvic pain.

  4. 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.

  5. Medical use of cannabis in Australia: "medical necessity" defences under current Australian law and avenues for reform.

    Science.gov (United States)

    Martin, Charles

    2014-06-01

    The possession of cannabis is an offence in all Australian jurisdictions. No exception is made for medical use under any of the State and Territory Drug Acts, nor the Commonwealth's pharmaceutical regulation scheme. Nevertheless, questions remain about the scope for defences argued on the basis of necessitous medical use. More fundamentally the increasingly favourable light in which the medical use of cannabis is growing to be seen by state and national legislatures overseas raises important questions about the need for reform of Australian drug laws. This article explores those questions.

  6. Discharge of hospitalized under-fives against medical advice in ...

    African Journals Online (AJOL)

    DAMA) among under-fives in Benin City, document reasons for these discharges and suggest ways of reducing its occurrence. Methods: The admissions and discharges registers as well as the case-notes of all children aged between one and ...

  7. Shift Work and Related Health Problems among Medical and Diagnostic Staff of the General Teaching Hospitals Affiliated to Shiraz University of Medical Sciences, 2012

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    Zahra Sajjadnia

    2015-07-01

    Full Text Available Introduction:Today, shift work is considered as a necessity in many jobs and for some 24-hour services the use of shift-work is growing. However, shift work can lead to physiological and psycho-social problems for shift workers. This study aimed to determine the effects of shift work on the associated health problems, together with the demographic and job characteristics underlying the problems, among the medical and diagnostic staff of the general teaching hospitals affiliated to Shiraz University of Medical Sciences in 2012. Method:This study was an applied, cross-sectional and descriptive-analytical one. The study employed a sample of 205 employees from the medical and diagnostic staff using stratified sampling proportional to the size and simple random sampling methods. Data were collected using the Survey of Shift workers (SOS questionnaire, validity and reliability of which have already been confirmed. Finally, the collected data were analyzed using SPSS 16.0 software through ANOVA, Chi-square, Independent-Samples T-Test, as well as Pearson Correlation Coefficient. A P<0.05 was considered statistically significant. Results: The results showed that among the demographic and job characteristics studied, the individual, family and social problems had significant associations with work schedules, shift work and job satisfaction. In addition, there were significant associations between musculoskeletal disorders and the satisfaction of shift work; cardiovascular disorders and marital status and occupation; digestive disorders and the work schedules; sleep disorders and the satisfaction of shift work; musculoskeletal disorders, cardiovascular disorders and sleep disorders and age, job experience and shift work experience. And finally, there were significant associations among sleep disorders and age, job experience and the shift work experience. Conclusion: Based on the findings of this study, demographic characteristics such as age, marital

  8. Active teaching-learning methodologies: medical students' views of problem-based learning

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    José Roberto Bittencourt Costa

    Full Text Available The prevailing undergraduate medical training process still favors disconnection and professional distancing from social needs. The Brazilian Ministries of Education and Health, through the National Curriculum Guidelines, the Incentives Program for Changes in the Medical Curriculum (PROMED, and the National Program for Reorientation of Professional Training in Health (PRO-SAÚDE, promoted the stimulus for an effective connection between medical institutions and the Unified National Health System (SUS. In accordance to the new paradigm for medical training, the Centro Universitário Serra dos Órgãos (UNIFESO established a teaching plan in 2005 using active methodologies, specifically problem-based learning (PBL. Research was conducted through semi-structured interviews with third-year undergraduate students at the UNIFESO Medical School. The results were categorized as proposed by Bardin's thematic analysis, with the purpose of verifying the students' impressions of the new curriculum. Active methodologies proved to be well-accepted by students, who defined them as exciting and inclusive of theory and practice in medical education.

  9. Sonography and hypotension: a change to critical problem solving in undergraduate medical education

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    Amini R

    2016-01-01

    Full Text Available Richard Amini, Lori A Stolz, Nicholas C Hernandez, Kevin Gaskin, Nicola Baker, Arthur Barry Sanders, Srikar AdhikariDepartment of Emergency Medicine, University of Arizona Medical Center, College of Medicine, University of Arizona, Tucson, AZ, USAStudy objectives: Multiple curricula have been designed to teach medical students the basics of ultrasound; however, few focus on critical problem-solving. The objective of this study is to determine whether a theme-based ultrasound teaching session, dedicated to the use of ultrasound in the management of the hypotensive patient, can impact medical students’ ultrasound education and provide critical problem-solving exercises.Methods: This was a cross-sectional study using an innovative approach to train 3rd year medical students during a 1-day ultrasound training session. The students received a 1-hour didactic session on basic ultrasound physics and knobology and were also provided with YouTube hyperlinks, and links to smart phone educational applications, which demonstrated a variety of bedside ultrasound techniques. In small group sessions, students learned how to evaluate patients for pathology associated with hypotension. A knowledge assessment questionnaire was administered at the end of the session and again 3 months later. Student knowledge was also assessed using different clinical scenarios with multiple-choice questions.Results: One hundred and three 3rd year medical students participated in this study. Appropriate type of ultrasound was selected and accurate diagnosis was made in different hypotension clinical scenarios: pulmonary embolism, 81% (95% CI, 73%–89%; abdominal aortic aneurysm, 100%; and pneumothorax, 89% (95% CI, 82%–95%. The average confidence level in performing ultrasound-guided central line placement was 7/10, focused assessment with sonography for trauma was 8/10, inferior vena cava assessment was 8/10, evaluation for abdominal aortic aneurysm was 8/10, assessment for

  10. The University Hospital Zurich Offers a Medical Online Consultation Service for Men With Intimate Health Problems.

    Science.gov (United States)

    Schmidt-Weitmann, Sabine; Schulz, Urs; Schmid, Daniel Max; Brockes, Christiane

    2017-05-01

    The University Hospital of Zurich offers a text-based, Medical Online Consultation Service to the public since 1999. Users asked health questions anonymously to tele-doctors. This study focused on the characteristics of male enquirers with intimate health problems, the content of their questions, the medical advice given by tele-doctors and the rating of the service to prove the benefit of an online service for medical laymen. This retrospective study included 5.1% of 3,305 enquiries from 2008 to 2010 using the International Classification of Diseases-10 and International Classification of Primary Care codes relevant for intimate and sexual health problems in men. A professional text analysis program (MAXQDA) supported the content analysis, which is based on the procedure of inductive category development described by Mayring. The average age was 40 years, 63.1% enquirers had no comorbidity, in 62.5% it was the first time they consulted a doctor, and 70.2% asked for a specific, single, intimate health issue. In 64.3%, the most important organ of concern was the penis. Overall, 30.4% asked about sexually transmitted diseases. In 74.4% a doctor visit was recommended to clarify the health issue. The rating of the problem solving was very good. The service was mainly used by younger men without comorbidity and no previous contact with a doctor with regard to an intimate health problem. The anonymous setting of the teleconsultation provided men individual, professional medical advice and decision support. Teleconsultation is suggested to empower patients by developing more health literacy.

  11. A snapshot of the status of problem-based learning (PBL) in Chinese medical schools.

    Science.gov (United States)

    Fan, Angela Pei-Chen; Kosik, Russell O; Tsai, Thomas Chen-Chia; Cai, Qiaoling; Xu, Guo-Tong; Guo, Li; Su, Tung-Ping; Wang, Shuu-Jiun; Chiu, Allen Wen-Hsiang; Chen, Qi

    2014-07-01

    In North America, where it was born, problem-based learning (PBL) has seen dips and rises in its popularity, but its inherent strengths have led to its spread to medical schools all over the world. Although its use at medical schools in some Western countries has already been examined, no one has looked at its status in many other countries, including China. The aim of this study is to determine the number of schools currently using PBL in China, the degree to which they use it, and the reasoning behind such usage. We used survey and internet search to examine PBL usage at Chinese medical schools. We were able to collect data from 43 first-class Chinese medical schools that are geographically diverse and thus representative of medical schools all across China. 34 (79.1%) of the 43 medical schools use PBL in the preclinical curriculum. Of the 34, data were collected from 24 (70.6%) medical schools regarding the extent of their PBL usage. Nine (37.5%) schools use PBL for less than 10% of preclinical hours, 14 (58.3%) schools use PBL for 10-50% of preclinical hours, and one (4.2%) school uses PBL for more than 50% of preclinical hours. In our sample of Chinese medical institutions, a large majority of schools use PBL, however, most schools use it for less than 50% of total preclinical curricular hours. Our results suggest that schools are interested in increasing the number of curricular hours devoted to PBL but are constrained by resources.

  12. Factors affecting progress of Australian and international students in a problem-based learning medical course.

    Science.gov (United States)

    Treloar, C; McCall, N; Rolfe, I; Pearson, S A; Garvey, G; Heathcote, A

    2000-09-01

    Research on the factors affecting progress in medical schools has typically focused on mainstream (non-Indigenous Australian, non-international) students in traditional, didactic programmes. These results may not be applicable to students, particularly those from culturally diverse backgrounds, undertaking problem-based learning courses. This study used qualitative methodology to explore and compare factors affecting progress for mainstream Australian students (non-Indigenous Australian, non-international) and international students (full fee-paying students who had relocated countries to study) in a problem-based learning medical course. Intervention strategies were devised on the basis of the participants' experiences. Six focus group discussions were conducted (three with mainstream Australian and three with international participants). Transcripts of these discussions were coded and analysed independently by two researchers and discussed until consensus was attained. Participants identified both positive and negative experiences related to the course structure, which were consistent with previous findings. The participants' experiences demonstrated a relationship between sense of 'belongingness' to the medical school community, participation in learning opportunities and progress through the course. The results suggest that interventions aimed at reducing barriers to progress need to promote students' confidence, motivation and subsequent participation in course learning opportunities. These results have application to other problem-based learning courses particularly those which face the challenge of providing an optimal learning environment for students from diverse backgrounds.

  13. Class attendance and cardiology examination performance: a study in problem-based medical curriculum.

    Science.gov (United States)

    Bamuhair, Samira S; Al Farhan, Ali I; Althubaiti, Alaa; Ur Rahman, Saeed; Al-Kadri, Hanan M

    2016-01-01

    Information on the effect of students' class attendance on examination performance in a problem-based learning medical curriculum is limited. This study investigates the impact of different educational activities on students' academic performance in a problem-based learning curriculum. This is a retrospective cohort study conducted on the cardiology block at the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. All students who undertook the cardiology block during the academic year 2011-2012 were included. The students' attendance was measured using their overall attendance percentage. This percentage is a product of their attendance of many activities throughout the block. The students' performance was assessed by the final mark obtained, which is a product of many assessment elements. Statistical correlation between students' attendance and performance was established. A total of 127 students were included. The average lecture attendance rate for the medical students in this study was found to be 86%. A significant positive correlation was noted between the overall attendance and the accumulated students' block mark (r=0.52; Pattendance to different education activities was correlated to their final mark. Lecture attendance was the most significant predictor (Pattendance has predicted a 0.27 increase in students' final block mark. Class attendance has a positive effect on students' academic performance with stronger effect for lecture attendance compared to attendance in other teaching modalities. This suggests that lecture attendance is critical for learning even when a problem-based learning medical curriculum is applied.

  14. A snapshot of residents in medical oncology in Turkey: A Nationwide survey on profile and key problems

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    Erdinc Nayir

    2016-04-01

    Conclusion: Recognition of the subspecialty residents who are the future of medical oncology, and determination of their needs, and problems will contribute to the development of recommendations for their solution. In our country their main problems are medical conscription, inadequate education, and burnout.

  15. An interactive problem-solving approach to teach traumatology for medical students.

    Science.gov (United States)

    Abu-Zidan, Fikri M; Elzubeir, Margaret A

    2010-08-13

    We aimed to evaluate an interactive problem-solving approach for teaching traumatology from perspectives of students and consider its implications on Faculty development. A two hour problem-solving, interactive tutorial on traumatology was structured to cover main topics in trauma management. The tutorial was based on real cases covering specific topics and objectives. Seven tutorials (5-9 students in each) were given by the same tutor with the same format for fourth and fifth year medical students in Auckland and UAE Universities (n = 50). A 16 item questionnaire, on a 7 point Likert-type scale, focusing on educational tools, tutor-based skills, and student-centered skills were answered by the students followed by open ended comments. The tutorials were highly ranked by the students. The mean values of educational tools was the highest followed by tutor-centered skills and finally student-centered skills. There was a significant increase of the rating of studied attributes over time (F = 3.9, p = 0.004, ANOVA). Students' open ended comments were highly supportive of the interactive problem-solving approach for teaching traumatology. The interactive problem-solving approach for tutorials can be an effective enjoyable alternative or supplement to traditional instruction for teaching traumatology to medical students. Training for this approach should be encouraged for Faculty development.

  16. Development of a clinician reputation metric to identify appropriate problem-medication pairs in a crowdsourced knowledge base.

    Science.gov (United States)

    McCoy, Allison B; Wright, Adam; Rogith, Deevakar; Fathiamini, Safa; Ottenbacher, Allison J; Sittig, Dean F

    2014-04-01

    Correlation of data within electronic health records is necessary for implementation of various clinical decision support functions, including patient summarization. A key type of correlation is linking medications to clinical problems; while some databases of problem-medication links are available, they are not robust and depend on problems and medications being encoded in particular terminologies. Crowdsourcing represents one approach to generating robust knowledge bases across a variety of terminologies, but more sophisticated approaches are necessary to improve accuracy and reduce manual data review requirements. We sought to develop and evaluate a clinician reputation metric to facilitate the identification of appropriate problem-medication pairs through crowdsourcing without requiring extensive manual review. We retrieved medications from our clinical data warehouse that had been prescribed and manually linked to one or more problems by clinicians during e-prescribing between June 1, 2010 and May 31, 2011. We identified measures likely to be associated with the percentage of accurate problem-medication links made by clinicians. Using logistic regression, we created a metric for identifying clinicians who had made greater than or equal to 95% appropriate links. We evaluated the accuracy of the approach by comparing links made by those physicians identified as having appropriate links to a previously manually validated subset of problem-medication pairs. Of 867 clinicians who asserted a total of 237,748 problem-medication links during the study period, 125 had a reputation metric that predicted the percentage of appropriate links greater than or equal to 95%. These clinicians asserted a total of 2464 linked problem-medication pairs (983 distinct pairs). Compared to a previously validated set of problem-medication pairs, the reputation metric achieved a specificity of 99.5% and marginally improved the sensitivity of previously described knowledge bases. A

  17. Prevalence of drug-related problems in self-medication in Danish community pharmacies

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    Bente Frøkjær

    2012-01-01

    Full Text Available Background: Drug-related problems are known to be a major problem associated with pharmacotherapy. A broad range of studies, mainly in the area of prescription-only medicines, supports this fact. Only a few studies have evaluated drug-related problems with over-the-counter medicine and the role of community pharmacies in this. Purpose: To quantify drug-related problems in self-medication (use of over-the-counter medicine identified by community pharmacies in Denmark and to document the interventions by pharmacy staff in relation to the identified drug-related problems. Method: A descriptive study mapping drug-related problems in self-medication registered at the counter at a selected number of Danish community pharmacies. Results: Data for 3,868 consecutive customers with requests for over-the-counter (OTC medicines were registered at 39 community pharmacies. The pharmacies registered a total number of 4,324 OTC medicines requests, illustrating that a customer requested 1.1 OTC medicines on average. Drug-related problems (DRPs were identified for 813 customers, equivalent to DRPs for 21.0 % of all customers, presenting symptoms or requesting OTC medicines, and for 20 % of all over-the-counter medicines requests. 1,239 DRPs were registered, corresponding to an average of 1.5 DRPs per customer requesting OTC medicines. Community pharmacies estimated that they solved or partly solved 76.2 % of the detected DRPs; 73 % were solved without involving a general practitioner. Conclusions: DRPs were identified for 21.0 % of the pharmacy customers presenting a symptom or asking for an OTC medicine. The community pharmacy counselled the customers with DRPs more thoroughly than other customers by giving 2.4 pieces of professional advice, compared to an average of 2.1 to customers in general. It is not possible to determine the magnitude of the safety risk involved. Based on the most frequent categories of DRPs, there were risks of insufficient effect

  18. Prevalence of drug-related problems in self-medication in Danish community pharmacies

    Directory of Open Access Journals (Sweden)

    Charlotte Rossing

    2012-01-01

    Full Text Available Background: Drug-related problems are known to be a major problem associated with pharmacotherapy. A broad range of studies, mainly in the area of prescription-only medicines, supports this fact. Only a few studies have evaluated drug-related problems with over-the-counter medicine and the role of community pharmacies in this.Purpose: To quantify drug-related problems in self-medication (use of over-the-counter medicine identified by community pharmacies in Denmark and to document the interventions by pharmacy staff in relation to the identified drug-related problems.Method: A descriptive study mapping drug-related problems in self-medication registered at the counter at a selected number of Danish community pharmacies.Results: Data for 3,868 consecutive customers with requests for over-the-counter (OTC medicines were registered at 39 community pharmacies. The pharmacies registered a total number of 4,324 OTC medicines requests, illustrating that a customer requested 1.1 OTC medicines on average. Drug-related problems (DRPs were identified for 813 customers, equivalent to DRPs for 21.0 % of all customers, presenting symptoms or requesting OTC medicines, and for 20 % of all over-the-counter medicines requests. 1,239 DRPs were registered, corresponding to an average of 1.5 DRPs per customer requesting OTC medicines.Community pharmacies estimated that they solved or partly solved 76.2 % of the detected DRPs; 73 % were solved without involving a general practitioner.Conclusions: DRPs were identified for 21.0 % of the pharmacy customers presenting a symptom or asking for an OTC medicine. The community pharmacy counselled the customers with DRPs more thoroughly than other customers by giving 2.4 pieces of professional advice, compared to an average of 2.1 to customers in general. It is not possible to determine the magnitude of the safety risk involved. Based on the most frequent categories of DRPs, there were risks of insufficient effect, unintended

  19. [Problems in integrative postgraduate medical training of physicians at anthroposophic hospitals in Germany and Switzerland].

    Science.gov (United States)

    Heusser, Peter; Eberhard, Sabine; Weinzirl, Johannes; Orlow, Pascale; Berger, Bettina

    2014-01-01

    Anthroposophic hospitals provide integrative medical care by complementing conventional (CON) with anthroposophic medicine (AM). They teach integrative medicine in postgraduate medical training (PGMT). In a first evaluation of PGMT quality in AM, we analyzed the problems of this training from the perspectives of trainers and trainees. We conducted an anonymous cross-sectional full survey of all trainee and trainer physicians at the 15 AM hospitals in Germany (DE) and Switzerland (CH) with questionnaires of the Swiss Institute of Technology (ETH) Zürich, complemented by a module for AM. We also conducted descriptive statistics for questions with answering scales as well as calculations of group differences (two-tailed Mann-Whitney U test) and a qualitative content analysis (Mayring) of free text answers related to the problem analysis. The response rate in DE embraced 89 out of 215 (41.39%) surveyed trainees and 78 out of 184 (42.39%) trainers; in CH, the response rate comprised 19 out of 25 (76%) trainees and 22 out of 30 (73.33%) trainers. Free text answers related to problem analysis in DE and CH were given by 16 out of 108 (14.8%) trainees and by 20 out of 100 (20%) trainers, overall. Perceived main problems include work overload; shortcomings in work organization; delimitation of competences; interprofessional cooperation; financial resources (trainers); wages (trainees DE); practical relevance of AM (trainees and trainers in DE); professional or didactic competence of trainers; lack of interest in AM (trainees); problems with learning and practicing AM; no curriculum for postgraduate medical training in AM; tensions between AM and CON. Explanations for the differences between DE and CH include larger departments and the DRG system in DE, but also better structural conditions for AM PGMT in CH. Main problems of PGMT in AM include not only non-specific and systemic aspects, but also AM-specific issues. In order to develop a basis for concrete problem solving

  20. 78 FR 50136 - Notice of Information Collection Under Emergency Review: Medical History and Examination for...

    Science.gov (United States)

    2013-08-16

    ... of Information Collection Under Emergency Review: Medical History and Examination for Foreign Service... submit comments by any of the following methods: Web: Persons with access to the Internet may use the... of Information Collection: Medical History and Examination for Foreign Service. OMB Control Number...

  1. [Child-pedestrian injuries inflicted in the road traffic accidents as a forensic medical problem].

    Science.gov (United States)

    Savenkova, E N; Efimov, A A

    The road traffic accidents are known to make the greatest contribution to the overall structure of pediatric traumatism with the fatal outcome. The problem of pediatric traumatism remains on top of its relevancy despite numerous administrative, legal, technical, and financial measures taken at the government level in an attempt to reduce the mortality rate associated with the child-pedestrian injuries inflicted in the road traffic accidents. The objective of the present study was to summarize and interpret the results published in the scientific literature concerning child-pedestrian injuries inflicted in the road traffic accidents with special reference to the age of the victims and the type of the injury. The analysis of the publications of the domestic and foreign authors has demonstrated that the available data of interest remain to be systematized and that the forensic medical aspects of the problem in question are poorly represented in these materials. It was shown that forensic medical expertises of child-pedestrian injuries inflicted in the road traffic accidents are frequently carried out without taking into consideration the peculiar anatomical and physiological features of the child's organism. The available data concerning the mechanisms and evaluation of severe injuries inflicted to the children in the road traffic accidents are insufficient for the development of the algorithms for the relevant adequate forensic medical expertise. In the light of these findings, the problem of the child-pedestrian injuries inflicted in the road traffic accidents takes on new significance when considered in the context of pediatric traumatism. There is evidently the growing necessity to formulate the universal database containing systematized objective information for the development of new methods of forensic medical expertise for the elucidation of the mechanisms of road traffic injuries inflicted to the children of different age groups depending on the type of the

  2. 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.

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

    Science.gov (United States)

    2018-01-01

    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. PMID:29510609

  4. An analysis of medical students' reflective essays in problem-based learning.

    Science.gov (United States)

    Si, Jihyun

    2018-03-01

    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. 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. 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. 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.

  5. Problem-based learning in continuing medical education: review of randomized controlled trials.

    Science.gov (United States)

    Al-Azri, Hilal; Ratnapalan, Savithiri

    2014-02-01

    To investigate the effects of problem-based learning (PBL) in continuing medical education. PubMed, MEDLINE, EMBASE, CINAHL, and ERIC databases were searched for randomized controlled trials published in English from January 2001 to May 2011 using key words problem-based learning, practice-based, self-directed, learner-centered, and active learning, combined with continuing medical education, continuing professional development, post professional, postgraduate, and adult learning. Randomized controlled trials that described the effects of PBL on knowledge enhancement, performance improvement, participants' satisfaction, or patients' health outcomes were selected for analysis. Fifteen studies were included in this review: 4 involved postgraduate trainee doctors, 10 involved practising physicians, and 1 had both groups. Online learning was used in 7 studies. Among postgraduate trainees PBL showed no significant differences in knowledge gain compared with lectures or non-case-based learning. In continuing education, PBL showed no significant difference in knowledge gain when compared with other methods. Several studies did not provide an educational intervention for the control group. Physician performance improvement showed an upward trend in groups participating in PBL, but no significant differences were noted in health outcomes. Online PBL is a useful method of delivering continuing medical education. There is limited evidence that PBL in continuing education would enhance physicians' performance or improve health outcomes.

  6. On Advice Complexity of the k-server Problem under Sparse Metrics

    DEFF Research Database (Denmark)

    Gupta, S.; Kamali, S.; López-Ortiz, A.

    2013-01-01

    We consider the k-Server problem under the advice model of computation when the underlying metric space is sparse. On one side, we introduce Θ (1)-competitive algorithms for a wide range of sparse graphs, which require advice of (almost) linear size. Namely, we show that for graphs of size N...... for the 2-server problem on a path metric of size N ≥ 5. Through another lower bound argument, we show that at least n/2 (log α - 1.22) bits of advice is required to obtain an optimal solution for metric spaces of treewidth α, where 4 ≤ α

  7. A descriptive study of medical educators' views of problem-based learning

    Directory of Open Access Journals (Sweden)

    Dennick Reg

    2009-11-01

    Full Text Available Abstract Background There is a growing amount of literature on the benefits and drawbacks of Problem-Based Learning (PBL compared to conventional curricula. However, it seems that PBL research studies do not provide information rigorously and formally that can contribute to making evidence-based medical education decisions. The authors performed an investigation aimed at medical education scholars around the question, "What are the views of medical educators concerning the PBL approach?" Methods After framing the question, the method of data collection relied on asking medical educators to report their views on PBL. Two methods were used for collecting data: the questionnaire survey and an online discussion forum. Results The descriptive analysis of the study showed that many participants value the PBL approach in the practice and training of doctors. However, some participants hold contrasting views upon the importance of the PBL approach in basic medical education. For example, more than a third of participants (38.5% had a neutral stance on PBL as a student-oriented educational approach. The same proportion of participants also had a neutral view of the efficiency of traditional learning compared to a PBL tutorial. The open-ended question explored the importance of faculty development in PBL. A few participants had negative perceptions of the epistemological assumptions of PBL. Two themes emerged from the analysis of the forum repliers: the importance of the faculty role and self-managed education. Conclusion Whilst many participants valued the importance of the PBL approach in the practice and training of doctors and agreed with most of the conventional descriptions of PBL, some participants held contrasting views on the importance of the PBL approach in undergraduate medical education. However there was a strong view concerning the importance of facilitator training. More research is needed to understand the process of PBL better.

  8. Teaching medical professionals and trainees about adolescent suicide prevention: five key problems.

    Science.gov (United States)

    Sher, Leo

    2012-01-01

    Predicting and preventing suicide represent very difficult challenges for clinicians. The awareness of adolescent suicide as a major social and medical problem has increased over the past years. However, many health care professionals who have frequent contact with adolescents are not sufficiently trained in suicide evaluation techniques and approaches to adolescents with suicidal behavior. Suicide prevention efforts among adolescents are restricted by the fact that there are five key problems related to the evaluation and management of suicidality in adolescents: 1. Many clinicians underestimate the importance of the problem of adolescent suicidal behavior and underestimate its prevalence. 2. There is a misconception that direct questioning of adolescents about suicidality is sufficient to evaluate suicide risk. 3. Another misconception is that adolescents with non-psychiatric illnesses do not need to be evaluated for suicidality. 4. Many clinicians do not know about or underestimate the role of contagion in adolescent suicidal behavior. 5. There is a mistaken belief that adolescent males are at lower suicide risk than adolescent females. Educating medical professionals and trainees about the warning signs and symptoms of adolescent suicide and providing them with tools to recognize, evaluate, and manage suicidal patients represent a promising approach to adolescent suicide prevention.

  9. A rules based algorithm to generate problem lists using emergency department medication reconciliation.

    Science.gov (United States)

    Joseph, Joshua W; Chiu, David T; Nathanson, Larry A; Horng, Steven

    2016-10-01

    To evaluate the sensitivity and specificity of a problem list automatically generated from the emergency department (ED) medication reconciliation. We performed a retrospective cohort study of patients admitted via the ED who also had a prior inpatient admission within the past year of an academic tertiary hospital. Our algorithm used the First Databank ontology to group medications into therapeutic classes, and applied a set of clinically derived rules to them to predict obstructive lung disease, hypertension, diabetes, congestive heart failure (CHF), and thromboembolism (TE) risk. This prediction was compared to problem lists in the last discharge summary in the electronic health record (EHR) as well as the emergency attending note. A total of 603 patients were enrolled from 03/29/2013-04/30/2013. The algorithm had superior sensitivity for all five conditions versus the attending problem list at the 99% confidence level (Obstructive Lung Disease 0.93 vs 0.47, Hypertension 0.93 vs 0.56, Diabetes 0.97 vs 0.73, TE Risk 0.82 vs 0.36, CHF 0.85 vs 0.38), while the attending problem list had superior specificity for both hypertension (0.76 vs 0.94) and CHF (0.87 vs 0.98). The algorithm had superior sensitivity for all conditions versus the EHR problem list (Obstructive Lung Disease 0.93 vs 0.34, Hypertension 0.93 vs 0.30, Diabetes 0.97 vs 0.67, TE Risk 0.82 vs 0.23, CHF 0.85 vs 0.32), while the EHR problem list also had superior specificity for detecting hypertension (0.76 vs 0.95) and CHF (0.87 vs 0.99). The algorithm was more sensitive than clinicians for all conditions, but less specific for conditions that are not treated with a specific class of medications. This suggests similar algorithms may help identify critical conditions, and facilitate thorough documentation, but further investigation, potentially adding alternate sources of information, may be needed to reliably detect more complex conditions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  10. Do learning approaches of medical students affect their satisfaction with problem-based learning?

    Science.gov (United States)

    Gurpinar, Erol; Kulac, Esin; Tetik, Cihat; Akdogan, Ilgaz; Mamakli, Sumer

    2013-03-01

    The aim of this research was to determine the satisfaction of medical students with problem-based learning (PBL) and their approaches to learning to investigate the effect of learning approaches on their levels of satisfaction. The study group was composed of medical students from three different universities, which apply PBL at different levels in their curricula. The revised two-factor study process survey was applied to the study group to determine their approaches to learning as "deep" or "surface" learning. In addition, another survey of 20 questions was used to determine satisfaction levels of students with PBL and other variables. Of the study group, 64.6% were found to adopt a deep approach to learning, and we confirmed that these students were reasonably more satisfied with PBL.

  11. Learning styles, academic achievement, and mental health problems among medical students in Thailand

    Directory of Open Access Journals (Sweden)

    Salilthip Paiboonsithiwong

    2016-10-01

    Full Text Available Purpose This study aimed to investigate the prevalence of various learning styles among medical students and their correlations with academic achievement and mental health problems in these students. Methods This study was conducted among 140 first-year medical students of Chiang Mai University, Thailand in 2014. The participants completed the visual-aural-read/write-kinesthetic (VARK questionnaire, the results of which can be categorized into 4 modes, corresponding to how many of the 4 types are preferred by a respondent. The 10-item Perceived Stress Scale (PSS-10 and the 21-item Outcome Inventory (OI-21 were also used. The participants’ demographic data, grade point average (GPA, and scores of all measurements are presented using simple statistics. Correlation and regression analysis were employed to analyze differences in the scores and to determine the associations among them. Results Sixty percent of the participants were female. The mean age was 18.86±0.74 years old. Quadmodal was found to be the most preferred VARK mode (43.6%. Unimodal, bimodal, and trimodal modes were preferred by 35%, 12.9%, and 18.6% of the participants, respectively. Among the strong unimodal learners, visual, aural, read/write, and kinesthetic preferences were reported by 4.3%, 7.1%, 11.4%, and 12.1% of participants, respectively. No difference was observed in the PSS-10, OI-anxiety, OI-depression, and OI-somatization scores according to the VARK modes, although a significant effect was found for OI-interpersonal (F=2.788, P=0.043. Moreover, neither VARK modes nor VARK types were correlated with GPA. Conclusion The most preferred VARK learning style among medical students was quadmodal. Learning styles were not associated with GPA or mental health problems, except for interpersonal problems.

  12. Consumers' willingness to pay for pharmacy services that reduce risk of medication-related problems.

    Science.gov (United States)

    Suh, D C

    2000-01-01

    To measure willingness to pay (WTP) for pharmacists' services directed toward reducing the risk of medication-related problems and to determine factors that have a significant influence on WTP. WTP was measured using a contingent valuation method that involved asking respondents about their maximum WTP for pharmacists' services using a self-administered questionnaire. Respondents' WTP through ex post (out of pocket) and ex ante (insurance premium) methods were measured using three hypothetical scenarios illustrating reductions in the risk of medication-related problems. Logistic regression and semilog regression were performed to evaluate the responses to the survey. Outpatient clinic of Robert Wood Johnson University Hospital and two physician offices located in New Jersey. A convenience sample of 316 patients and/or family members, who visited the study site between March 1 and September 15, 1999, were included. Amounts patients were willing to pay out of pocket or through insurance premiums for pharmacists' services. The mean WTP out of pocket for pharmacy services ranged from $4.02 to $5.48 per prescription, depending on the level of risk reduction. Mean WTP through an increased insurance premium ranged from $28.79 to $36.29 per year. Overall, the average WTP for a pharmacist's consultation was $5.57, and WTP increased by $0.87 as counseling time increased by 1 minute. WTP was sensitive to changes in the magnitude of risk reduction in both ex post and ex ante scenarios. Income was positively related to WTP, but not to the level of statistical significance. Respondents were willing to pay for pharmacists' services that reduce the risk of medication-related problems. Additional investigations to determine the factors that influence WTP for health care professionals' services are warranted.

  13. Learning styles, academic achievement, and mental health problems among medical students in Thailand.

    Science.gov (United States)

    Paiboonsithiwong, Salilthip; Kunanitthaworn, Natchaya; Songtrijuck, Natchaphon; Wongpakaran, Nahathai; Wongpakaran, Tinakon

    2016-01-01

    This study aimed to investigate the prevalence of various learning styles among medical students and their correlations with academic achievement and mental health problems in these students. This study was conducted among 140 first-year medical students of Chiang Mai University, Thailand in 2014. The participants completed the visual-aural-read/write-kinesthetic (VARK) questionnaire, the results of which can be categorized into 4 modes, corresponding to how many of the 4 types are preferred by a respondent. The 10-item Perceived Stress Scale (PSS-10) and the 21-item Outcome Inventory (OI-21) were also used. The participants' demographic data, grade point average (GPA), and scores of all measurements are presented using simple statistics. Correlation and regression analysis were employed to analyze differences in the scores and to determine the associations among them. Sixty percent of the participants were female. The mean age was 18.86±0.74 years old. Quadmodal was found to be the most preferred VARK mode (43.6%). Unimodal, bimodal, and trimodal modes were preferred by 35%, 12.9%, and 18.6% of the participants, respectively. Among the strong unimodal learners, visual, aural, read/write, and kinesthetic preferences were reported by 4.3%, 7.1%, 11.4%, and 12.1% of participants, respectively. No difference was observed in the PSS-10, OI-anxiety, OI-depression, and OI-somatization scores according to the VARK modes, although a significant effect was found for OI-interpersonal (F=2.788, P=0.043). Moreover, neither VARK modes nor VARK types were correlated with GPA. The most preferred VARK learning style among medical students was quadmodal. Learning styles were not associated with GPA or mental health problems, except for interpersonal problems.

  14. Using team-based learning to prepare medical students for future problem-based learning.

    Science.gov (United States)

    Abdelkhalek, Nahed; Hussein, Amal; Gibbs, Trevor; Hamdy, Hossam

    2010-01-01

    The original concept of problem-based learning (PBL) was built upon an acceptance that its participants would be of a more mature age, and with personal and potential qualities that would equip them for problem solving as part of their learning process. However, despite global acceptance for the use of PBL in medical and health sciences education, and knowledge of the diverse background of students about to embark upon PBL, structured programs preparing medical students for such an educational activity are not common. The primary aim of this study is to describe the experience in adopting and adapting an educational approach analogous to PBL, team-based learning (TBL), in preparing medical students to later study in a PBL environment and secondarily, to measure the students' reaction to this experience. At the University of Sharjah, 363 students were enrolled over four semesters in the 'Introduction to Medical Sciences Education (IMSE)' course. They were divided into groups of 25-27 students per class, where their learning was facilitated through a TBL approach. The course was evaluated both quantitatively and qualitatively and appropriate statistical analysis was applied to their responses. Out of 363 students, 304 (84%) responded to a 28-item closed-ended questionnaire. Their mean scores and consensus measurements indicated a high degree of students' satisfaction. Eighty-two students (65%) responded to the open-ended questions providing 139 comments. Content analysis of the responses supported the quantitative results. This study demonstrated a high degree of students' satisfaction from the course in acquiring skills preparing them for future PBL. Although this represents an evaluation of the TBL effects upon the early exposures to PBL, TBL was considered to be a feasible, efficient and cost-effective educational approach in preparing the students for their new educational experience.

  15. Sonography and hypotension: a change to critical problem solving in undergraduate medical education.

    Science.gov (United States)

    Amini, Richard; Stolz, Lori A; Hernandez, Nicholas C; Gaskin, Kevin; Baker, Nicola; Sanders, Arthur Barry; Adhikari, Srikar

    2016-01-01

    Multiple curricula have been designed to teach medical students the basics of ultrasound; however, few focus on critical problem-solving. The objective of this study is to determine whether a theme-based ultrasound teaching session, dedicated to the use of ultrasound in the management of the hypotensive patient, can impact medical students' ultrasound education and provide critical problem-solving exercises. This was a cross-sectional study using an innovative approach to train 3rd year medical students during a 1-day ultrasound training session. The students received a 1-hour didactic session on basic ultrasound physics and knobology and were also provided with YouTube hyperlinks, and links to smart phone educational applications, which demonstrated a variety of bedside ultrasound techniques. In small group sessions, students learned how to evaluate patients for pathology associated with hypotension. A knowledge assessment questionnaire was administered at the end of the session and again 3 months later. Student knowledge was also assessed using different clinical scenarios with multiple-choice questions. One hundred and three 3rd year medical students participated in this study. Appropriate type of ultrasound was selected and accurate diagnosis was made in different hypotension clinical scenarios: pulmonary embolism, 81% (95% CI, 73%-89%); abdominal aortic aneurysm, 100%; and pneumothorax, 89% (95% CI, 82%-95%). The average confidence level in performing ultrasound-guided central line placement was 7/10, focused assessment with sonography for trauma was 8/10, inferior vena cava assessment was 8/10, evaluation for abdominal aortic aneurysm was 8/10, assessment for deep vein thrombus was 8/10, and cardiac ultrasound for contractility and overall function was 7/10. Student performance in the knowledge assessment portion of the questionnaire was an average of 74% (SD =11%) at the end of workshop and 74% (SD =12%) 3 months later (P=0.00). At our institution, we

  16. PROBLEM OF SUPPORTING THE VERSIONS OF DISTANCE EDUCATION SYSTEM MOODLE IN THE MEDICAL UNIVERSITY

    Directory of Open Access Journals (Sweden)

    Andrii V. Semenets

    2014-01-01

    Full Text Available Moodle is one of the open-source software learning management system using to support an educational process. The problem of updating the outdated Moodle versions is studied in the article. It is shown a successful implementation of a modified version on the basis of I. Ya. Horbachevsky Ternopil State Medical University. The step-by-step manual of the updating and a new server migration process are described. Examples of the application of the virtualization techniques and version control system to the SDE Moodle system administration tasks solving are presented. The SDE Moodle server optimization and customization recommendations are also given.

  17. Class attendance and cardiology examination performance: a study in problem-based medical curriculum

    Directory of Open Access Journals (Sweden)

    Bamuhair SS

    2016-02-01

    Full Text Available Samira S Bamuhair,1 Ali I Al Farhan,1,2 Alaa Althubaiti,1 Saeed ur Rahman,1,2 Hanan M Al-Kadri1,3 1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, 2Department of Family Medicine and Primary Health Care, 3Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Riyadh, Saudi Arabia Background and aims: Information on the effect of students' class attendance on examination performance in a problem-based learning medical curriculum is limited. This study investigates the impact of different educational activities on students' academic performance in a problem-based learning curriculum. Methods: This is a retrospective cohort study conducted on the cardiology block at the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. All students who undertook the cardiology block during the academic year 2011–2012 were included. The students' attendance was measured using their overall attendance percentage. This percentage is a product of their attendance of many activities throughout the block. The students' performance was assessed by the final mark obtained, which is a product of many assessment elements. Statistical correlation between students' attendance and performance was established. Results: A total of 127 students were included. The average lecture attendance rate for the medical students in this study was found to be 86%. A significant positive correlation was noted between the overall attendance and the accumulated students' block mark (r=0.52; P<0.001. Students' attendance to different education activities was correlated to their final mark. Lecture attendance was the most significant predictor (P<0.001, that is, 1.0% increase in lecture attendance has predicted a 0.27 increase in students' final block mark. Conclusion: Class attendance has a positive effect on students' academic performance with stronger effect for lecture attendance compared to

  18. Medical problems of survivors of nuclear war: Infection and the spread of communicable disease

    International Nuclear Information System (INIS)

    Abrams, H.L.; VonKaenel, W.E.

    1984-01-01

    The nature of the medical problems produced by the aftermath of nuclear war is discussed. The survivors of nuclear war will live without the social structure needed to assure food, water, and shelter. They will experience malnutrition, exposure, and fatigue, which are all favorable to infection and the epidemic spread of communicable disease. The authors analyze the problem of infectious illness in the postattack period, assuming the 6,559 megaton attack scenario used by the Federal Emergency Management Agency. A particular contribution of this analysis is that it is based on government technical reports that describe the available computer modeling of postattack conditions. Such simulations allow a semiquantitative estimate of deaths due to infection. They estimate that postattack infectious disease mortality will be 25%. These studies are not accessible to the general reader and are difficult for health professionals to interpret

  19. The problem-based learning tutorial laboratory - a method for training medical teachers.

    Science.gov (United States)

    Vanhanen, Hannu; Pitkälä, Kaisu; Puolakkainen, Pauli; Strandberg, Timo E.; Lonka, Kirsti

    2001-01-01

    An extensive staff development program was started in 1998 in the Faculty of Medicine at the University of Helsinki. A problem-based learning method was introduced as a new style of teaching in the curriculum reform. This paper describes a teaching method 'Problem-based learning - tutorial laboratory' for training medical teachers to act as tutors and to understand their roles as facilitators of learning and the dynamics of a small group. The method was based on learning cycles: teachers had a possibility to experience tutoring, to get feedback about it from an educational expert and from a peer teacher and also they were able to reflect on their views in the group. The teachers were content with the training. Sessions improved teacher cooperation across the departments and brought new teaching ideas for shared use. It also helped to cope with the resistance related to the curriculum change process.

  20. Homotopy Method for a General Multiobjective Programming Problem under Generalized Quasinormal Cone Condition

    Directory of Open Access Journals (Sweden)

    X. Zhao

    2012-01-01

    Full Text Available A combined interior point homotopy continuation method is proposed for solving general multiobjective programming problem. We prove the existence and convergence of a smooth homotopy path from almost any interior initial interior point to a solution of the KKT system under some basic assumptions.

  1. Health Problems of the Under-Five Children in an Urban Slum in ...

    African Journals Online (AJOL)

    Objective: To determine the health problems common among under-five children in a typical urban slum in Nigeria and assess the treatment patterns commonly offered to these children. Methods: A community-based, cross-sectional survey was conducted in May-July 2010. A cluster sampling technique was used to select ...

  2. Mathematics Teaching as Problem Solving: A Framework for Studying Teacher Metacognition Underlying Instructional Practice in Mathematics.

    Science.gov (United States)

    Artzt, Alice F.; Armour-Thomas, Eleanor

    1998-01-01

    Uses a "teaching as problem solving" perspective to examine the components of metacognition underlying the instructional practice of seven experienced and seven beginning secondary-school mathematics teachers. Data analysis of observations, lesson plans, videotapes, and audiotapes of structured interviews suggests that the metacognition of…

  3. Stress and mental health problems in 1st year medical students: a survey of two medical colleges in Kanpur, India

    OpenAIRE

    Shivendra Jena; Harish Chandra Tiwari

    2015-01-01

    Background: Incidence of stress among medical students has been reported to be between high and very high. Medical students in pre-clinical phase are more likely to develop psychological distress than medical students in clinical phase. It may affect academic performance and lead to anxiety, depression and substance abuse. Methods: First year students of one government medical college and one private medical college of Kanpur, Uttar Pradesh, India, were surveyed to find out stress and men...

  4. Lecturing skills as predictors of tutoring skills in a problem-based medical curriculum

    Directory of Open Access Journals (Sweden)

    Kassab SE

    2016-01-01

    Full Text Available Salah Eldin Kassab,1 Nahla Hassan,1 Marwan F Abu-Hijleh,2 Reginald P Sequeira3 1Department of Medical Education, Faculty of Medicine, Suez Canal University, Ismailia, Egypt; 2College of Medicine, Qatar University, Doha, Qatar; 3College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain Purpose: Recruitment of tutors to work in problem-based learning (PBL programs is challenging, especially in that most of them are graduated from discipline-based programs. Therefore, this study aims at examining whether lecturing skills of faculty could predict their PBL tutoring skills. Methods: This study included evaluation of faculty (n=69 who participated in both tutoring and lecturing within particular PBL units at the College of Medicine and Medical Sciences (CMMS, Arabian Gulf University, Bahrain. Each faculty was evaluated by medical students (n=45±8 for lecturing and 8±2 for PBL tutoring using structured evaluation forms based on a Likert-type scale (poor to excellent. The prediction of tutoring skills using lecturing skills was statistically analyzed using stepwise linear regression. Results: Among the parameters used to judge lecturing skills, the most important predictor for tutoring skills was subject matter mastery in the lecture by explaining difficult concepts and responding effectively to students' questions. Subject matter mastery in the lecture positively predicted five tutoring skills and accounted for 25% of the variance in overall effectiveness of the PBL tutors (F=22.39, P=0.000. Other important predictors for tutoring skills were providing a relaxed class atmosphere and effective use of audiovisual aids in the lecture. Conclusion: Predicting the tutoring skills based on lecturing skills could have implications for recruiting tutors in PBL medical programs and for tutor training initiatives. Keywords: PBL, tutor, tutoring skills, lecturing skills

  5. The Parity of Set Systems under Random Restrictions with Applications to Exponential Time Problems

    DEFF Research Database (Denmark)

    Björklund, Andreas; Dell, Holger; Husfeldt, Thore

    2015-01-01

    We reduce the problem of detecting the existence of an object to the problem of computing the parity of the number of objects in question. In particular, when given any non-empty set system, we prove that randomly restricting elements of its ground set makes the size of the restricted set system...... an odd number with significant probability. When compared to previously known reductions of this type, ours excel in their simplicity: For graph problems, restricting elements of the ground set usually corresponds to simple deletion and contraction operations, which can be encoded efficiently in most...... and Husfeldt (FOCS 2013) that computes the parity of the number of Hamiltonian cycles in time 1.619^n. 2. A new result in the framework of Cygan et al. (CCC 2012) for analyzing the complexity of NP-hard problems under the Strong Exponential Time Hypothesis: If the parity of the number of Set Covers can...

  6. Mental health problems among medical students in Brazil: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    João P. Pacheco

    2017-08-01

    Full Text Available Objective: To provide a comprehensive picture of mental health problems (MHPs in Brazilian medical students by documenting their prevalence and association with co-factors. Methods: We systematically searched the MEDLINE/PubMed, SciELO, LILACS, and PsycINFO databases for cross-sectional studies on the prevalence of MHPs among medical students in Brazil published before September 29, 2016. We pooled prevalences using a random-effects meta-analysis, and summarized factors associated with MHP. Results: We included 59 studies in the analysis. For meta-analyses, we identified the summary prevalence of different MHPs, including depression (25 studies, prevalence 30.6%, common mental disorders (13 studies, prevalence 31.5%, burnout (three studies, prevalence 13.1%, problematic alcohol use (three studies, prevalence 32.9%, stress (six studies, prevalence 49.9%, low sleep quality (four studies, prevalence 51.5%, excessive daytime sleepiness (four studies, prevalence 46.1%, and anxiety (six studies, prevalence 32.9%. Signs of lack of motivation, emotional support, and academic overload correlated with MHPs. Conclusion: Several MHPs are highly prevalent among future physicians in Brazil. Evidence-based interventions and psychosocial support are needed to promote mental health among Brazilian medical students.

  7. Graduate-entry medical students' self-directed learning capabilities in a problem-based curriculum.

    Science.gov (United States)

    Elzubeir, Margaret A

    2009-09-01

    To explore junior and senior students' perceptions of their self-directed learning (SDL) capabilities in an innovative graduate-entry medical program and to determine the construct reliability of the survey instrument utilized. A cross-sectional survey design in which a self-report questionnaire was administered to undergraduate medical students (n=43) of King Saud bin Abdul Aziz University for Health Sciences, Riyadh in October 2008 and March 2009; soon after entry and in their year 3 of an integrated problem-based learning (PBL) program. The questionnaire sought self-assessment on 14 SDL capabilities. Questionnaire construct reliability was high (Cronbach's alpha=0.945). Respondents had medium to high perceptions of their self-directed learning capabilities in areas that are among the main building-blocks of self-directed learning. In comparison to junior students, senior students had statistically significantly higher mean scores on 11 of 14 self-assessed SDL competencies (pcapabilities. Knowledge of learners' perceived levels of self-directedness is helpful for both students and medical educators. By understanding learners' conceptions of their self-directed learning capabilities we can design evidence-based program modifications that are likely to promote intended curriculum objectives. Longitudinal studies are needed observing the application and stability of perceived capabilities.

  8. [On the problem of HIV infection in the objects of forensic medical expertise].

    Science.gov (United States)

    Ivanov, P L; Timoshenko, T V; Zemskova, E Yu

    The authors overview the current state of research in the field of diagnostics and identification of the signs suggesting the presence of HIV in the materials obtained from the human corpses undergoing forensic medical expertise at different stages of their post-mortem changes. Another objective of the present work was to evaluate the risk of HIV infection for the medical personnel involved in the autopsy studies taking into consideration the significance attached in different countries to the problem of anti-infectious protection of the staff of the state institutions of forensic medical expertise. The authors discuss the possibilities and limitations of the application of the methods for HIV diagnostics, such as immunoenzymatic assays. The special attention is given to the advantages of the molecular genetic methods based on the use of the specific fragments of the viral RNA genome as the diagnostic markers. The solid methodological basis for molecular genetic diagnostics of HIV infection is provided by PCR-amplification with the detection in the real-time regime. It is supposed that this approach will make it possible not only to determine, with the high degree of accuracy and specificity, the presence of the viral genome in the biological materials but also to reduce to a minimum the probability of both false-positive and false-negative responses.

  9. Experience of Problem-Based Learning in Nursing Education at Kaohsiung Medical University

    Directory of Open Access Journals (Sweden)

    Fan-Hao Chou

    2009-05-01

    Full Text Available Nursing education must keep up with the rapidly changing medical landscape to support the competences of nurses in the areas of critical thinking, problem solving, and creativity. Problem-based learning (PBL provides an appropriate strategy for nursing education innovation. Nursing curricula based on PBL remain in the growing stage in Taiwan. Kaohsiung Medical University introduced PBL into nursing education in 2002. The critical events in the process included: (1 nurturing key tutors; (2 using PBL teaching methods in an elective course—Oncology Nursing, and designing a new elective course—Symposiums Regarding Clinical Cases; (3 holding conferences inside and outside the school to promote PBL teaching methods; (4 linking e-learning and PBL teaching methods; (5 conducting PBL research; (6 establishing a committee of PBL, objective structured clinical examination, and teaching material review for the College of Nursing; and (7 setting up a required course—Nursing Ethics. We now have 12 key tutors in the College of Nursing. We have also completed two studies to evaluate the ability of students and to explore the experience of tutors. From our studies, we know that PBL can increase learner abilities in self-directed learning, critical thinking, and PBL performance. The approach helps students to cope with the changing medical landscape. Furthermore, tutors and teachers develop adequate PBL teaching skills. Based on the experience above, we believe that we are on the right path in terms of continuing tutor development, gradually increasing the number of PBL courses, and undertaking further research to promote PBL methods in Taiwan.

  10. Experience of problem-based learning in nursing education at Kaohsiung Medical University.

    Science.gov (United States)

    Chou, Fan-Hao; Chin, Chi-Chun

    2009-05-01

    Nursing education must keep up with the rapidly changing medical landscape to support the competences of nurses in the areas of critical thinking, problem solving, and creativity. Problem-based learning (PBL) provides an appropriate strategy for nursing education innovation. Nursing curricula based on PBL remain in the growing stage in Taiwan. Kaohsiung Medical University introduced PBL into nursing education in 2002. The critical events in the process included: (1) nurturing key tutors; (2) using PBL teaching methods in an elective course--Oncology Nursing, and designing a new elective course--Symposiums Regarding Clinical Cases; (3) holding conferences inside and outside the school to promote PBL teaching methods; (4) linking e-learning and PBL teaching methods; (5) conducting PBL research; (6) establishing a committee of PBL, objective structured clinical examination, and teaching material review for the College of Nursing; and (7) setting up a required course--Nursing Ethics. We now have 12 key tutors in the College of Nursing. We have also completed two studies to evaluate the ability of students and to explore the experience of tutors. From our studies, we know that PBL can increase learner abilities in self-directed learning, critical thinking, and PBL performance. The approach helps students to cope with the changing medical landscape. Furthermore, tutors and teachers develop adequate PBL teaching skills. Based on the experience above, we believe that we are on the right path in terms of continuing tutor development, gradually increasing the number of PBL courses, and undertaking further research to promote PBL methods in Taiwan.

  11. Longterm effects of problem-based learning: a comparison of competencies acquired by graduates of a problem-based and a conventional medical school.

    Science.gov (United States)

    Schmidt, Henk G; Vermeulen, Lyanda; van der Molen, Henk T

    2006-06-01

    Problem-based learning (PBL) as an approach to the instruction of medical students has attracted much attention in recent years. However, its effect on the performance of its graduates is the subject of considerable debate. This article presents data from a large-scale study among graduates of a problem-based medical school and those of a conventional medical school to contribute to this discussion. To study the longterm effects of problem-based medical training on the professional competencies of graduates. A questionnaire was sent to all graduates since 1980 of a problem-based and a conventional medical school. Participants were requested to rate themselves on 18 professional competencies derived from the literature. The graduates of the PBL school scored higher on 14 of 18 professional competencies. Graduates of the problem-based school rated themselves as having much better interpersonal skills, better competencies in problem solving, self-directed learning and information gathering, and somewhat better task-supporting skills, such as the ability to work and plan efficiently. There were no sizeable differences with regard to general academic competencies, such as conducting research or writing a paper. Graduates from the conventional school rated themselves as having slightly more medical knowledge. The findings were shown to be valid and robust against possible response bias. The findings suggest that PBL not only affects the typical PBL-related competencies in the interpersonal and cognitive domains, but also the more general work-related skills that are deemed important for success in professional practice.

  12. Medical Students’ Perceptions of Peer Assessment in a Problem-based Learning Curriculum

    Directory of Open Access Journals (Sweden)

    Yasin I. Tayem

    2015-08-01

    Full Text Available Objectives: Peer assessment (PA is believed to support learning and help students develop both professionally and personally. The aim of this study was to examine medical students’ perceptions of intragroup PA in a problem-based learning (PBL setting. Methods: This study was carried out between September and November 2014 and involved six random groups of fourth-year undergraduate medical students (n = 60 enrolled at the Arabian Gulf University in Manama, Bahrain. While working on set tasks within a curriculum unit, each student evaluated a randomly selected peer using an English language adapted assessment tool to measure responsibility and respect, information processing, critical analysis, interaction and collaborative skills. At the end of the unit, students’ perceptions of PA were identified using a specifically-designed voluntary and anonymous selfadministered questionnaire in English. Results: A total of 55 students participated in the study (response rate: 92%. The majority of students reported that their learning (60%, attendance (67%, respect towards group members (70% and participation in group discussions (71% improved as a result of PA. Regarding problem analysis skills, most participants believed that PA improved their ability to analyse problems (65%, identify learning needs (64%, fulfil tasks related to the analysis of learning needs (72% and share knowledge within their group (74%. Lastly, a large proportion of students reported that this form of assessment helped them develop their communication (71% and self-assessment skills (73%, as well as collaborative abilities (75%. Conclusion: PA was well accepted by the students in this cohort and led to self-reported improvements in learning, skills, attitudes, engagement and other indicators of personal and professional development. PA was also perceived to have a positive impact on intragroup attitudes.

  13. A novel modeling approach for job shop scheduling problem under uncertainty

    Directory of Open Access Journals (Sweden)

    Behnam Beheshti Pur

    2013-11-01

    Full Text Available When aiming on improving efficiency and reducing cost in manufacturing environments, production scheduling can play an important role. Although a common workshop is full of uncertainties, when using mathematical programs researchers have mainly focused on deterministic problems. After briefly reviewing and discussing popular modeling approaches in the field of stochastic programming, this paper proposes a new approach based on utility theory for a certain range of problems and under some practical assumptions. Expected utility programming, as the proposed approach, will be compared with the other well-known methods and its meaningfulness and usefulness will be illustrated via a numerical examples and a real case.

  14. The Role of Argumentation in Hypothetico-Deductive Reasoning during Problem-Based Learning in Medical Education: A Conceptual Framework

    Science.gov (United States)

    Ju, Hyunjung; Choi, Ikseon

    2018-01-01

    One of the important goals of problem-based learning (PBL) in medical education is to enhance medical students' clinical reasoning--hypothetico-deductive reasoning (HDR) in particular--through small group discussions. However, few studies have focused on explicit strategies for promoting students' HDR during group discussions in PBL. This paper…

  15. Cloninger's temperament and character traits in medical students of Korea with problem eating behaviors.

    Science.gov (United States)

    Lee, Soo Jin; Cloninger, C Robert; Chae, Han

    2015-05-01

    The personality profiles of patients with eating disorder have been extensively investigated, but those of people in the general population with eating behavior problems need to be evaluated to assess the relationship between personality, health behavior and level of overall well-being in non-clinical samples. Temperament and character traits, reasons for over-eating, and the negative influence of functional dyspepsia on quality of life were measured by the Temperament and Character Inventory (TCI), Dutch Eating Behavior Questionnaire (DEBQ), and Functional Dyspepsia Quality of Life (FDQOL) inventory, respectively, in 199 Korean medical students. The associations among TCI, FDQOL, DEBQ and body mass index (BMI) were examined by correlational analysis. Multiple regression analysis was carried out to measure how well personality (TCI) accounted for patterns of overeating (DEBQ) and impaired quality of life from functional dyspepsia (FDQOL). Individual differences in personality (especially harm-avoidance, self-transcendence, and self-directedness) were weakly associated with overeating and impaired quality of life from functional dyspepsia. Gender, social desirability and body mass index also played important roles in predicting eating behavior problems in the nonclinical population. We found that the personality traits observed in clinical patients with eating disorders are also found in people with eating behavior problems in the nonclinical population of Korea. The ways that personality traits affect eating behaviors were discussed along with recommendations for future studies in light of the limitations of available data. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Applications of the Monte Carlo simulation in dosimetry and medical physics problems

    International Nuclear Information System (INIS)

    Rojas C, E. L.

    2010-01-01

    At the present time the computers use to solve important problems extends to all the areas. These areas can be of social, economic, of engineering, of basic and applied science, etc. With and appropriate handling of computation programs and information can be carried out calculations and simulations of real models, to study them and to solve theoretical or application problems. The processes that contain random variables are susceptible of being approached with the Monte Carlo method. This is a numeric method that, thanks to the improvements in the processors of the computers, it can apply in many tasks more than what was made in the principles of their practical application (at the beginning of the decade of 1950). In this work the application of the Monte Carlo method will be approached in the simulation of the radiation interaction with the matter, to investigate dosimetric aspects of some problems that exist in the medical physics area. Also, contain an introduction about some historical data and some general concepts related with the Monte Carlo simulation are revised. (Author)

  17. Low parental tolerance for infant crying: an underlying factor in infant sleep problems?

    Science.gov (United States)

    Sadeh, Avi; Juda-Hanael, Michal; Livne-Karp, Efrat; Kahn, Michal; Tikotzky, Liat; Anders, Thomas F; Calkins, Susan; Sivan, Yakov

    2016-10-01

    Parenting behaviours play a major role in the evolution of infant sleep. Sleep problems in infancy have been associated with excessive parental involvement at night-time, and with shorter delays in response to infant night wakings and signalling. Infant crying and sleep problems are linked, yet little is known about the impact of parental responses to crying on infant sleep patterns. This study examined the hypothesis that lower parental tolerance for crying is associated with infant sleep problems. We studied 144 married couples divided into three groups: parents of infants suffering from night-waking problems (i.e. the clinical group), parents of infants without sleep problems and childless couples. Crying tolerance was assessed using questionnaires, audio recordings of crying infants and using a novel paradigm, in which participants were shown a video of a crying infant and asked when they would intervene. Parents in the clinical group demonstrated shorter intervention delays in the crying infant clip (group effect: P sleep-disturbed infants appear to have lower tolerance for infant crying, which may be a predisposition underlying their excessive involvement in soothing their infants to sleep which may lead to the development of sleep problems. These preliminary findings should be explored further to assess their clinical validity and utility. © 2016 European Sleep Research Society.

  18. Utility of a Brief Screening Tool for Medication-Related Problems

    Science.gov (United States)

    Snyder, Margie E.; Pater, Karen S.; Frail, Caitlin K.; Hudmon, Karen Suchanek; Doebbeling, Brad N.; Smith, Randall B.

    2014-01-01

    Background Medication therapy management (MTM) services position pharmacists to prevent, detect, and resolve medication-related problems (MRPs.) However, selecting patients for MTM who are most at risk for MRPs is a challenge. Using self-administered scales that are practical for use in clinical practice are one approach. Objective The objective of this study was to estimate the psychometric properties of a brief self-administered scale as a screening tool for MRPs. Methods This was a non-randomized study utilizing questionnaires administered cross-sectionally. In Phase 1, patients (n=394) at community pharmacies and outpatient clinics completed 78 items, provided to the study team by item authors, assessing perceived MRPs. These data were used to select items for further investigation as a brief, self-administered scale, and estimate the reliability and construct validity of the resulting instrument. In Phase 2, a convenience sample of patients (n=200) at community pharmacies completed a nine-item, self-administered scale. After completion, they were engaged in a comprehensive medication review by their pharmacist who was blinded to questionnaire responses. The main outcome measure for estimating the criterion-related validity of the scale was the number of pharmacist-identified medication-related problems (MRPs.) Item statistics were computed as well as bivariate associations between scale scores and other variables with MRPs. A multivariate model was constructed to examine the influence of scale scores on MRPs after controlling for other significant variables. Results Higher scores on the questionnaire were positively correlated with more pharmacist-identified MRPs (r = 0.24; p= 0.001) and scores remained as a significant predictor (p= 0.031) when controlling for other relevant variables in a multivariate regression model (R2= 0.21; p < 0.001.) Conclusions Patient responses on the scale may have a modest role in predicting MRPs. The use of self

  19. Heuristics for the Economic Production Quantity Problem under Restrictions on Production and Maintenance Time

    Directory of Open Access Journals (Sweden)

    Qi Xu

    2016-01-01

    Full Text Available This paper proposes an economic production quantity problem with the maximal production run time and minimal preventive maintenance time over a finite planning horizon. The objective is to find the efficient production and maintenance policy to minimize the total cost composed of production, maintenance, shortages, and holding costs under the restriction on the production run time and the preventive maintenance time. The production and maintenance decisions include the production and maintenance frequencies and the production run and the maintenance time. The variability and the boundedness of the production run and maintenance time make the problem difficult to solve. Two heuristic algorithms are developed using different techniques based on the optimal properties of the relaxed problem. The performance comparison between the two algorithms is illustrated by numerical examples. The numerical results show that, for the most part, there exists a heuristic algorithm which is more effective than the other.

  20. Dynamic Network Design Problem under Demand Uncertainty: An Adjustable Robust Optimization Approach

    Directory of Open Access Journals (Sweden)

    Hua Sun

    2014-01-01

    Full Text Available This paper develops an adjustable robust optimization approach for a network design problem explicitly incorporating traffic dynamics and demand uncertainty. In particular, a cell transmission model based network design problem of linear programming type is considered to describe dynamic traffic flows, and a polyhedral uncertainty set is used to characterize the demand uncertainty. The major contribution of this paper is to formulate such an adjustable robust network design problem as a tractable linear programming model and justify the model which is less conservative by comparing its solution performance with the robust solution from the usual robust model. The numerical results using one network from the literature demonstrate the modeling advantage of the adjustable robust optimization and provided strategic managerial insights for enacting capacity expansion policies under demand uncertainty.

  1. Medical and sociological explication of the problem of infectious diseases prophylaxis among pregnant women

    Directory of Open Access Journals (Sweden)

    N.B. Merzlova

    2016-12-01

    Full Text Available The research is focused on revealing the TORCH-infections prophylaxis problems during preconception period and culture of personal infection safety among pregnant women. The research involved 2060 women. Epidemiological monitoring was accompanied by a social survey of the Perinatal Center patients using the continuous sampling method. The problems of the population’s response adequacy regarding the dangers of TORCH-infection are presented on the basis of questionnaire survey of 55 pregnant women – patients of the Perinatal Center. Sociological explication of the problems of TORCH-infections prophylaxis revealed the positive and negative behavioral stereotypes of the Perm Region population from the point of view of assuring the personal infection safety. The positive stereotypes include cleanliness and vitamin prophylaxis practice. The regional hygienic culture can be developed by increased involvement in sport, immunological prophylaxis propaganda, safe sex, helminth prophylaxis in pets and regular tooth brushing. The survey has explicated the common negative behavour stereotypes leading to toxoplasmosis contamination during pregnancy. Only a half of the surveyed women avoid the intake of meat that did not undergo sufficient heat treatment, 72.7 % of respondents cannot be relieved from the duties of cleaning the cat’s toilet. The rating made on the basis of the survey concerning the popularity of measures assuring personal infection safety has shown a neglectful attitude of population towards the immunological prophylaxis and modern medical products affecting the immune system, that inevitably leads to problems with compliance of pregnant women to vaccination and immunological correction by immune modulators during treatment of the revealed infectious diseases. We found a mismatch between the behavioral stereotypes of the Perm Region population in ensuring personal infection safety and the academic principles of TORCH-infections prevention

  2. Medication problems are frequent and often serious in a Danish emergency department and may be discovered by clinical pharmacists

    DEFF Research Database (Denmark)

    Backer Mogensen, Christian; Thisted, Anette Rehn; Olsen, Inger

    2012-01-01

    Transferring a patient from one health-care sector to another implies a risk of medication errors. It is of interest to evaluate whether a specialist in clinical pharmacy is beneficial for the patients in the emergency departments (ED). The aim of the present study was to report the incidence, ca......, categories and seriousness of medication problems discovered by clinical pharmacists in an ED and to evaluate if it is possible for pharmacists to identify those groups of patients who are most at risk of medication problems....

  3. Personal drug selection: problem-based learning in pharmacology: experience from a medical school in Nepal.

    Science.gov (United States)

    Shankar, P Ravi; Palaian, Subish; Gyawali, Sudesh; Mishra, Pranaya; Mohan, Lalit

    2007-06-13

    At the Manipal College of Medical Sciences, Pokhara, Nepal, Pharmacology is taught during the first four semesters of the undergraduate medical course. Personal or P-drug selection is an important exercise. The present study was carried out to obtain student opinion about the P-drug learning sessions, the assessment examinations, and on the small group dynamics. The practical sessions on P-drug selection are carried out in small groups. Student feedback about the session was obtained using focus group discussions. The focus groups were selected to represent both genders and the three main nationalities, Nepalese, Indians, and Sri Lankans. There were four Nepalese, five Indians, and three Sri Lankans. Within each nationality and gender category the students were randomly selected. The respondents were explained the objectives of the study and were invited to participate. Written informed consent was obtained. The discussion lasted around two hours and was conducted in the afternoon in two groups of six students each. The first author (PRS) acted as a facilitator. The responses were recorded and analyzed qualitatively. The overall student opinion was positive. Around 25% (3 respondents) of respondents were confused about whether P-drugs were for a disease or a patient. Group consensus was commonly used to give numerical values for the different criteria. The large number of brands created problems in calculating cost. The students wanted more time for the exercise in the examination. Formative assessment during the learning sessions may be considered. The group members usually got along well. Absenteeism was a problem and not all members put in their full effort. The physical working environment should be improved. Based on what the students say, the sessions on P-drugs should be continued and strengthened. Modifications in the sessions are required. Sessions during the clinical years and internship training can be considered.

  4. Personal drug selection: problem-based learning in pharmacology: experience from a medical school in Nepal.

    Directory of Open Access Journals (Sweden)

    P Ravi Shankar

    Full Text Available BACKGROUND: At the Manipal College of Medical Sciences, Pokhara, Nepal, Pharmacology is taught during the first four semesters of the undergraduate medical course. Personal or P-drug selection is an important exercise. The present study was carried out to obtain student opinion about the P-drug learning sessions, the assessment examinations, and on the small group dynamics. METHOD: The practical sessions on P-drug selection are carried out in small groups. Student feedback about the session was obtained using focus group discussions. The focus groups were selected to represent both genders and the three main nationalities, Nepalese, Indians, and Sri Lankans. There were four Nepalese, five Indians, and three Sri Lankans. Within each nationality and gender category the students were randomly selected. The respondents were explained the objectives of the study and were invited to participate. Written informed consent was obtained. The discussion lasted around two hours and was conducted in the afternoon in two groups of six students each. The first author (PRS acted as a facilitator. The responses were recorded and analyzed qualitatively. RESULTS: The overall student opinion was positive. Around 25% (3 respondents of respondents were confused about whether P-drugs were for a disease or a patient. Group consensus was commonly used to give numerical values for the different criteria. The large number of brands created problems in calculating cost. The students wanted more time for the exercise in the examination. Formative assessment during the learning sessions may be considered. The group members usually got along well. Absenteeism was a problem and not all members put in their full effort. The physical working environment should be improved. CONCLUSIONS: Based on what the students say, the sessions on P-drugs should be continued and strengthened. Modifications in the sessions are required. Sessions during the clinical years and internship training

  5. Task-based learning versus problem-oriented lecture in neurology continuing medical education.

    Science.gov (United States)

    Vakani, Farhan; Jafri, Wasim; Ahmad, Amina; Sonawalla, Aziz; Sheerani, Mughis

    2014-01-01

    To determine whether general practitioners learned better with task-based learning or problem-oriented lecture in a Continuing Medical Education (CME) set-up. Quasi-experimental study. The Aga Khan University, Karachi campus, from April to June 2012. Fifty-nine physicians were given a choice to opt for either Task-based Learning (TBL) or Problem Oriented Lecture (PBL) in a continuing medical education set-up about headaches. The TBL group had 30 participants divided into 10 small groups, and were assigned case-based tasks. The lecture group had 29 participants. Both groups were given a pre and a post-test. Pre/post assessment was done using one-best MCQs. The reliability coefficient of scores for both the groups was estimated through Cronbach's alpha. An item analysis for difficulty and discriminatory indices was calculated for both the groups. Paired t-test was used to determine the difference between pre- and post-test scores of both groups. Independent t-test was used to compare the impact of the two teaching methods in terms of learning through scores produced by MCQ test. Cronbach's alpha was 0.672 for the lecture group and 0.881 for TBL group. Item analysis for difficulty (p) and discriminatory indexes (d) was obtained for both groups. The results for the lecture group showed pre-test (p) = 42% vs. post-test (p) = 43%; pre- test (d) = 0.60 vs. post-test (d) = 0.40. The TBL group showed pre -test (p) = 48% vs. post-test (p) = 70%; pre-test (d) = 0.69 vs. post-test (d) = 0.73. Lecture group pre-/post-test mean scores were (8.52 ± 2.95 vs. 12.41 ± 2.65; p learning through TBL delivery and calls for further exploration of longitudinal studies in the context of CME.

  6. Longterm effects of problem-based learning: A comparison of competencies acquired by graduates of a problem-based and a conventional medical school

    NARCIS (Netherlands)

    H.G. Schmidt (Henk); L. Vermeulen (Lyanda); H.T. van der Molen (Henk)

    2006-01-01

    textabstractBACKGROUND: Problem-based learning (PBL) as an approach to the instruction of medical students has attracted much attention in recent years. However, its effect on the performance of its graduates is the subject of considerable debate. This article presents data from a large-scale study

  7. Risk of serious cardiovascular problems with medications for attention-deficit hyperactivity disorder.

    Science.gov (United States)

    Martinez-Raga, Jose; Knecht, Carlos; Szerman, Nestor; Martinez, María I

    2013-01-01

    Attention-deficit hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder characterized by persistent symptoms of inattention, hyperactivity and/or impulsivity. The proportion of patients diagnosed with ADHD receiving pharmacological treatments has increased enormously in recent years. Despite the well established efficacy and the good safety and tolerability profile, there is concern about the potential for rare but serious cardiovascular adverse events, as well as sudden cardiac death, with pharmacotherapies used for treating ADHD in children, adolescents and adults. The present paper aims to comprehensively and critically review the published evidence on the controversial association between medications approved for treating patients with ADHD and the risk of serious cardiovascular problems, specifically the risk of corrected QT interval (QTc) prolongation, and the risk of sudden cardiac death. A comprehensive search of relevant databases (PubMed, EMBASE and PsychINFO) was conducted to identify studies published in peer-reviewed journals until 21 July 2012. Clinical reports, as well as retrospective or prospective population-based studies with children, adolescents or adults as participants, of pharmacotherapies for ADHD reporting cardiovascular adverse events were included. Stimulant medications for ADHD, including methylphenidate and amphetamine derivatives, are generally safe and well tolerated. Small but statistically significant increases in blood pressure (BP) and heart rate (HR) are among the adverse events of stimulant treatment in all age groups. Similarly, the non-stimulant medication atomoxetine has also been associated with increased HR and BP, although as is the case with stimulants, these are generally minor, time limited and of minor clinical significance in children, adolescents or adults. Growing evidence suggests that these medications do not cause sudden and unexpected cardiac death or serious cardiovascular problems including

  8. Prevalence of depressive symptoms among medical students taught using problem-based learning versus traditional methods.

    Science.gov (United States)

    Aragão, José Aderval; Freire, Marianna Ribeiro de Menezes; Nolasco Farias, Lucas Guimarães; Diniz, Sarah Santana; Sant'anna Aragão, Felipe Matheus; Sant'anna Aragão, Iapunira Catarina; Lima, Tarcisio Brandão; Reis, Francisco Prado

    2018-06-01

    To compare depressive symptoms among medical students taught using problem-based learning (PBL) and the traditional method. Beck's Depression Inventory was applied to 215 medical students. The prevalence of depression was calculated as the number of individuals with depression divided by the total number in the sample from each course, with 95% confidence intervals. The statistical significance level used was 5% (p ≤ .05). Among the 215 students, 52.1% were male and 47.9% were female; and 51.6% were being taught using PBL methodology and 48.4% using traditional methods. The prevalence of depression was 29.73% with PBL and 22.12% with traditional methods. There was higher prevalence among females: 32.8% with PBL and 23.1% with traditional methods. The prevalence of depression with PBL among students up to 21 years of age was 29.4% and among those over 21 years, 32.1%. With traditional methods among students up to 21 years of age, it was 16.7%%, and among those over 21 years, 30.1%. The prevalence of depression with PBL was highest among students in the second semester and with traditional methods, in the eighth. Depressive symptoms were highly prevalent among students taught both with PBL and with traditional methods.

  9. Academic satisfaction among traditional and problem based learning medical students. A comparative study.

    Science.gov (United States)

    Albarrak, Ahmed I; Mohammed, Rafiuddin; Abalhassan, Mohammed F; Almutairi, Nasser K

    2013-11-01

    To evaluate the academic satisfaction and importance among traditional learning (TL) and problem based learning (PBL) medical students, and to further evaluate the areas of concern in the academic education from the student's point of view. A cross sectional study was conducted at the College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia from May to June 2012. The survey questionnaires were self-administered and consisted of mainly 6 sections: teaching, learning, supervision, course organization, information technology (IT) facilities, and development of skills. A total of 92 TL (males: 66 [71.7%]; females: 26 [28.3%]), and 108 PBL (males: 84 [77.8%]; females: 24 [22.1%]), with a mean age of 21.3 +/- 1.3 (TL), and 20.7 +/- 1.0 (PBL) were included in the study. The overall satisfaction rate was higher in the PBL students when compared with TL students in: teaching (84.7%/60.3%); learning (81.4%/64.5%); supervision (80%/51.5%); course organization (69.3%/46.9%); IT facilities (74.0%/58.9%); and development of skills (79.1%/53.9%). There was statistical significance difference in academic satisfaction comparing both groups of students (pdisadvantages of the traditional system. The PBL was potentially considered a successful method in enhancing medical education.

  10. Generalisability theory analyses of concept mapping assessment scores in a problem-based medical curriculum.

    Science.gov (United States)

    Kassab, Salah E; Fida, Mariam; Radwan, Ahmed; Hassan, Adla B; Abu-Hijleh, Marwan; O'Connor, Brian P

    2016-07-01

    In problem-based learning (PBL), students construct concept maps that integrate different concepts related to the PBL case and are guided by the learning needs generated in small-group tutorials. Although an instrument to measure students' concept maps in PBL programmes has been developed, the psychometric properties of this instrument have not yet been assessed. This study evaluated the generalisability of and sources of variance in medical students' concept map assessment scores in a PBL context. Medical students (Year 4, n = 116) were asked to construct three integrated concept maps in which the content domain of each map was to be focused on a PBL clinical case. Concept maps were independently evaluated by four raters based on five criteria: valid selection of concepts; hierarchical arrangement of concepts; degree of integration; relationship to the context of the problem, and degree of student creativity. Generalisability theory was used to compute the reliability of the concept map scores. The dependability coefficient, which indicates the reliability of scores across the measured facets for making absolute decisions, was 0.814. Students' concept map scores (universe scores) accounted for the largest proportion of total variance (47%) across all score comparisons. Rater differences accounted for 10% of total variance, and the student × rater interaction accounted for 25% of total variance. The variance attributable to differences in the content domain of the maps was negligible (2%). The remaining 16% of the variance reflected unexplained sources of error. Results from the D study suggested that a dependability level of 0.80 can be achieved by using three raters who each score two concept map domains, or by using five raters who each score only one concept map domain. This study demonstrated that concept mapping assessment scores of medical students in PBL have high reliability. Results suggested that greater improvements in dependability might be made

  11. The professional medical ethics model of decision making under conditions of clinical uncertainty.

    Science.gov (United States)

    McCullough, Laurence B

    2013-02-01

    The professional medical ethics model of decision making may be applied to decisions clinicians and patients make under the conditions of clinical uncertainty that exist when evidence is low or very low. This model uses the ethical concepts of medicine as a profession, the professional virtues of integrity and candor and the patient's virtue of prudence, the moral management of medical uncertainty, and trial of intervention. These features combine to justifiably constrain clinicians' and patients' autonomy with the goal of preventing nondeliberative decisions of patients and clinicians. To prevent biased recommendations by the clinician that promote such nondeliberative decisions, medically reasonable alternatives supported by low or very low evidence should be offered but not recommended. The professional medical ethics model of decision making aims to improve the quality of decisions by reducing the unacceptable variation that can result from nondeliberative decision making by patients and clinicians when evidence is low or very low.

  12. Californians newly eligible for Medi-Cal under health care reform.

    Science.gov (United States)

    Pourat, Nadereh; Martinez, Ana E; Kominski, Gerald F

    2011-05-01

    About 2.13 million nonelderly Californians who were uninsured for all or part of 2009 are newly-eligible for Medi-Cal under the Patient Protection and Affordable Care Act (ACA) of 2010. Analysis of the 2009 California Health Interview Survey indicates that this newly-eligible population is often single, working-age and employed. Their rates of most chronic conditions are similar to those currently enrolled in Medi-Cal, but they have less access to care. The characteristics of the population of the newly-eligible for Medi-Cal under ACA are likely to change by 2014 when the major provisions of the law are fully implemented. However, coverage of this newly-eligible low-income population is likely to improve their access to health services.

  13. Undocumented Immigration, Drug Problems, and Driving Under the Influence in the United States, 1990-2014.

    Science.gov (United States)

    Light, Michael T; Miller, Ty; Kelly, Brian C

    2017-09-01

    To examine the influence of undocumented immigration in the United States on 4 different metrics of drug and alcohol problems: drug arrests, drug overdose fatalities, driving under the influence (DUI) arrests, and DUI deaths. We combined newly developed state-level estimates of the undocumented population between 1990 and 2014 from the Center for Migration Studies with arrest data from the Federal Bureau of Investigation Uniform Crime Reports and fatality information from the Fatality Analysis Reporting System and the Centers for Disease Control and Prevention Underlying Cause of Death database. We used fixed-effects regression models to examine the longitudinal association between increased undocumented immigration and drug problems and drunk driving. Increased undocumented immigration was significantly associated with reductions in drug arrests, drug overdose deaths, and DUI arrests, net of other factors. There was no significant relationship between increased undocumented immigration and DUI deaths. This study provides evidence that undocumented immigration has not increased the prevalence of drug or alcohol problems, but may be associated with reductions in these public health concerns.

  14. Radiation protection problems at compact cyclotrons for medical and other use

    International Nuclear Information System (INIS)

    Sauerman, P.F.; Friedrich, W.; Knieper, J.; Komnick, K.; Printz, H.

    1980-01-01

    Small high yield cyclotrons (compact cyclotrons) will be widely used in the future in the fields of nuclear medicine, biology and solid state physics. The main radiation protection problems at such accelerators are: a) proper design of shielding, b) handling of activation problems, and c) reduction of exposures to workers resulting from handling of short-lived radionuclides. These problems were studied by us in the last five years at the compact cyclotron CV-28 of the Juelich Nuclear Research Centre. The effectiveness of concretes as shielding materials against fast neutrons and gamma-radiation from (d,n)-, (p,n)- ( 3 He,n)- and ( 4 He,n)-reactions was studied in the experimental shield testing facility at the cyclotron using gas targets and solid targets, such as beryllium, carbon, aluminium, iron, copper and tantalum. The activation of air, target and building construction material was studied under different operating conditions of the cyclotron. The results of efforts to reduce doses to workers to one tenth of the permissible value are presented. (H.K.)

  15. Orodental status and medical problems of stroke inpatients undergoing rehabilitation at a rehabilitation hospital in Japan.

    Science.gov (United States)

    Asahi, Yoshinao; Omichi, Shiro; Ono, Takahiro

    2015-09-01

    Many stroke patients may have oral problems and systemic diseases, but clinical information on treatment provided to stroke patients for dental problems during inpatient rehabilitation is rare. The objective of this study was to research stroke inpatients' requirements for dental treatment and the accompanying risks. We included 165 stroke patients undergoing inpatient rehabilitation at Morinomiya Hospital during the year 2010 and researched the causes of stroke and the patients' orodental status, underlying diseases, antithrombotic drugs prescribed and special considerations or difficulties in the treatment. Cerebral infarction was the most common causes of stroke. Many patients had hypertension, heart disease or diabetes mellitus, and 54.5% had been prescribed antithrombotic drugs. Dentists diagnosed 57.0% patients with untreated dental cavities. Approximately 30% did not use dentures despite having a requirement. In total, 142 patients underwent dental treatment including periodontal treatment, prosthetic treatment and tooth extraction under management of circulation and haemostasis such as monitoring vital signs and surgical splints in cases of the difficult extraction. The current study revealed a high requirement for dental treatment among stroke patients and demonstrated the effectiveness of performing dental treatment during inpatient rehabilitation of these patients. © 2014 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd.

  16. 'On the doctor's orders': A pilot study of the effects of website marketing for medical specialist providers under gatekeeping arrangements

    NARCIS (Netherlands)

    Zwier, S.

    2017-01-01

    Websites from medical specialist providers are becoming increasingly marketing oriented, but there exists a paucity of empirical research on the effects. This experimental study explored effects of exposure to real websites from medical specialist providers among Dutch adults under physician

  17. Feasibility of a self-administered survey to identify primary care patients at risk of medication-related problems

    Directory of Open Access Journals (Sweden)

    Makowsky MJ

    2014-02-01

    Full Text Available Mark J Makowsky,1 Andrew J Cave,2 Scot H Simpson1 1Faculty of Pharmacy and Pharmaceutical Sciences, 2Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada Background and objectives: Pharmacists working in primary care clinics are well positioned to help optimize medication management of community-dwelling patients who are at high risk of experiencing medication-related problems. However, it is often difficult to identify these patients. Our objective was to test the feasibility of a self-administered patient survey, to facilitate identification of patients at high risk of medication-related problems in a family medicine clinic. Methods: We conducted a cross-sectional, paper-based survey at the University of Alberta Hospital Family Medicine Clinic in Edmonton, Alberta, which serves approximately 7,000 patients, with 25,000 consultations per year. Adult patients attending the clinic were invited to complete a ten-item questionnaire, adapted from previously validated surveys, while waiting to be seen by the physician. Outcomes of interest included: time to complete the questionnaire, staff feedback regarding impact on workflow, and the proportion of patients who reported three or more risk factors for medication-related problems. Results: The questionnaire took less than 5 minutes to complete, according to the patient's report on the last page of the questionnaire. The median age (and interquartile range of respondents was 57 (45–69 years; 59% were women; 47% reported being in very good or excellent health; 43 respondents of 100 had three or more risk factors, and met the definition for being at high risk of a medication-related problem. Conclusions: Distribution of a self-administered questionnaire did not disrupt patients, or the clinic workflow, and identified an important proportion of patients at high risk of medication-related problems. Keywords: screening tool, pharmacists, primary

  18. [Problems impeding the introduction of care services under the long-term care insurance system].

    Science.gov (United States)

    Suzuki, Hiroko; Yamanaka, Katsuo; Fujita, Yoshio; Hirano, Yasuyuki; Iijima, Setsu

    2012-03-01

    To identify problems currently impeding the introduction of care services to seniors who are not yet taking advantage of such services despite the need for some kind of in-home care, and to examine effective solutions by creating a model that clarifies relationships among these problems based on covariance structural analysis. An anecdotal self-completion questionnaire was sent by mail to public health nurses who provide consultations to seniors in 657 locations throughout the mainland Japan, Honshu. The cases targeted in this survey were seniors for whom the introduction of care services was perceived to be difficult. Respondents were asked to relate one particularly memorable case encountered since April 2000 in which intervention assistance was provided through home visits. The survey consisted of 43 questions, including demographic information, basic case data, the outcome of intervention assistance in the case cited, and obstacles to introducing nursing services. We analyzed the 311 valid responses received (valid response rate: 47.3%). After performing factor analysis on the problems that were considered to impede the introduction of care services, we examined the relationships among these problems using covariance structural analysis and selected the model that best fit the data. 1) Problems that were considered to impede the introduction of care services were extracted from the results of an item analysis and factor analysis as follows. Factor 1: "Resistance to changing lifestyle." Factor 2: "Relative's lack of understanding or cooperation." Factor 3: "Lack of ability to handle procedures and contracts." Factor 4: "Lack of informal support." Factor 5: "Resistance to undergoing medical exams." 2) We performed a covariance structural analysis using the five factors derived from the factor analysis as the latent variables, and selected the best-fitting model, in which GFI = 0.929, AGFI = 0.901, and CFI = 0.950. The model showed that factors 3, 4, and 5

  19. Medical resource inventory model for emergency preparation with uncertain demand and stochastic occurrence time under considering different risk preferences at the airport.

    Directory of Open Access Journals (Sweden)

    Wei Pan

    Full Text Available With the high accident rate of civil aviation, medical resource inventory becomes more important for emergency management at the airport. Meanwhile, medical products usually are time-sensitive and short lifetime. Moreover, we find that the optimal medical resource inventory depends on multiple factors such as different risk preferences, the material shelf life and so on. Thus, it becomes very complex in a real-life environment. According to this situation, we construct medical resource inventory decision model for emergency preparation at the airport. Our model is formulated in such a way as to simultaneously consider uncertain demand, stochastic occurrence time and different risk preferences. For solving this problem, a new programming is developed. Finally, a numerical example is presented to illustrate the proposed method. The results show that it is effective for determining the optimal medical resource inventory for emergency preparation with uncertain demand and stochastic occurrence time under considering different risk preferences at the airport.

  20. The problems of hygienic classification of radioactive waste under restoration of contaminated areas

    International Nuclear Information System (INIS)

    Savkin, M.; Shandala, N.; Novikova, N.; Petukhova, E.; Shishkin, V.; Egorov, B.; Ziborov, A.

    2002-01-01

    Experience on restoration of contaminated areas in the past ten years reveals a specific problem in the general problem of solid radioactive waste management as a result of decontamination of the settlements. That specific problem concerns conventionally radioactive waste (CRW), which might be to some extent dangerous for human being. In the documents of IAEA and ICRP the approaches aimed at exemption or exclusion insignificant amount of radioactive wastes from regulatory control are actively being developed. In turn, Russia does not have so far either methodic or regulatory documents on management of very low level radioactive waste. Two approaches are considered in the paper under development of derived levels for CRW in case of restoration of contaminated areas. The first one is based on restriction of individual risk at level about 10 -6 per year (negligible level). The second one accounts for global man-made background and uses acceptable factor of excess of that background as a criterion.Under the first approach (restriction of individual risk) the lowest boundary of CRW is estimated to be equal to 3 Bq kg -1 for 239 Pu; 30 Bq kg -1 for 90 Sr; and 300 Bq kg -1 for 137 Cs, respectively. Those levels of specific activity approximately correspond to the areas contaminated by the above mentioned radionuclides 0.3 kBq m -2 , 3 kBq m -2 , and 30 kBq m -2 , respectively. Under the second approach if one accepts factor of 3 of excess of global man-made background, than the levels of specific activity will be 0.05 kBq m -2 for 239 Pu; 2.5 kBq m -2 for 90 Sr, and 7.2 kBq m -2 for 137 Cs. Comparison of the levels obtained according to the second approach shows that they will be several times lower than that according to the first approach. (author)

  1. Acute stress reactions among medical and non-medical personnel in a general hospital under missile attacks.

    Science.gov (United States)

    Koren, Danny; Caspi, Yael; Leiba, Ronit; Bloch, Doron; Vexler, Batia; Klein, Ehud

    2009-01-01

    Recent mass level traumatic events further boosted the growing interest in understanding the effects of primary (direct) and secondary (indirect) traumatic exposure on "helping professionals." The objectives of this study are: (1) to assess the rates and severity of PTSD symptoms (PS) among hospital workers operating under fire while treating war-related injured patients, (2) to explore the effect of PS on level of functioning in real time, and (3) to estimate the added effect of secondary traumatization over and above that of primary traumatization. Rates of PS, level of psychological distress, and level of functioning were assessed in 412 medical and non-medical personnel working in a hospital that was under missile attacks during the Second Lebanon War in the summer of 2006. The Posttraumatic Stress Disorder Scale (PSS) was used to assess severity of PS, as well as to estimate probable DSM-IV diagnosis of PTSD. The mean number of reported PS was 8.6 (SD=4.4). Forty-three (10.2%) of the participants met the symptom and severity threshold for a probable diagnosis of PTSD, however only 13 of these 43 reported impaired level of functioning. There were no significant differences between personnel who had direct exposure to injured or traumatized casualties of the war and those who were not on PS severity and frequency of probable PTSD. These findings suggest that hospital workers operating under prolonged life-threatening conditions are at moderate risk for PTSD. However, they do not support an incremental effect of secondary traumatic exposure. (c) 2008 Wiley-Liss, Inc.

  2. [Simulation exercises, a problem oriented method of learning public health in medical education].

    Science.gov (United States)

    Yano, E; Tamiya, N; Hasegawa, T

    1998-03-01

    Using the case method of learning of American business schools, we introduced "Simulation Exercises (SE)," a problem oriented method of public health education for medical students. With SE, a group of students were given simulated cases of patients or situations (SC), and were asked to assume the role of physicians or other public health workers using their skills and knowledge of public health. Students learn on their own, with the aid of tutors, through discussion, role-play, investigation of literature, and a small field survey. There have been a whole variety of SC covering most of the current topics in public health ranging from mental health, dental health, industrial health, maternal & child health, elderly care, terminal care and international health. Each SC has 5 to 10 questions which stimulate and direct the students' group discussion. Some of the questions do not have a correct answer, but the criteria used to evaluate the students included clarity, consistency, and comprehensiveness of their ideas in addition to the positive commitment to the group discussion. At the end of the week-long group learning, each group demonstrated the results of their discussion. Role play was often used to demonstrate what they learned. As a result, students participated positively and concentrated and enjoyed the learning exercise very much. An anonymous survey shortly after SE showed that more than 80% of students felt a positive change in their rating of public health among the many subjects of study. Tutors also changed their rating of the students after observing their positive attitude and sometimes very creative ideas. In conclusion, we found SE to be useful for practical learning by medical students of public health.

  3. A multiple ship routing and speed optimization problem under time, cost and environmental objectives

    DEFF Research Database (Denmark)

    Wen, M.; Pacino, Dario; Kontovas, C.A.

    2017-01-01

    The purpose of this paper is to investigate a multiple ship routing and speed optimization problem under time, cost and environmental objectives. A branch and price algorithm as well as a constraint programming model are developed that consider (a) fuel consumption as a function of payload, (b......) fuel price as an explicit input, (c) freight rate as an input, and (d) in-transit cargo inventory costs. The alternative objective functions are minimum total trip duration, minimum total cost and minimum emissions. Computational experience with the algorithm is reported on a variety of scenarios....

  4. A model for the inverse 1-median problem on trees under uncertain costs

    Directory of Open Access Journals (Sweden)

    Kien Trung Nguyen

    2016-01-01

    Full Text Available We consider the problem of justifying vertex weights of a tree under uncertain costs so that a prespecified vertex become optimal and the total cost should be optimal in the uncertainty scenario. We propose a model which delivers the information about the optimal cost which respect to each confidence level \\(\\alpha \\in [0,1]\\. To obtain this goal, we first define an uncertain variable with respect to the minimum cost in each confidence level. If all costs are independently linear distributed, we present the inverse distribution function of this uncertain variable in \\(O(n^{2}\\log n\\ time, where \\(n\\ is the number of vertices in the tree.

  5. A comparison between the effectiveness of PBL and LBL on improving problem-solving abilities of medical students using questioning

    DEFF Research Database (Denmark)

    He, Yunfeng; Du, Xiangyun; Toft, Egon

    2018-01-01

    of problem-based learning (PBL) and lecture-based learning in improving the questioning abilities of medical students (N = 104) was assessed by a modified 20-question task. In this task, the participants were asked to identify target pictures by asking questions, the problem-solving process of which....... This finding suggests that PBL curricula may help improve the questioning strategies of medical students and help them diagnose more efficiently in future diagnosis practice.......In daily patient-history taking and diagnosis practice, doctors ask questions to gather information from patients and narrow down diagnostic hypotheses. Training medical students to be efficient problem solvers through the use of questioning is therefore important. In this study, the effectiveness...

  6. Reinforced concrete structures under impact and impulsive loading: recent development, problems and trends

    International Nuclear Information System (INIS)

    Plauk, G.; Herter, J.

    1984-01-01

    Nuclear plant facilities and other reinforced concrete structures have to be regarded as to their safety in design and construction with respect to impact and impulsive loading in order to avoid serious damage to mankind and environment. The paper gives a survey on theoretical and experimental developments currently in progress, in particular regarding airplane crash. Some new results arising out of several research programs relevant to particular problems of impact loading have been reviewed and are presented. Experimental investigation for determination of material properties of plain concrete, reinforcing steel as well as steel-concrete bond under high strain-rates are treated in this paper including theoretical approaches for the respective material laws. An outline of soft missile impact tests performed on structural members, e.g. beams and plates, to determine the load deformation or fracture behaviour is given. Furthermore, numerical models and calculations to analyse structural components and structures under impact loading were discussed. (Author) [pt

  7. Integration of QFD, AHP, and LPP methods in supplier development problems under uncertainty

    Science.gov (United States)

    Shad, Zahra; Roghanian, Emad; Mojibian, Fatemeh

    2014-04-01

    Quality function deployment (QFD) is a customer-driven approach, widely used to develop or process new product to maximize customer satisfaction. Last researches used linear physical programming (LPP) procedure to optimize QFD; however, QFD issue involved uncertainties, or fuzziness, which requires taking them into account for more realistic study. In this paper, a set of fuzzy data is used to address linguistic values parameterized by triangular fuzzy numbers. Proposed integrated approach including analytic hierarchy process (AHP), QFD, and LPP to maximize overall customer satisfaction under uncertain conditions and apply them in the supplier development problem. The fuzzy AHP approach is adopted as a powerful method to obtain the relationship between the customer requirements and engineering characteristics (ECs) to construct house of quality in QFD method. LPP is used to obtain the optimal achievement level of the ECs and subsequently the customer satisfaction level under different degrees of uncertainty. The effectiveness of proposed method will be illustrated by an example.

  8. A Decision Optimization Model for Leased Manufacturing Equipment with Warranty under Forecasting Production/Maintenance Problem

    Directory of Open Access Journals (Sweden)

    Zied Hajej

    2015-01-01

    Full Text Available Due to the expensive production equipment, many manufacturers usually lease production equipment with a warranty period during a finite leasing horizon, rather than purchasing them. The lease contract contains the possibility of obtaining an extended warranty for a given additional cost. In this paper, based on the forecasting production/maintenance optimization problem, we develop a mathematical model to study the lease contract with basic and extended warranty based on win-win relationship between the lessee and the lessor. The influence of the production rates in the equipment degradation consequently on the total cost by each side during the finite leasing horizon is stated in order to determine a theoretical condition under which a compromise-pricing zone exists under different possibilities of maintenance policies.

  9. Bi-Objective Flexible Job-Shop Scheduling Problem Considering Energy Consumption under Stochastic Processing Times.

    Science.gov (United States)

    Yang, Xin; Zeng, Zhenxiang; Wang, Ruidong; Sun, Xueshan

    2016-01-01

    This paper presents a novel method on the optimization of bi-objective Flexible Job-shop Scheduling Problem (FJSP) under stochastic processing times. The robust counterpart model and the Non-dominated Sorting Genetic Algorithm II (NSGA-II) are used to solve the bi-objective FJSP with consideration of the completion time and the total energy consumption under stochastic processing times. The case study on GM Corporation verifies that the NSGA-II used in this paper is effective and has advantages to solve the proposed model comparing with HPSO and PSO+SA. The idea and method of the paper can be generalized widely in the manufacturing industry, because it can reduce the energy consumption of the energy-intensive manufacturing enterprise with less investment when the new approach is applied in existing systems.

  10. Explicit Solution of Reinsurance-Investment Problem for an Insurer with Dynamic Income under Vasicek Model

    Directory of Open Access Journals (Sweden)

    De-Lei Sheng

    2016-01-01

    Full Text Available Unlike traditionally used reserves models, this paper focuses on a reserve process with dynamic income to study the reinsurance-investment problem for an insurer under Vasicek stochastic interest rate model. The insurer’s dynamic income is given by the remainder after a dynamic reward budget being subtracted from the insurer’s net premium which is calculated according to expected premium principle. Applying stochastic control technique, a Hamilton-Jacobi-Bellman equation is established and the explicit solution is obtained under the objective of maximizing the insurer’s power utility of terminal wealth. Some economic interpretations of the obtained results are explained in detail. In addition, numerical analysis and several graphics are given to illustrate our results more meticulous.

  11. Data quality in electronic medical records in Manitoba: Do problem lists reflect chronic disease as defined by prescriptions?

    Science.gov (United States)

    Singer, Alexander; Kroeker, Andrea L; Yakubovich, Sari; Duarte, Roberto; Dufault, Brenden; Katz, Alan

    2017-05-01

    To determine if the problem list (health conditions) in primary care electronic medical records (EMRs) accurately reflects the conditions for which chronic medications are prescribed in the EMR. A retrospective analysis of EMR data. Eighteen primary care clinics across rural and urban Manitoba using the Accuro EMR. Data from the EMRs of active patients seen in an 18-month period (December 18, 2011, to June 18, 2013, or December 3, 2012, to June 3, 2014) were used. The likelihood of documentation in the EMR problem list of those specific chronic diseases for which drug prescriptions were documented in the EMR. Regression modeling was performed to determine the effect of clinic patient load and remuneration type on the completeness of EMR problem lists. Overall problem-list completeness was low but was highest for diabetes and lowest for insomnia. Fee-for-service clinics generally had lower problem-list completeness than salaried clinics did for all prescription medications examined. Panel size did not affect problem-list completeness rates. The low EMR problem-list completeness suggests that this field is not reliable for use in quality improvement initiatives or research until higher reliability has been demonstrated. Further research is recommended to explore the reasons for the poor quality and to support improvement efforts. Copyright© the College of Family Physicians of Canada.

  12. Public opinion and medical cannabis policies: examining the role of underlying beliefs and national medical cannabis policies

    OpenAIRE

    Sznitman, Sharon R.; Bretteville-Jensen, Anne Line

    2015-01-01

    Background Debate about medical cannabis legalization are typically informed by three beliefs: (1) cannabis has medical effects, (2) medical cannabis is addictive and (3) medical cannabis legalization leads to increased used of cannabis for recreational purposes (spillover effects). We examined how strongly these beliefs are associated with public support for medical cannabis legalization and whether this association differs across divergent medical cannabis policy regimes. Methods Robust reg...

  13. Problems with film processing in medical X-ray imaging in Lithuania

    International Nuclear Information System (INIS)

    Sniureviciute, M.; Adliene, D.

    2005-01-01

    Optimisation in X-ray imaging in order to reduce patient doses during diagnostic X-ray examinations is a complex process given the high level of image quality required. When quality systems are implemented as a basis for optimisation, attention should be paid to the qualifications of the staff and quality control of the equipment and of the X-ray imaging procedures, as well as to the methods used to evaluate the quality of these procedures. Until recently, quality control procedures at health care institutions in Lithuania were limited to the testing of X-ray units. Since film processing is one of the most important factors influencing patient doses and image quality during X-ray examinations, in 2003 the Kaunas department of the Radiation Protection Centre organised inspections of film processing laboratories in 11 health care institutions - hospitals and outpatient departments - in the Kaunas region. Problems of non-compliance with requirements identified during these inspections are discussed in this paper. Most of the health care institutions inspected already had quality assurance programmes. However, the implementation of these programmes was sometimes erratic because of the insufficient attention paid to the film developing processes. The worst situation was found in 4 institutions where the films were developed manually. Only 3 of the 11 departments inspected had sensitometers and densitometers for quality control of the processing. In many cases there was no control of chemicals, film sensitivity and density, or else control was irregular. In only a few departments were the effects of repeated controls investigated and discussed. Despite the current problems occurring in medical X-ray diagnostic departments in Lithuania, the situation is rapidly improving. New equipment is being installed, new devices for quality control are being used and, last but not least, the view of hospital administrators, radiologists and laboratory workers towards quality

  14. Problems in complying with regulations related to low activity materials: Industry, medical, research

    International Nuclear Information System (INIS)

    Steen, J. van der

    1997-01-01

    The new Basic Safety Standards (BSS) for protection against ionizing radiation and for the safety of radiation sources contain nuclide specific exemption levels on reporting. In many cases, these exemption levels differ orders of magnitude, higher or lower, compared to those from the old standards. For the natural radionuclides, the exempted specific activity is much lower (10 or even 1 Bq/g, depending on the radionuclide, compared to 500 Bq/g in the old BSS). As a consequence, industrial activities with certain minerals or raw materials containing elevated concentrations of radionuclides, which were exempted from the radiation protection control system under the old BSS, may have to be declared as radiologically relevant activities and may now come under regulatory control. Examples of these activities are the phosphate ore processing, the refining of a number of metals, the use of slag, and the oil and natural gas production. This might give rise, in some cases, to large volumes of waste which should be treated, conditioned and disposed of in a controlled way. For artificial radionuclides with higher exemption levels, the use of such radionuclides for industrial, medical or research purposes, such as tracers, sealed sources and beta lights, may increase considerably without being controlled any longer by the regulatory system. (author)

  15. Predictors of medical student remediation and their underlying causes: early lessons from a curriculum change in the University of Auckland Medical Programme.

    Science.gov (United States)

    Grainger, Brian; Yielder, Jill; Reid, Papaarangi; Bagg, Warwick

    2017-08-11

    The purpose of this study was to identify predictors of remediation in a medical programme and assess the underlying causes and the quality of remediation provided within the context of a recent curriculum change. A mixed methods study incorporating a retrospective cohort analysis of demographic predictors of remediation during 2013 and 2014, combined with thematic qualitative analysis of educator perspectives derived by interview on factors underlying remediation and the quality of that currently provided by the faculty. 17.7% of all students required some form of remedial assistance and 93% of all students offered remediation passed their year of study. Multivariate analysis showed international students (OR 4.59 95% CI 2.62-7.98) and students admitted via the Māori and Pacific Admission Scheme (OR 3.43 2.29-5.15) were significantly more likely to require remediation. Male students were also slightly more likely than their female classmates to require assistance. No effect was observed for rural origin students, completion of a prior degree or completion of clinical placement in a peripheral hospital. Knowledge application and information synthesis were the most frequently identified underlying problems. Most faculty believed remediation was successful, however, flexibility in the programme structure, improved diagnostics and improved access to dedicated teaching staff were cited as areas for improvement. Remediation is required by nearly a fifth of University of Auckland medical students, with MAPAS and international students being particularly vulnerable groups. Remediation is largely successful, however, interventions addressing reasoning and knowledge application may improve its effectiveness.

  16. The Social And Academic Problems Of Medical Colleges Students And How It Is Related To Students Level Case Study Of Medical Applied Sciences College.

    Directory of Open Access Journals (Sweden)

    Amal Ramadan Abd Elhalim

    2015-08-01

    Full Text Available University works to provide all the material educational and psychological needs of the university students in order to achieve the social of the university. it affects the quality of the output descriptive survey method was used to identify the academic and social problems of the female students at the Faculty of Applied medical Science and correlate problems to the level of their performance. there was a questionnaire consists of 64 phrases which were distributed into 8 axes and applied to a random sample of 210 at different levels in the first semester of the academic year 2014-2015 Departments of MLT PHT CLN DRD. The study showed the problem of University environment ranked the first place University library in the Scand placebut the problems related to Curriculum the in third place the problems related to the field training in fourth placeFollowed by problems related to psychological and social problems in fifth place problems related to academic guidance in sixth place the problems related to the time table in seventh place finally came problems on the faculty staff in the eighth and last place and that the most important variables affecting the academic performance of the students There are significant correlation relationship between each of the University environment academic guidanceUniversity library and field training on the one hand and the cumulative average of the other hand no significant correlation relationships between the academic performance of students in the study and curriculum faculty staff where it appeared that the correlation coefficients were not significant at the 5 level Recommendations to the college administration to conceived proposal for mechanisms to confirm how to deal with the academic problems in the college through comprehensive strategy to solve and prevent academic problems faced the studentssolve the problem of Library And reconsider some courses need to Attention to academic guidance processes And of

  17. The introduction of large class problem-based learning into an undergraduate medical curriculum: an evaluation.

    Science.gov (United States)

    Roberts, Chris; Lawson, Mary; Newble, David; Self, Ashley; Chan, Philip

    2005-09-01

    When considering implementing integrated curriculum models, such as problem-based learning (PBL), concerns may be expressed about the need for increased staff resources required to deliver tutor-led small group PBL. Less staff intensive ways of supporting PBL need to be explored. We compared the outcomes of a PBL module conducted in a large class format within a lecture theatre with a module having the same defined learning outcomes delivered in small group PBL format, both supported by e-learning resources. The pre-existing 27 small groups within the whole class (n = 246) of first year students undertaking a cardiovascular basic science module at Sheffield undergraduate medical school, UK, were randomized to 22 groups undertaking the large class Integrated Learning Activity (ILA) and 5 groups to traditional small group facilitated PBL sessions. Outcome measures were: a pre-post knowledge based test, a student educational effectiveness questionnaire, and assessment of student group work and presentations. There seemed to be no significant differences in learning outcomes between the methods although it is recognized that students would prefer the small group teaching format. Within institutions where resources to support small group PBL are limited, the large group ILA format supported with e-learning techniques may be a useful alternative approach.

  18. Study of patient satisfaction and self-expressed problems after emergency caesarean delivery under subarachnoid block

    Directory of Open Access Journals (Sweden)

    V R Hemanth Kumar

    2014-01-01

    Full Text Available Background and Aims: Subarachnoid block is one of the common modes of anaesthesia opted for emergency caesarean section, if the maternal and foetal conditions are favourable. Various factors influence the quality of care administered during the procedure. This questionnaire based study was undertaken to look for self-expressed problems in peri-operative period in patients undergoing emergency caesarean surgery under subarachnoid block. Methods: All the parturients who underwent emergency caesarean section under subarachnoid block during 6 months period were distributed a questionnaire in post-operative period. They were encouraged to fill and return the form within 15 days. Patient satisfaction and the self-expressed problems were analysed at the end of 6 months. Results: One hundred and seventy five out of 220 parturients responded. 58.3% of them said that they were explained about the anaesthesia prior to surgery and 85.3% overall remained anxious. With people around them, 93.1% of them felt comfortable and 91.4% expressed that they were made comfortable inside the theatre. The self-expressed problems were shivering (43.4%, breathlessness (21.7%, pain (20%, post-operative headache (15.4% and backache (19.4%. Parturients who heard their babies cry was 85.1%. After their babies were shown after delivery, 77.1% mothers slept well; 86.9% fed their babies within 4 h of delivery. Conclusion: Pre-operative communication in emergency caesarean section by health personnel did not reduce the anxiety level, which shows that communication was ineffective. Intra-operative psychological support like making the patient comfortable, showing baby to mother and early breast feeding improve bonding between child and mother and essentially contribute to patient satisfaction.

  19. On the problem of studying physical properties of rock collectors under conditions modelling layer ones

    Energy Technology Data Exchange (ETDEWEB)

    Petkevich, G.I.

    1972-01-01

    A review is given of the state in studying physical properties of rock collectors under conditions modelling the layer ones. From the theoretical point of view, this direction is determined as petrophysics of multiphase systems and from the practical, as oil field petrophysics. The following aspects of the problem are considered: models of porous media, thermodynamic conditions of deformation process, parameters of stressed state of porous deformed media, and analysis of experimental data. To describe collector behavior under thermodynamic conditions of natural occurrence, it is necessary to construct the model of the porous deformed medium. In connection with heterogeneity and multiphase character of rock collectors, they may be considered as differential-elastic media, and to characterize the stressed state such indices as coefficients of compressibility of skeleton, solid and liquid phase, as well as coefficients of pore compressibility, relaxation, structural parameter, etc. may be used. It is emphasized that only reversable (elastic) parameter changes are studied under laboratory conditions. The results of laboratory measurements of collector parameters are summarized on the basis of different researcher data. (54 refs.)

  20. Khat chewing, cardiovascular diseases and other internal medical problems: the current situation and directions for future research.

    Science.gov (United States)

    Al-Motarreb, A; Al-Habori, M; Broadley, K J

    2010-12-01

    The leaves of khat (Catha edulis Forsk.) are chewed as a social habit for the central stimulant action of their cathinone content. This review summarizes the prevalence of the habit worldwide, the actions, uses, constituents and adverse health effects of khat chewing. There is growing concern about the health hazards of chronic khat chewing and this review concentrates on the adverse effects on health in the peripheral systems of the body, including the cardiovascular system and gastrointestinal tract. Comparisons are made with amphetamine and ecstasy in particular on the detrimental effects on the cardiovascular system. The underlying mechanisms of action of khat and its main constituent, cathinone, on the cardiovascular system are discussed. Links have been proposed between khat chewing and the incidence of myocardial infarction, dilated cardiomyopathy, vascular disease such as hypertension, cerebrovascular ischaemia and thromboembolism, diabetes, sexual dysfunction, duodenal ulcer and hepatitis. The evidence, however, is often based on limited numbers of case reports and only few prospective controlled studies have been undertaken. There is therefore an urgent need for more thorough case-control studies to be performed. This review outlines the current knowledge on the adverse health effects of khat chewing on the cardiovascular system and other internal medical problems, it assesses the evidence and the limitations of the studies and identifies the questions that future studies should address. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  1. Can Friedberg’s Triad Solve Persistent Anesthesia Problems? Over-Medication, Pain Management, Postoperative Nausea and Vomiting

    Directory of Open Access Journals (Sweden)

    Barry L. Friedberg, MD

    2017-10-01

    Full Text Available Summary:. Friedberg’s Triad is (1 measure the brain; (2 preempt the pain; (3 emetic drugs abstain. Persistent anesthesia problems include over- and under-medication, postoperative pain management, and postoperative nausea and vomiting. Inspired by Vinnik’s diazepam-ketamine paradigm, Friedberg’s propofol ketamine paradigm was first published in 1993. The 1997 addition of the bispectral (BIS index brain monitor made the propofol ketamine paradigm numerically reproducible. The 1998 addition of the frontalis electromyogram (EMG as a secondary trend to the BIS transformed the time-delayed BIS monitor into a real-time, extremely useful device. Before BIS monitoring, anesthesiologists only had heart rate (HR and blood pressure (BP changes to guide depth of anesthesia. Not surprisingly, the American Society of Anesthesiologists’ Awareness study showed no HR or BP changes in half of the patients experiencing awareness with recall. HR and BP changes may only reflect brain stem signs while consciousness and pain are processed at higher, cortical brain levels. BIS/electromyogram measurement can accurately reflect propofol effect on the cerebral cortex in real time. Although propofol requirements can vary as much as a hundred-fold, titrating propofol to 60 < BIS < 75 with baseline electromyogram assures every patient will be anesthetized to the same degree and allows more scientific analysis of outcomes. Numerous publications are cited to support the author’s 25-year clinical experience. Over that period, no office-based, cosmetic surgery patients were admitted to the hospital for unmanageable pain or postoperative nausea and vomiting. Friedberg’s Triad appears to solve persistent anesthesia problems.

  2. Collaborative diagramming during problem based learning in medical education: Do computerized diagrams support basic science knowledge construction?

    NARCIS (Netherlands)

    de Leng, Bas; Gijlers, Aaltje H.

    2015-01-01

    Aim: To examine how collaborative diagramming affects discussion and knowledge construction when learning complex basic science topics in medical education, including its effectiveness in the reformulation phase of problem-based learning. Methods: Opinions and perceptions of students (n = 70) and

  3. Simulation-Based Medical Education Is No Better than Problem-Based Discussions and Induces Misjudgment in Self-Assessment

    Science.gov (United States)

    Wenk, Manuel; Waurick, Rene; Schotes, David; Wenk, Melanie; Gerdes, Christina; Van Aken, Hugo K.; Popping, Daniel M.

    2009-01-01

    Simulation-based teaching (SBT) is increasingly used in medical education. As an alternative to other teaching methods there is a lack of evidence concerning its efficacy. The aim of this study was to evaluate the potency of SBT in anesthesia in comparison to problem-based discussion (PBD) with students in a randomized controlled setting.…

  4. Ontology-based vector space model and fuzzy query expansion to retrieve knowledge on medical computational problem solutions.

    Science.gov (United States)

    Bratsas, Charalampos; Koutkias, Vassilis; Kaimakamis, Evangelos; Bamidis, Panagiotis; Maglaveras, Nicos

    2007-01-01

    Medical Computational Problem (MCP) solving is related to medical problems and their computerized algorithmic solutions. In this paper, an extension of an ontology-based model to fuzzy logic is presented, as a means to enhance the information retrieval (IR) procedure in semantic management of MCPs. We present herein the methodology followed for the fuzzy expansion of the ontology model, the fuzzy query expansion procedure, as well as an appropriate ontology-based Vector Space Model (VSM) that was constructed for efficient mapping of user-defined MCP search criteria and MCP acquired knowledge. The relevant fuzzy thesaurus is constructed by calculating the simultaneous occurrences of terms and the term-to-term similarities derived from the ontology that utilizes UMLS (Unified Medical Language System) concepts by using Concept Unique Identifiers (CUI), synonyms, semantic types, and broader-narrower relationships for fuzzy query expansion. The current approach constitutes a sophisticated advance for effective, semantics-based MCP-related IR.

  5. Modeling Soil Sodicity Problems under Dryland and Irrigated Conditions: Case Studies in Argentina and Colombia

    Science.gov (United States)

    Pla-Sentís, Ildefonso

    2014-05-01

    Salt-affected soils, both saline and sodic, my develop both under dryland and irrigated conditions, affecting negatively the physical and chemical soil properties, the crop production and the animal and human health.Among the development processes of salt-affected soils, the processes of sodification have been generally received less attention and is less understood than the development of saline soils. Although in both of them, hydrological processes are involved in their development, in the case of sodic soils we have to consider some additional chemical and physicochemical reactions, making more difficult their modeling and prediction. In this contribution we present two case studies: one related to the development of sodic soils in the lowlands of the Argentina Pampas, under dryland conditions and sub-humid temperate climate, with pastures for cattle production; the other deals with the development of sodic soils in the Colombia Cauca Valley, under irrigated conditions and tropical sub-humid climate, in lands used for sugarcane cropping dedicated to sugar and ethanol production. In both cases the development of sodicity in the surface soil is mainly related to the effects of the composition and level of groundwater, affected in the case of Argentina Pampas by the off-site changes in dryland use and management in the upper zones and by the drainage conditions in the lowlands, and in the case of the Cauca Valley, by the on-site irrigation and drainage management in lands with sugarcane. There is shown how the model SALSODIMAR, developed by the main author, based on the balance of water and soluble componentes of both the irrigation water and groundwater under different water and land management conditions, may be adapted for the diagnosis and prediction of both problems, and for the selection of alternatives for their management and amelioration.

  6. Stochastic Benders decomposition for the supply chain investment planning problem under demand uncertainty

    Directory of Open Access Journals (Sweden)

    Fabricio Oliveira

    2012-12-01

    Full Text Available This paper presents the application of a stochastic Benders decomposition algorithm for the problem of supply chain investment planning under uncertainty applied to the petroleum byproducts supply chain. The uncertainty considered is related with the unknown demand levels for oil products. For this purpose, a model was developed based on two-stage stochastic programming. It is proposed two different solution methodologies, one based on the classical cutting plane approach presented by Van Slyke & Wets (1969, and other, based on a multi cut extension of it, firstly introduced by Birge & Louveaux (1988. The methods were evaluated on a real sized case study. Preliminary numerical results obtained from computational experiments are encouraging.

  7. Stochastic thermoelastic problem of a functionally graded plate under random temperature load

    Energy Technology Data Exchange (ETDEWEB)

    Chiba, R. [Miyagi National College of Technology, Department of Mechanical Engineering, Natori (Japan); Sugano, Y. [Iwate University, Department of Mechanical Engineering, Morioka (Japan)

    2007-04-15

    This study attempts to derive the statistics of temperature and thermal stress in functionally graded material (FGM) plates exposed to random external temperatures. The thermomechanical properties of the FGM plates are assumed to vary arbitrarily only in the plate thickness direction. The external temperatures are expressed as random functions with respect to time. The transient temperature field in the FGM plate is determined by solving a nonhomogeneous heat conduction problem for a multilayered plate with linear nonhomogeneous thermal conductivity and different homogeneous heat capacity in each layer. The autocorrelations and power spectrum densities (PSDs) of temperature and thermal stress are derived analytically. These statistics for FGM plates composed of partially stabilised zirconia (PSZ) and austenitic stainless steel (SUS304) are computed under the condition that the fluctuation in the external temperature can be considered as white noise or a stationary Markov process. (orig.)

  8. Motions of Kepler circumbinary planets in restricted three-body problem under radiating primaries

    Energy Technology Data Exchange (ETDEWEB)

    Dermawan, B., E-mail: budider@as.itb.ac.id; Hidayat, T., E-mail: taufiq@as.itb.ac.id [Astronomy Research Division, Faculty of Mathematics and Natural Sciences, Bandung Institute of Technology, Jalan Ganesha 10, Bandung 40132 (Indonesia); Huda, I. N., E-mail: ibnu.nurul@students.itb.ac.id; Mandey, D., E-mail: mandey.de@gmail.com; Utama, J. A., E-mail: judhistira@yahoo.com; Tampubolon, I., E-mail: ihsan.tampubolon@gmail.com [Department of Astronomy, Faculty of Mathematics and Natural Sciences, Bandung Institute of Technology, Jalan Ganesha 10, Bandung 40132 (Indonesia); Wibowo, R. W., E-mail: ridlo.w.wibowo@gmail.com [Department of Computational Science, Faculty of Mathematics and Natural Sciences, Bandung Institute of Technology, Jalan Ganesha 10, Bandung 40132 (Indonesia)

    2015-09-30

    By observing continuously a single field of view in the sky, Kepler mission reveals outstanding results on discoveries of exoplanets. One of its recent progress is the discoveries of circumbinary planets. A circumbinary planet is an exoplanet that moves around a binary system. In this study we investigate motions of Kepler circumbinary planets belong to six binary systems, namely Kepler-16, -34, -35, -38, -47, and -413. The motions are considered to follow the Restricted Three-Body Problem (RTBP). Because the primaries (central massive objects) are stars, they are both radiatives, while the planet is an infinitesimal object. The primaries move in nearly circular and elliptic orbits with respect to their center of masses. We describe, in general, motions of the circumbinary planets in RTBP under radiating primaries. With respect to the averaged zero velocity curves, we show that motions of the exoplanets are stable, in accordance with their Hill stabilities.

  9. Normal Mode Analysis to a Poroelastic Half-Space Problem under Generalized Thermoelasticity

    Directory of Open Access Journals (Sweden)

    Chunbao Xiong

    Full Text Available Abstract The thermo-hydro-mechanical problems associated with a poroelastic half-space soil medium with variable properties under generalized thermoelasticity theory were investigated in this study. By remaining faithful to Biot’s theory of dynamic poroelasticity, we idealized the foundation material as a uniform, fully saturated, poroelastic half-space medium. We first subjected this medium to time harmonic loads consisting of normal or thermal loads, then investigated the differences between the coupled thermohydro-mechanical dynamic models and the thermo-elastic dynamic models. We used normal mode analysis to solve the resulting non-dimensional coupled equations, then investigated the effects that non-dimensional vertical displacement, excess pore water pressure, vertical stress, and temperature distribution exerted on the poroelastic half-space medium and represented them graphically.

  10. What Is Robustness?: Problem Framing Challenges for Water Systems Planning Under Change

    Science.gov (United States)

    Herman, J. D.; Reed, P. M.; Zeff, H. B.; Characklis, G. W.

    2014-12-01

    Water systems planners have long recognized the need for robust solutions capable of withstanding deviations from the conditions for which they were designed. Faced with a set of alternatives to choose from—for example, resulting from a multi-objective optimization—existing analysis frameworks offer competing definitions of robustness under change. Robustness analyses have moved from expected utility to exploratory "bottom-up" approaches in which vulnerable scenarios are identified prior to assigning likelihoods; examples include Robust Decision Making (RDM), Decision Scaling, Info-Gap, and Many-Objective Robust Decision Making (MORDM). We propose a taxonomy of robustness frameworks to compare and contrast these approaches, based on their methods of (1) alternative selection, (2) sampling of states of the world, (3) quantification of robustness measures, and (4) identification of key uncertainties using sensitivity analysis. Using model simulations from recent work in multi-objective urban water supply portfolio planning, we illustrate the decision-relevant consequences that emerge from each of these choices. Results indicate that the methodological choices in the taxonomy lead to substantially different planning alternatives, underscoring the importance of an informed definition of robustness. We conclude with a set of recommendations for problem framing: that alternatives should be searched rather than prespecified; dominant uncertainties should be discovered rather than assumed; and that a multivariate satisficing measure of robustness allows stakeholders to achieve their problem-specific performance requirements. This work highlights the importance of careful problem formulation, and provides a common vocabulary to link the robustness frameworks widely used in the field of water systems planning.

  11. Single Machine Problem with Multi-Rate-Modifying Activities under a Time-Dependent Deterioration

    Directory of Open Access Journals (Sweden)

    M. Huang

    2013-01-01

    Full Text Available The single machine scheduling problem with multi-rate-modifying activities under a time-dependent deterioration to minimize makespan is studied. After examining the characteristics of the problem, a number of properties and a lower bound are proposed. A branch and bound algorithm and a heuristic algorithm are used in the solution, and two special cases are also examined. The computational experiments show that, for the situation with a rate-modifying activity, the proposed branch and bound algorithm can solve situations with 50 jobs within a reasonable time, and the heuristic algorithm can obtain the near-optimal solution with an error percentage less than 0.053 in a very short time. In situations with multi-rate-modifying activities, the proposed branch and bound algorithm can solve the case with 15 jobs within a reasonable time, and the heuristic algorithm can obtain the near-optimal with an error percentage less than 0.070 in a very short time. The branch and bound algorithm and the heuristic algorithm are both shown to be efficient and effective.

  12. What is happening under the surface? Power, conflict and the performance of medical teams.

    Science.gov (United States)

    Janss, Rozemarijn; Rispens, Sonja; Segers, Mien; Jehn, Karen A

    2012-09-01

    The effect of teamwork on team performance is broadly recognised in the medical field. This recognition is manifested in educational programmes in which attention to interpersonal behaviours during teamwork is growing. Conflict and power differences influence interpersonal behaviours and are marked topics in studies of group functioning in the social and organisational psychology literature. Insights from the domain of social sciences put the ongoing improvement of teamwork into broader perspective. This paper shows how knowledge from the domain of social and organisational psychology contributes to the understanding of teamwork in the medical environment. More specifically, this paper suggests that unfolding the underlying issues of power and conflict within medical teams can be of extra help in the development of educational interventions aimed at improving team performance. We review the key social psychology and organisational behaviour literature concerning power and conflict, and relate the insights derived from this to the team process of ad hoc medical action teams. We present a theoretical framework in which insights into power and conflict are used to explain and predict team dynamics in ad hoc medical action teams. Power and conflict strongly influence interpersonal behaviour. Characteristics of medical action teams give rise to all kinds of issues of disagreement and are accompanied by complex issues of intra-team power distribution. We argue that how team members coordinate, cooperate and communicate is steered by members' personal motivations, which, in turn, strongly depend on their perceptions of power and conflict. Given the importance of the performance of these teams, we suggest future directions for the development of training interventions building on knowledge and theories derived from social and organisational psychology. © Blackwell Publishing Ltd 2012.

  13. Medical student knowledge of global health problems: obstetric fistulas in developing countries.

    Science.gov (United States)

    Foust-Wright, Caroline E; Shobeiri, S Abbas; Curry, Christine L; Quiroz, Lieschen H; Nihira, Mikio A

    2012-01-01

    To evaluate medical students in the United States at several medical schools regarding their knowledge of the global health burden of obstetric fistulas. A cross-sectional survey was conducted in 8 schools across the United States over a period of 6 months. The survey was composed of 18 questions on epidemiology, pathology, and treatment of fistulas. It was a web-based module accessed through an emailed link. It was sent to 5,103 medical students' email addresses at the 8 institutions once a week for 4 weeks. SPSS paired student t tests was used for statistical analysis. Of the 1,089 students from 8 medical schools that initially began the survey, 965 completed this voluntary and anonymous survey, with a 21% response rate and 19% completion rate. Overall the students averaged 11/18 (60.7%) correct on this survey. The knowledge of obstetric fistula improved, but not significantly, with increasing level of medical school education, with first-year medical students achieving 10/18 (55%) correct and senior medical students achieving 12/18 (67%) correct (p = 0.1). U.S. medical students' knowledge of obstetric fistulas in developing countries does not increase significantly over 4 years of medical school education. While this condition presents largely in the developing world, given rapid globalization as well as increased international health experiences for U.S.-trained health professionals,further effort should be placed in improving medical student knowledge of this devastating condition.

  14. Are Survivors Who Report Cancer-Related Financial Problems More Likely to Forgo or Delay Medical Care?

    Science.gov (United States)

    Kent, Erin E.; Forsythe, Laura P.; Yabroff, K. Robin; Weaver, Kathryn E.; de Moor, Janet S.; Rodriguez, Juan L.; Rowland, Julia H.

    2015-01-01

    BACKGROUND Financial problems caused by cancer and its treatment can substantially affect survivors and their families and create barriers to seeking health care. METHODS The authors identified cancer survivors diagnosed as adults (n = 1556) from the nationally representative 2010 National Health Interview Survey. Using multivariable logistic regression analyses, the authors report sociodemographic, clinical, and treatment-related factors associated with perceived cancer-related financial problems and the association between financial problems and forgoing or delaying health care because of cost. Adjusted percentages using the predictive marginals method are presented. RESULTS Cancer-related financial problems were reported by 31.8% (95% confidence interval, 29.3%–34.5%) of survivors. Factors found to be significantly associated with cancer-related financial problems in survivors included younger age at diagnosis, minority race/ethnicity, history of chemotherapy or radiation treatment, recurrence or multiple cancers, and shorter time from diagnosis. After adjustment for covariates, respondents who reported financial problems were more likely to report delaying (18.3% vs 7.4%) or forgoing overall medical care (13.8% vs 5.0%), prescription medications (14.2% vs 7.6%), dental care (19.8% vs 8.3%), eyeglasses (13.9% vs 5.8%), and mental health care (3.9% vs 1.6%) than their counterparts without financial problems (all Pfinancial problems are not only disproportionately represented in survivors who are younger, members of a minority group, and have a higher treatment burden, but may also contribute to survivors forgoing or delaying medical care after cancer. PMID:23907958

  15. Millennial medical anthropology: from there to here and beyond, or the problem of global health.

    Science.gov (United States)

    Gaines, Atwood D

    2011-03-01

    While much of Medical Anthropology was and is what we can call "Normal" (following Kuhn) Medical Anthropology, I coined the term Millennial Medical Anthropology for that branch of the discipline that, in the 1990s, was departing from the Normal research paradigms and was deserving of a distinct sobriquet. This paper considers the Strong Program in Medical Anthropology's Millennial Medical Anthropology and its key subdivisions, the Cultural Studies of Science and Cultural Bioethics. Specifically it considers Medical Anthropology's movement from the past into an ethical future wherein Normal Biomedicine, Bioethics and Global Health are problematized. This provides the basis for the construction of a truly anthropological global health (i.e., Global, Global Health or Global Health 2.0).

  16. Wonder vitamin or mass medication? Media and academic representation of folate fortification as a policy problem in Australia and New Zealand.

    Science.gov (United States)

    Begley, Andrea; Coveney, John

    2010-10-01

    The aim was to examine how representations of the 'problem' of folate fortification as policy strategy to reduce neural tube defects (NTDs) had been produced by examining the underlying discourses in media and health and medical journals. The objectives were to evaluate the various framings of the folate fortification 'problem', and discuss ways in which this policy problem could have been repositioned or reframed. All articles found in the Australian and New Zealand print media and in health and medical journals from June 1995 when the first expert report was released to one month after the approval of mandatory fortification in July 2007 were identified using two newspaper indexing databases (Factiva-Dow Jones Interactive & Proquest ANZ NewsStand) and multiple databases including PubMed, Expanded Academic ASAP and Informat (Australian Public Affairs). 176 print media articles and 83 peer-reviewed journal articles identified from the database analysis. Critical discourse analysis of these 259 articles resulted in three main discourses being evident in the representations; the dominance of biomedicine in the process of prioritisation of fortification of the food supply, issues of professional encroachment by nutritionists and the representation of fortification as iatrogenic. Food fortification as a policy response to nutritional deficiencies has implications for influencing food and nutrition policy implementation. Examining how policy problems are represented in the media and journals can help guide public health policy decisions. © 2010 The Authors. Journal Compilation © 2010 Public Health Association of Australia.

  17. Medical Treatment not Approved yet? No Problem! Welcome to Circumvention Tourism

    OpenAIRE

    Snyder, Jeremy; Crooks, Valorie

    2015-01-01

    China, Russia and countries in the Caribbean are positioning themselves as destinations for a new kind of medical tourist: the circumvention tourist. Increasingly people are traveling abroad for care that is unapproved by regulators in their home countries. In some cases, these so-called circumvention tourists may be seeking unproven and untested medical interventions.But why would someone want to skirt domestic regulations aimed at protecting patient safety? Our research about medical touris...

  18. Varsity Medical Ethics Debate 2015: should nootropic drugs be available under prescription on the NHS?

    Science.gov (United States)

    Thorley, Emma; Kang, Isaac; D'Costa, Stephanie; Vlazaki, Myrto; Ayeko, Olaoluwa; Arbe-Barnes, Edward H; Swerner, Casey B

    2016-09-13

    The 2015 Varsity Medical Ethics debate convened upon the motion: "This house believes nootropic drugs should be available under prescription". This annual debate between students from the Universities of Oxford and Cambridge, now in its seventh year, provided the starting point for arguments on the subject. The present article brings together and extends many of the arguments put forward during the debate. We explore the current usage of nootropic drugs, their safety and whether it would be beneficial to individuals and society as a whole for them to be available under prescription. The Varsity Medical Debate was first held in 2008 with the aim of allowing students to engage in discussion about ethics and policy within healthcare. The event is held annually and it is hoped that this will allow future leaders to voice a perspective on the arguments behind topics that will feature heavily in future healthcare and science policy. This year the Oxford University Medical Society at the Oxford Union hosted the debate.

  19. Online lecture capturing system: Expected and actual effects of implementation in a problem-based learning medical curriculum.

    Science.gov (United States)

    Kwon, Kyungbin; Saparova, Dinara; Hoffman, Kimberly

    2015-01-01

    An online lecture capturing system (OLCS) was implemented in a medical school integrating problem-based learning curriculum. An academic investigation examining how medical students used OLCS and what were its educational effects were required. This study examined medical students' perceptions of OLCS, actual usage of OLCS, and the effects on learning. An online questionnaire asking about the perceptions of OLCS was distributed to first and second year medical students. Individual student's OLCS usage was analyzed descriptively. Cluster analysis was conducted based on the OLCS usage and students' prior academic performance to reveal the academic effects of OLCS. Most students (82 out of 106) perceived OLCS as an effective educational tool. Their actual use of OLCS, however, was low and quite variable depending on their needs and preferences. Reviewing the captured lectures did not affect students' performance on exams of knowledge. This study calls for follow-up studies investigating personalized use of OLCS and student attributes in PBL.

  20. Sleep disturbances and memory impairment among pregnant women consuming khat: An under-recognized problem

    Directory of Open Access Journals (Sweden)

    Md. Dilshad Manzar

    2017-01-01

    Full Text Available Khat (Catha edulis is a evergreen flowering shrub that is cultivated at high altitudes, especially in East Africa and the southwest of the Arabian Peninsula. The plant contains alkaloids, of which cathinone and cathine have structural similarity and pharmacological action similar to amphetamines. The leaves are, therefore, consumed in some regions as a psychoactive stimulant due to cultural beliefs and misperceptions on the health benefits of khat consumption. This resulted in a growing prevalence of khat consumption among pregnant women. The myriad of physiological changes associated with pregnancy impairs sleep and memory. Moreover, khat has also been shown to have adverse effects on memory and sleep. Therefore, its use during pregnancy may further aggravate those impairments. The purpose of this mini-review is to summarize the changes in sleep and memory during pregnancy and the evidence supporting a relationship between khat consumption and neurocognitive deficits and sleep dysfunctions. The misperceptions of beneficial effects of khat, the high prevalence of consumption among pregnant women, and the possibility of under-reporting of khat abuse do necessitate the development of alternative methodologies to identify cases of unreported khat abuse in pregnant women. It is proposed that screening for sleep problems and memory deficits may help identify under-reported cases of khat abuse in pregnant women.

  1. Sleep disturbances and memory impairment among pregnant women consuming khat: An under-recognized problem.

    Science.gov (United States)

    Manzar, Md Dilshad; Salahuddin, Mohammed; Sony, Peter; Maru, Tarekegn Tesfaye; Pandi-Perumal, Seithikurippu R; Moscovitch, Adam; Bahammam, Ahmed S

    2017-01-01

    Khat ( Catha edulis ) is a evergreen flowering shrub that is cultivated at high altitudes, especially in East Africa and the southwest of the Arabian Peninsula. The plant contains alkaloids, of which cathinone and cathine have structural similarity and pharmacological action similar to amphetamines. The leaves are, therefore, consumed in some regions as a psychoactive stimulant due to cultural beliefs and misperceptions on the health benefits of khat consumption. This resulted in a growing prevalence of khat consumption among pregnant women. The myriad of physiological changes associated with pregnancy impairs sleep and memory. Moreover, khat has also been shown to have adverse effects on memory and sleep. Therefore, its use during pregnancy may further aggravate those impairments. The purpose of this mini-review is to summarize the changes in sleep and memory during pregnancy and the evidence supporting a relationship between khat consumption and neurocognitive deficits and sleep dysfunctions. The misperceptions of beneficial effects of khat, the high prevalence of consumption among pregnant women, and the possibility of under-reporting of khat abuse do necessitate the development of alternative methodologies to identify cases of unreported khat abuse in pregnant women. It is proposed that screening for sleep problems and memory deficits may help identify under-reported cases of khat abuse in pregnant women.

  2. COMPARISON OF PROBLEM BASED LEARNING WITH TRADITIONAL LECTURES AMONG FIRST YEAR MEDICAL STUDENTS IN PHYSIOLOGY

    OpenAIRE

    Evelyn

    2015-01-01

    BACKGROUND: Problem based learning has emerged as an effective teaching learning method. Students taught by the problem based learning method have better problem solving skills and better long-term memory than those taught by traditional lectures. OBJECTIVE: To compare the effectiveness of problem based learning with that of traditional lecture method. METHODOLOGY: First MBBS students (n=127) were divided into two groups. One group was taught a topic from Applied Physiolog...

  3. Patterns of Self-Medication Behavior for Oral Health Problems Among Adults Living in Riyadh, Saudi Arabia.

    Science.gov (United States)

    Aldeeri, Arwa; Alzaid, Haya; Alshunaiber, Renad; Meaigel, Shahad; Shaheen, Naila A; Adlan, Abdallah

    2018-02-01

    Self-medication is a widespread behavior worldwide. It is defined as the practice of self-diagnosis and drug prescription without proper professional consultation. Aim: To determine the prevalence and predictors of self-medication for oral health problems among adults living in Riyadh city. Methods: A cross-sectional study based on a structured close-ended questionnaire was distributed among adults visiting shopping malls in all different five regions of Riyadh. A two-stage sampling technique was used: cluster and simple random sampling. The questionnaire was composed of two main sections: demographic characteristics and questions assessing the behavior of self-medication. Results: The prevalence of self-medication was found to be 63.25%, with a higher prevalence among females than males. Gender and nationality were significantly associated with self-medication. Salt in hot water locally (52.57%) and acetaminophen (47.43%), a type of an analgesic, were, systemically, the most frequently used. Pharmacy shops were the main source of these medicaments (66.01%). Similarly, the advice for using them was mainly given by pharmacists (53.36%). Lack of time was claimed to be the main reason for practicing self-medication (54.55%) with abscess, toothache, and gingival bleeding being the main predictors. Conclusions: Self-medication was found to be a common practice among the population of Riyadh city.

  4. Patterns of Self-Medication Behavior for Oral Health Problems Among Adults Living in Riyadh, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Arwa Aldeeri

    2018-02-01

    Full Text Available Abstract: Self-medication is a widespread behavior worldwide. It is defined as the practice of self-diagnosis and drug prescription without proper professional consultation. Aim: To determine the prevalence and predictors of self-medication for oral health problems among adults living in Riyadh city. Methods: A cross-sectional study based on a structured close-ended questionnaire was distributed among adults visiting shopping malls in all different five regions of Riyadh. A two-stage sampling technique was used: cluster and simple random sampling. The questionnaire was composed of two main sections: demographic characteristics and questions assessing the behavior of self-medication. Results: The prevalence of self-medication was found to be 63.25%, with a higher prevalence among females than males. Gender and nationality were significantly associated with self-medication. Salt in hot water locally (52.57% and acetaminophen (47.43%, a type of an analgesic, were, systemically, the most frequently used. Pharmacy shops were the main source of these medicaments (66.01%. Similarly, the advice for using them was mainly given by pharmacists (53.36%. Lack of time was claimed to be the main reason for practicing self-medication (54.55% with abscess, toothache, and gingival bleeding being the main predictors. Conclusions: Self-medication was found to be a common practice among the population of Riyadh city.

  5. Stress in Medical Students in a Problem-Based Learning Curriculum

    Science.gov (United States)

    Dagistani, Ahmad; Al Hejaili, Fawwaz; Binsalih, Salih; Al Jahdali, Hamdan; Al Sayyari, Abdulla

    2016-01-01

    Background: This study aims to assess stress level and its drivers among medical students using a PBL teaching system Method: Higher Education Stress Inventory (HESI,) was used to assess stress among medical students. All students in the College of Medicine were enrolled. Results: The response rate was 99%.The prevalence of stress was 54.7%. The…

  6. Integration of the Problem of Medical Ecology on the Level of the Highly Urbanized Region

    Science.gov (United States)

    Rozenberg, Gennadiy S.; Lazareva, Natalya V.; Simonov, Yury V.; Lifirenko, Natalya G.; Sarapultseva, Lilija A.

    2016-01-01

    The urgency of the analyzed issue is due to the study of the basic issues of medical ecology: the dynamics of demographic indicators, the correlation of somatic and reproductive public health, depending on the influence of physical factors of the urban environment on public health on the basis of medical and geographic mapping. The article aims at…

  7. Medical attention proposal for patients under the iodo therapy in cardiac arrest cases

    International Nuclear Information System (INIS)

    Pinto, A.L.; Bacelar, A.; Campomar, A.; Fialkowski, S.; Zaluski, M.A.; Lucena, A.F.

    1996-01-01

    This research has like aim to present a proposition about how to attend the patients which are under the iodo therapy, and the possibility they can show a cardiac arrest during their hospitalization. The physical medical department with the nurse group and the team of ICU (Intensive Care Unit) looked for to establish basic norms of radiological protection in order to avoid the radiation and contamination of all workers involved with one patient, without changing the routine of attendance service. We analyzed all rules of service including the attendance the hospital room and mainly if it is necessary to lead the patient to the ICU. (authors). 4 refs

  8. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors

    Directory of Open Access Journals (Sweden)

    Polonsky WH

    2016-07-01

    Full Text Available William H Polonsky,1,2 Robert R Henry2,3 1Behavioral Diabetes Institute, San Diego, 2University of California, San Diego, 3Center for Metabolic Research, VA San Diego Healthcare System, San Diego, CA, USA Abstract: At least 45% of patients with type 2 diabetes (T2D fail to achieve adequate glycemic control (HbA1c <7%. One of the major contributing factors is poor medication adherence. Poor medication adherence in T2D is well documented to be very common and is associated with inadequate glycemic control; increased morbidity and mortality; and increased costs of outpatient care, emergency room visits, hospitalization, and managing complications of diabetes. Poor medication adherence is linked to key nonpatient factors (eg, lack of integrated care in many health care systems and clinical inertia among health care professionals, patient demographic factors (eg, young age, low education level, and low income level, critical patient beliefs about their medications (eg, perceived treatment inefficacy, and perceived patient burden regarding obtaining and taking their medications (eg, treatment complexity, out-of-pocket costs, and hypoglycemia. Specific barriers to medication adherence in T2D, especially those that are potentially modifiable, need to be more clearly identified; strategies that target poor adherence should focus on reducing medication burden and addressing negative medication beliefs of patients. Solutions to these problems would require behavioral innovations as well as new methods and modes of drug delivery. Keywords: glycemic control, HbA1c, hypoglycemia, medication adherence, psychosocial, type 2 diabetes

  9. Validation of a performance assessment instrument in problem-based learning tutorials using two cohorts of medical students.

    Science.gov (United States)

    Lee, Ming; Wimmers, Paul F

    2016-05-01

    Although problem-based learning (PBL) has been widely used in medical schools, few studies have attended to the assessment of PBL processes using validated instruments. This study examined reliability and validity for an instrument assessing PBL performance in four domains: Problem Solving, Use of Information, Group Process, and Professionalism. Two cohorts of medical students (N = 310) participated in the study, with 2 years of PBL evaluation data extracted from archive rated by a total of 158 faculty raters. Analyses based on generalizability theory were conducted for reliability examination. Validity was examined through following the Standards for Educational and Psychological Testing to evaluate content validity, response processes, construct validity, predictive validity, and the relationship to the variable of training. For construct validity, correlations of PBL scores with six other outcome measures were examined, including Medical College Admission Test, United States Medical Licensing Examination (USMLE) Step 1, National Board of Medical Examiners (NBME) Comprehensive Basic Science Examination, NBME Comprehensive Clinical Science Examination, Clinical Performance Examination, and USMLE Step 2 Clinical Knowledge. Predictive validity was examined by using PBL scores to predict five medical school outcomes. The highest percentage of PBL total score variance was associated with students (60 %), indicating students in the study differed in their PBL performance. The generalizability and dependability coefficients were moderately high (Ep(2) = .68, ϕ = .60), showing the instrument is reliable for ranking students and identifying competent PBL performers. The patterns of correlations between PBL domain scores and the outcome measures partially support construct validity. PBL performance ratings as a whole significantly (p < .01) predicted all the major medical school achievements. The second year PBL scores were significantly higher than those of the first

  10. Successes and problems in the development of medical radioisotope production in Russia

    Science.gov (United States)

    Zhuikov, B. L.

    2016-05-01

    There are many challenges that face radionuclide production and application for medical diagnostics and therapy in Russia. In this article, the development of novel production methods for medical radionuclides (82Sr, 82Sr/82Rb-generator, 117mSn, 225Ac, etc.) at the Institute for Nuclear Research, RAS is described, providing an example of how supporting basic nuclear facilities, backing fundamental research, granting scientists and medical specialists freedom in choosing a research area, and effective international collaboration involving developed countries combine to enable progress in the field.

  11. Promotion of Problem Solving Skills by Using Metacognitive-based Instruction in Students of Kermanshah University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    yahya safari

    2017-06-01

    Full Text Available Background and objective: Studies have indicated that metacognitive strategies control and direct cognitive strategies. Thus, application of metacognitive and cognitive strategies together is essential for successful learning to happen. The present study was conducted to examine the effect of metacognitive-oriented instruction on development of problem solving skills in students of Kermanshah University of Medical Sciences. Materials and Methods: This study was a quasi-experimental research with pretest/posttest and control group design. The study sample included the students of Kermanshah University of Medical Sciences (n=4283 in the academic year of 2013-2014. A total number of 40 students were selected through convenient sampling method as the study sample. The samples were randomly placed in experimental and control groups. For the experimental group, problem solving skills were taught based on metacognitive strategies in 8 sessions, each session for 1 and half hours. For the control group, however, problem solving skills were taught through conventional teaching method. The instrument for data collection was Heppner’s problem solving inventory (1988 whose validity and reliability were confirmed previously. Data were analyzed by descriptive statistics, mean and standard deviation, and the hypotheses were tested through t-test. Results: The results of the posttest showed that the total mean of scores for problem solving skills in the experimental group (99.75 was higher than that of the control group (26.800 (p<0.0001. This difference was significant in the case of confidence, approach/avoidance and personal control components (p<0.0001. Moreover, the mean of students’ scores was not significant in terms of gender and major. Conclusion: Given the positive effect of metacognitive strategies on the students’ performance and the necessity of teaching metacognition for the sake of academic achievement, these strategies are recommended to be

  12. Psychological problems of atomic bomb survivors from the medical social worker's standpoint

    International Nuclear Information System (INIS)

    Tomoike, Toshio

    1994-01-01

    Mental data from 80 A-bomb survivors were available during a 20-year period 1973-1992. Types of A-bomb survivors were classified into (1) directly exposed A-bomb survivors, (2) A-bomb survivors living in the United States, (3) those living in prefectures other than Nagasaki, (4) ex-soldiers, (5) A-bomb survivors having family problems and others, (6) the demented elderly, (7) the alcoholic, and (8) others. Mental problems were judged as psychogenic, endogenous, and exogenous. Mental problems were most frequently associated with Type 1 (34.9%), followed by Type 8 (21.0%), Type 2 (18.6%), and Type 3 (7.0%). Noticeable finding was that Type 1 A-bomb survivors suffered from psychogenic and exogenous mental problems in an extremely high incidence, as compared with the non-exposed group (66.3% vs 24%). The incidence of both exogenous and endogenous problems was higher in the non-exposed group (32.6% and 24.5%) than the exposed group (23.2% and 10.5%). There was no significant gender difference in the development of mental problems. According to types of A-bomb survivors, both psychogenic and exogenous mental problems were most common for Type 1. The incidence of psychogenic problems was 2.85 times higher than that of exogenous problems. (N.K.)

  13. Risk factors for problem behavior in adolescents of parents with a chronic medical condition.

    Science.gov (United States)

    Sieh, Dominik Sebastian; Visser-Meily, Johanna Maria Augusta; Oort, Frans Jeroen; Meijer, Anne Marie

    2012-08-01

    A wide array of risk factors for problem behavior in adolescents with chronically ill parents emerges from the literature. This study aims to identify those factors with the highest impact on internalizing problem behavior (anxious, depressed and withdrawn behavior, and somatic complaints) and externalizing problem behavior (aggressive and rule-breaking behavior) as measured by the Youth Self-Report (YSR). The YSR was filled in by 160 adolescents (mean age = 15.1 years) from 100 families (102 chronically ill parents and 83 healthy spouses). Linear mixed model analyses were used, enabling separation of variance attributable to individual factors and variance attributable to family membership (i.e., family cluster effect). Predictors were child, parent, illness-related and family characteristics. The results showed that almost half of the variance in internalizing problem scores was explained by family membership, while externalizing problems were mainly explained by individual factors. Roughly 60 % of the variance in internalizing problems was predicted by illness duration, adolescents' feeling of isolation, daily hassles affecting personal life and alienation from the mother. Approximately a third of the variance in externalizing problems was predicted by adolescents' male gender, daily hassles concerning ill parents and alienation from both parents. In conclusion, the variance in adolescent problem behavior is largely accounted for by family membership, children's daily hassles and parent-child attachment. To prevent marginalization of adolescents with a chronically ill parent, it is important to be alert for signs of problem behavior and foster the peer and family support system.

  14. Integrating Behavioral Health and Primary Care for Comorbid Behavioral and Medical Problems

    Science.gov (United States)

    2018-01-10

    Arthritis; Asthma; Chronic Obstructive Lung Disease; Diabetes; Heart Failure; Hypertension; Anxiety; Chronic Pain; Depression; Fibromyalgia; Insomnia; Irritable Bowel Syndrome; Problem Drinking; Substance Use Disorder

  15. Sources of Stress and Coping Strategies among Undergraduate Medical Students Enrolled in a Problem-Based Learning Curriculum

    Directory of Open Access Journals (Sweden)

    Samira S. Bamuhair

    2015-01-01

    Full Text Available Background. Medical education is rated as one of the most difficult trainings to endure. Throughout their undergraduate years, medical students face numerous stressors. Coping with these stressors requires access to a variety of resources, varying from personal strengths to social support. We aimed to explore the perceived stress, stressors, and coping strategies employed by medical students studying in a problem-based learning curriculum. Methodology. This is a cross-sectional study of randomly selected medical students that explored demographics, perceived stress scale, sources of stress, and coping strategies. Results. Of the 378 medical students that participated in the study, males were 59.3% and females 40.7%. Nearly 53% of the students often felt stressed, and a third felt that they could not cope with stress. Over 82% found studying stressful and 64.3% were not sleeping well. Half of the students reported low self-esteem. Perceived stress scores were statistically significantly high for specific stressors of studying in general, worrying about future, interpersonal conflict, and having low self-esteem. Coping strategies that were statistically significantly applied more often were blaming oneself and being self-critical, seeking advice and help from others, and finding comfort in religion. Female students were more stressed than males but they employ more coping strategies as well. Conclusions. Stress is very common among medical students. Most of the stressors are from coursework and interpersonal relationships. Low self-esteem coupled with self-blame and self-criticism is quite common.

  16. A comparison of course-related stressors in undergraduate problem-based learning (PBL) versus non-PBL medical programmes.

    Science.gov (United States)

    Lewis, Alexander D; Menezes, Darryl A Braganza; McDermott, Helen E; Hibbert, Louise J; Brennan, Sarah-Louise; Ross, Elizabeth E; Jones, Lisa A

    2009-09-13

    Medical students report high levels of stress related to their medical training as well as to other personal and financial factors. The aim of this study is to investigate whether there are differences in course-related stressors reported by medical students on undergraduate problem-based learning (PBL) and non-PBL programmes in the UK. A cross-sectional study of second-year medical students in two UK medical schools (one PBL and one non-PBL programme) was conducted. A 16-question self-report questionnaire, derived from the Perceived Medical Student Stress Scale and the Higher Education Stress Inventory, was used to measure course-related stressors. Following univariate analysis of each stressor between groups, multivariate logistic regression was used to determine which stressors were the best predictors of each course type, while controlling for socio-demographic differences between the groups. A total of 280 students responded. Compared to the non-PBL students (N = 197), the PBL students (N = 83) were significantly more likely to agree that: they did not know what the faculty expected of them (Odds Ratio (OR) = 0.38, p = 0.03); there were too many small group sessions facilitated only by students resulting in an unclear curriculum (OR = 0.04, p PBL and non-PBL programmes. Course designers and student support services should therefore tailor their work to minimise, or help students cope with, the specific stressors on each course type to ensure optimum learning and wellbeing among our future doctors.

  17. Job requirements compared to medical school education: differences between graduates from problem-based learning and conventional curricula

    Directory of Open Access Journals (Sweden)

    Federkeil Gero

    2010-01-01

    Full Text Available Abstract Background Problem-based Learning (PBL has been suggested as a key educational method of knowledge acquisition to improve medical education. We sought to evaluate the differences in medical school education between graduates from PBL-based and conventional curricula and to what extent these curricula fit job requirements. Methods Graduates from all German medical schools who graduated between 1996 and 2002 were eligible for this study. Graduates self-assessed nine competencies as required at their day-to-day work and as taught in medical school on a 6-point Likert scale. Results were compared between graduates from a PBL-based curriculum (University Witten/Herdecke and conventional curricula. Results Three schools were excluded because of low response rates. Baseline demographics between graduates of the PBL-based curriculum (n = 101, 49% female and the conventional curricula (n = 4720, 49% female were similar. No major differences were observed regarding job requirements with priorities for "Independent learning/working" and "Practical medical skills". All competencies were rated to be better taught in PBL-based curriculum compared to the conventional curricula (all p Conclusion Among medical graduates in Germany, PBL demonstrated benefits with regard to competencies which were highly required in the job of physicians. Research and business competence deserve closer attention in future curricular development.

  18. "Should I prioritize medical problem solving or attentive listening?": the dilemmas and challenges that medical students experience when learning to conduct consultations.

    Science.gov (United States)

    Aper, Leen; Veldhuijzen, Wemke; Dornan, Tim; van de Ridder, Monica; Koole, Sebastiaan; Derese, Anselme; Reniers, Jan

    2015-01-01

    Communication skills can be trained alongside clinical reasoning, history taking or clinical examination skills. This is advocated as a solution to the low transfer of communication skills. Still, students have to integrate the knowledge/skills acquired during different curriculum parts in patient consultations at some point. How do medical students experience these integrated consultations within a simulated environment and in real practice when dealing with responsibility? Six focus groups were conducted with (pre-)/clerkship students. Students were motivated to practice integrated consultations with simulated patients and felt like 'real physicians'. However, their focus on medical problem solving drew attention away from improving their communication skills. Responsibility for real patients triggered students' identity development. This identity formation guided the development of an own consultation style, a process that was hampered by conflicting demands of role models. Practicing complete consultations results in the dilemma of prioritizing medical problem solving above attention for patient communication. Integrated consultation training advances this dilemma to the pre-clerkship period. During clerkships this dilemma is heightened because real patients trigger empathy and responsibility, which invites students to define their role as doctor. When training integrated consultations, educators should pay attention to students' learning priorities and support the development of students' professional identity. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  19. Students’ perceptions of anatomy across the undergraduate problem-based learning medical curriculum: a phenomenographical study

    OpenAIRE

    Bergman, Esther M; de Bruin, Anique BH; Herrler, Andreas; Verheijen, Inge WH; Scherpbier, Albert JJA; van der Vleuten, Cees PM

    2013-01-01

    Background To get insight in how theoretical knowledge is transformed into clinical skills, important information may arise from mapping the development of anatomical knowledge during the undergraduate medical curriculum. If we want to gain a better understanding of teaching and learning in anatomy, it may be pertinent to move beyond the question of how and consider also the what, why and when of anatomy education. Methods A purposive sample of 78 medical students from the 2nd, 3rd, 4th and 6...

  20. The problems of material pairs under the specific conditions of high-temperature reactors

    International Nuclear Information System (INIS)

    Schoening, J.

    1981-01-01

    This dissertation gives a detailed descirption of the problems of friction and solid lubrication of slide and ball bearings under HTR conditions. The first part is concerned with an analysis of established approaches for determining the friction factor and the development of a mathematical model on this basis, taking particular account of the following parameters. (1) Surface characteristics (peak-to-valley height, pressure angles of roughness elevations) and, (2) material properties of the friction partner (ductility, brittleness, crystal structure). The formula for friction factor thus arrived at incorporates the microscopic and sub-microscopic influence of the surface grain structure. In addition, the effects of elastic and plastic properties at the region of contact was studied. The derived equation is used to characterise frictional properties and enables a suitable and economic friction pair to be selected. The second part deals with the application of solid lubrication and the effect of the solid lubricant film on the mechanicsm and kinematics of ball bearings. In the final part of this investigation an evaluation of experimental results is carried out on the basis of the preceding theoretical studies in order to confirm the theoretical approach and to provide information of practical use on limits of application, cost details and aids to construction. (orig./IHOE) [de

  1. MOQPSO-D/S for Air and Missile Defense WTA Problem under Uncertainty

    Directory of Open Access Journals (Sweden)

    Hao Xu

    2017-01-01

    Full Text Available Aiming at the shortcomings of single objective optimization for solving weapon target assignment (WTA and the existing multiobjective optimization based WTA method having problems being applied in air and missile defense combat under uncertainty, a fuzzy multiobjective programming based WTA method was proposed to enhance the adaptability of WTA decision to the changes of battlefield situation. Firstly, a multiobjective quantum-behaved particle swarm optimization with double/single-well (MOQPSO-D/S algorithm was proposed by adopting the double/single-well based position update method, the hybrid random mutation method, and the two-stage based guider particles selection method. Secondly, a fuzzy multiobjective programming WTA model was constructed with consideration of air and missile defense combat’s characteristics. And, the uncertain WTA model was equivalently clarified based on the necessity degree principle of uncertainty theory. Thirdly, with particles encoding and illegal particles adjusting, the MOQPSO-D/S algorithm was adopted to solve the fuzzy multiobjective programming based WTA model. Finally, example simulation was conducted, and the result shows that the WTA model constructed is rational and MOQPSO-D/S algorithm is efficient.

  2. Rewarding Multitasking: Negative Effects of an Incentive on Problem Solving under Divided Attention

    Science.gov (United States)

    Wieth, Mareike B.; Burns, Bruce D.

    2014-01-01

    Research has consistently shown negative effects of multitasking on tasks such as problem solving. This study was designed to investigate the impact of an incentive when solving problems in a multitasking situation. Incentives have generally been shown to increase problem solving (e.g., Wieth & Burns, 2006), however, it is unclear whether an…

  3. An Examination of the Personality Constructs Underlying Dimensions of Creative Problem-Solving Style

    Science.gov (United States)

    Isaksen, Scott G.; Kaufmann, Astrid H.; Bakken, Bjørn T.

    2016-01-01

    This study investigated the personality facets that underpin the construct of problem-solving style, particularly when approaching more creative kinds of problem-solving. Cattell's Sixteen Personality Factors Questionnaire and VIEW--An Assessment of Problem Solving Style were administered to 165 students from the Norwegian Business School. We…

  4. Reasons and remedies for under-representation of women in medical leadership roles: a qualitative study from Australia.

    Science.gov (United States)

    Bismark, Marie; Morris, Jennifer; Thomas, Laura; Loh, Erwin; Phelps, Grant; Dickinson, Helen

    2015-11-16

    To elicit medical leaders' views on reasons and remedies for the under-representation of women in medical leadership roles. Qualitative study using semistructured interviews with medical practitioners who work in medical leadership roles. Interviews were transcribed verbatim and transcripts were analysed using thematic analysis. Public hospitals, private healthcare providers, professional colleges and associations and government organisations in Australia. 30 medical practitioners who hold formal medical leadership roles. Despite dramatic increases in the entry of women into medicine in Australia, there remains a gross under-representation of women in formal, high-level medical leadership positions. The male-dominated nature of medical leadership in Australia was widely recognised by interviewees. A small number of interviewees viewed gender disparities in leadership roles as a 'natural' result of women's childrearing responsibilities. However, most interviewees believed that preventable gender-related barriers were impeding women's ability to achieve and thrive in medical leadership roles. Interviewees identified a range of potential barriers across three broad domains-perceptions of capability, capacity and credibility. As a counter to these, interviewees pointed to a range of benefits of women adopting these roles, and proposed a range of interventions that would support more women entering formal medical leadership roles. While women make up more than half of medical graduates in Australia today, significant barriers restrict their entry into formal medical leadership roles. These constraints have internalised, interpersonal and structural elements that can be addressed through a range of strategies for advancing the role of women in medical leadership. These findings have implications for individual medical practitioners and health services, as well as professional colleges and associations. Published by the BMJ Publishing Group Limited. For permission to use

  5. Investigating Problem-Based Learning Tutorship in Medical and Engineering Programs in Malaysia

    Science.gov (United States)

    Servant, Virginie F. C.; Dewar, Eleanor F. A.

    2015-01-01

    Although Malaysia was the first country in Asia to adopt problem-based learning (PBL), the impact that this has had on its tutors remains largely unexplored. This paper details a qualitative study of the changing perceptions of teaching roles in two groups of problem-based learning tutors in two institutional contexts--one in medicine located in…

  6. Expanding the Space of Plausible Solutions in a Medical Tutoring System for Problem-Based Learning

    Science.gov (United States)

    Kazi, Hameedullah; Haddawy, Peter; Suebnukarn, Siriwan

    2009-01-01

    In well-defined domains such as Physics, Mathematics, and Chemistry, solutions to a posed problem can objectively be classified as correct or incorrect. In ill-defined domains such as medicine, the classification of solutions to a patient problem as correct or incorrect is much more complex. Typical tutoring systems accept only a small set of…

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

    Directory of Open Access Journals (Sweden)

    H. Jay Biem

    2003-09-01

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

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

    Science.gov (United States)

    Saqr, Mohammed; Fors, Uno; Tedre, Matti

    2017-07-01

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

  9. [The problems of professional competence in the complementary professional forensic medical expertise programs of advanced training and professional requalification].

    Science.gov (United States)

    Shadymov, A B; Fominykh, S A; Dik, V P

    This article reports the results of the analysis of the new tendencies and normatives of the working legislation in the field of additional professional education in the speciality of «forensic medical expertise» and the application of the competency-based approach to the training of specialists in the framework of professional requalification and advanced training programs. Special attention is given to the problems of organization of the educational process and the elaboration of additional training programs based on the competency approach to the training of specialists at the Department of Forensic Medicine and Law with the professor V.N. Kryukov Course of Advanced Professional Training and Professional Requalification of Specialists at the state budgetary educational Institution of higher professional education «Altai State Medical University», Russian Ministry of Health. The study revealed the problems pertaining to the development of professional competencies in the framework of educational programs for the professional requalification and advanced training in the speciality «forensic medical expertise». The authors propose the legally substantiated approaches to the solution of these problems.

  10. Medication cost problems among chronically ill adults in the US: did the financial crisis make a bad situation even worse?

    Directory of Open Access Journals (Sweden)

    Piette JD

    2011-04-01

    Full Text Available John D Piette1, Ann Marie Rosland1, Maria J Silveira1, Rodney Hayward1, Colleen A McHorney21Ann Arbor VA Healthcare System, Ann Arbor, MI, USA; 2US Outcomes Research, Merck and Co, Inc, North Wales, PA, USAAbstract: A national internet survey was conducted between March and April 2009 among 27,302 US participants in the Harris Interactive Chronic Illness Panel. Respondents reported behaviors related to cost-related medication non-adherence (CRN and the impacts of medication costs on other aspects of their daily lives. Among respondents aged 40–64 and looking for work, 66% reported CRN in 2008, and 41% did not fill a prescription due to cost pressures. More than half of respondents aged 40–64 and nearly two-thirds of those in this group who were looking for work or disabled reported other impacts of medication costs, such as cutting back on basic needs or increasing credit card debt. More than one-third of respondents aged 65+ who were working or looking for work reported CRN. Regardless of age or employment status, roughly half of respondents reporting medication cost hardship said that these problems had become more frequent in 2008 than before the economic recession. These data show that many chronically ill patients, particularly those looking for work or disabled, reported greater medication cost problems since the economic crisis began. Given links between CRN and worse health, the financial downturn may have had significant health consequences for adults with chronic illness.Keywords: medication adherence, cost-of-care, access to care, chronic disease

  11. Job requirements compared to medical school education: differences between graduates from problem-based learning and conventional curricula.

    Science.gov (United States)

    Schlett, Christopher L; Doll, Hinnerk; Dahmen, Janosch; Polacsek, Ole; Federkeil, Gero; Fischer, Martin R; Bamberg, Fabian; Butzlaff, Martin

    2010-01-14

    Problem-based Learning (PBL) has been suggested as a key educational method of knowledge acquisition to improve medical education. We sought to evaluate the differences in medical school education between graduates from PBL-based and conventional curricula and to what extent these curricula fit job requirements. Graduates from all German medical schools who graduated between 1996 and 2002 were eligible for this study. Graduates self-assessed nine competencies as required at their day-to-day work and as taught in medical school on a 6-point Likert scale. Results were compared between graduates from a PBL-based curriculum (University Witten/Herdecke) and conventional curricula. Three schools were excluded because of low response rates. Baseline demographics between graduates of the PBL-based curriculum (n = 101, 49% female) and the conventional curricula (n = 4720, 49% female) were similar. No major differences were observed regarding job requirements with priorities for "Independent learning/working" and "Practical medical skills". All competencies were rated to be better taught in PBL-based curriculum compared to the conventional curricula (all p learning/working" (Delta + 0.57), "Psycho-social competence" (Delta + 0.56), "Teamwork" (Delta + 0.39) and "Problem-solving skills" (Delta + 0.36), whereas "Research competence" (Delta--1.23) and "Business competence" (Delta--1.44) in the PBL-based curriculum needed improvement. Among medical graduates in Germany, PBL demonstrated benefits with regard to competencies which were highly required in the job of physicians. Research and business competence deserve closer attention in future curricular development.

  12. Efficacy of Atypical Antipsychotic Medication in the Management of Behaviour Problems in Children with Intellectual Disabilities and Borderline Intelligence: A Systematic Review

    Science.gov (United States)

    Unwin, Gemma L.; Deb, Shoumitro

    2011-01-01

    The use of medications to manage problem behaviours is widespread. However, robust evidence to support their use seems to be lacking. The aim was to review research evidence into the efficacy of atypical antipsychotic medication in managing problem behaviour in children with intellectual disabilities and borderline intelligence. A systematic…

  13. Emergency medical service systems in Sri Lanka: problems of the past, challenges of the future.

    Science.gov (United States)

    Wimalaratne, Kelum; Lee, Jeong Il; Lee, Kang Hyun; Lee, Hee Young; Lee, Jung Hun; Kang, In Hye

    2017-12-01

    The concept of emergency medical services (EMS) is new to Sri Lanka. This article describes the development, delivery, and future ideas for EMS in Sri Lanka. Sri Lanka also faces frequent natural hazards that justify the establishment of an EMS service. Data and information regarding emergency medical care in Sri Lanka were collected and reviewed from resources including websites and research papers. Currently, there are no qualified emergency medical physicians in Sri Lanka. However, a specialist training program for emergency physicians was initiated in 2012. There is no formal system to train emergency medical technicians (EMTs). Sri Lankans usually use taxies or their private vehicles to get to the hospital in the case of an emergency. All of the hospitals have ambulances that they can use to transport patients between hospitals. Most hospitals have emergency treatment units. Those at larger hospitals tend to be better than those at smaller hospitals. Although there is a disaster management system, it is not focused on emergency medical needs. Many aspects of the EMS system in Sri Lanka need improvement. To start, the emergency telephone number should cover the entire country. Training programs for EMTs should be conducted regularly. In addition, ambulances should be allocated for prehospital care. In the process of these developmental changes, public awareness programs are essential to improve the function of the EMS system. Despite many current shortcomings, Sri Lanka is capable of developing a successful EMS system.

  14. Polypharmacy and inappropriate medication use in patients with dementia: an underresearched problem

    Science.gov (United States)

    Parsons, Carole

    2016-01-01

    Multimorbidity and polypharmacy are increasingly prevalent across healthcare systems and settings as global demographic trends shift towards increased proportions of older people in populations. Numerous studies have demonstrated an association between polypharmacy and potentially inappropriate prescribing (PIP), and have reported high prevalence of PIP across settings of care in Europe and North America and, as a consequence, increased risk of adverse drug reactions, healthcare utilization, morbidity and mortality. These studies have not focused specifically on people with dementia, despite the high risk of adverse drug reactions and PIP in this patient cohort. This narrative review considers the evidence currently available in the area, including studies examining prevalence of PIP in older people with dementia, how appropriateness of prescribing is assessed, the medications most commonly implicated, the clinical consequences, and research priorities to optimize prescribing for this vulnerable patient group. Although there has been a considerable research effort to develop criteria to assess medication appropriateness in older people in recent years, the majority of tools do not focus on people with dementia. Of the limited number of tools available, most focus on the advanced stages of dementia in which life expectancy is limited. The development of tools to assess medication appropriateness in people with mild to moderate dementia or across the full spectrum of disease severity represents an important gap in the research literature and is beginning to attract research interest, with recent studies considering the medication regimen as a whole, or misprescribing, overprescribing or underprescribing of certain medications/medication classes, including anticholinergics, psychotropics, antibiotics and analgesics. Further work is required in development and validation of criteria to assess prescribing appropriateness in this vulnerable patient population, to

  15. Developing an integrated framework of problem-based learning and coaching psychology for medical education: a participatory research.

    Science.gov (United States)

    Wang, Qing; Li, Huiping; Pang, Weiguo; Liang, Shuo; Su, Yiliang

    2016-01-05

    Medical schools have been making efforts to develop their own problem-based learning (PBL) approaches based on their educational conditions, human resources and existing curriculum structures. This study aimed to explore a new framework by integrating the essential features of PBL and coaching psychology applicable to the undergraduate medical education context. A participatory research design was employed. Four educational psychology researchers, eight undergraduate medical school students and two accredited PBL tutors participated in a four-month research programme. Data were collected through participatory observation, focus groups, semi-structured interviews, workshop documents and feedback surveys and then subjected to thematic content analysis. The triangulation of sources and member checking were used to ensure the credibility and trustworthiness of the research process. Five themes emerged from the analysis: current experience of PBL curriculum; the roles of and relationships between tutors and students; student group dynamics; development of self-directed learning; and coaching in PBL facilitation. On the basis of this empirical data, a systematic model of PBL and coaching psychology was developed. The findings highlighted that coaching psychology could be incorporated into the facilitation system in PBL. The integrated framework of PBL and coaching psychology in undergraduate medical education has the potential to promote the development of the learning goals of cultivating clinical reasoning ability, lifelong learning capacities and medical humanity. Challenges, benefits and future directions for implementing the framework are discussed in this paper.

  16. Can Hybrid Educational Activities of Team and Problem Based Learning Program be Effective for Japanese Medical Students?

    Science.gov (United States)

    Iwata, Kentaro; Doi, Asako

    2017-11-10

    The purpose of this study is to investigate the medical students'perceptions of the Hybrid Educational Activities between team based learning (TBL) and problem based learning (PBL) Program (HEATAPP), a novel educational program that combines characteristics of PBL and TBL. A five-day HEATAPP on infectious diseases was provided to 4th year medical students at Kobe University School of Medicine, Kobe, Japan. After the program, a focus group discussion was held among 6 medical students who participated in HEATAPP. We qualitatively analyzed the recorded data to delineate the effectiveness of, and the perceptions on, HEATAPP. Some students considered HEATAPP being effective as an active learning, and in developing questions. However, some students found active learning difficult to execute, since they were so familiar with passive learning such as lectures and examinations. They also found it difficult to identify important points by reading authentic textbooks on given issues, particularly English textbooks. Even though active learning and group discussion are underscored as important in medicine, some Japanese medical students may be reluctant to shift towards these since they are so used to passive learning since childhood. English language is another barrier to active learning. The introduction of active learning in the earlier stages of education might be an effective solution. Teachers at medical schools in Japan should be mindful of the students'potentially negative attitudes towards active learning, which is claimed to be successful in western countries.

  17. Event-based home safety problem detection under the CPS home safety architecture

    OpenAIRE

    Yang, Zhengguo; Lim, Azman Osman; Tan, Yasuo

    2013-01-01

    This paper presents a CPS(Cyber-physical System) home safety architecture for home safety problem detection and reaction and shows some example cases. In order for home safety problem detection, there are three levels of events defined: elementary event, semantic event and entire event, which representing the meaning from parameter to single safety problem, and then the whole safety status of a house. For the relationship between these events and raw data, a Finite State Machine (FSM) based m...

  18. Reasons and remedies for under-representation of women in medical leadership roles: a qualitative study from Australia

    Science.gov (United States)

    Bismark, Marie; Morris, Jennifer; Thomas, Laura; Loh, Erwin; Phelps, Grant; Dickinson, Helen

    2015-01-01

    Objective To elicit medical leaders’ views on reasons and remedies for the under-representation of women in medical leadership roles. Design Qualitative study using semistructured interviews with medical practitioners who work in medical leadership roles. Interviews were transcribed verbatim and transcripts were analysed using thematic analysis. Setting Public hospitals, private healthcare providers, professional colleges and associations and government organisations in Australia. Participants 30 medical practitioners who hold formal medical leadership roles. Results Despite dramatic increases in the entry of women into medicine in Australia, there remains a gross under-representation of women in formal, high-level medical leadership positions. The male-dominated nature of medical leadership in Australia was widely recognised by interviewees. A small number of interviewees viewed gender disparities in leadership roles as a ‘natural’ result of women's childrearing responsibilities. However, most interviewees believed that preventable gender-related barriers were impeding women's ability to achieve and thrive in medical leadership roles. Interviewees identified a range of potential barriers across three broad domains—perceptions of capability, capacity and credibility. As a counter to these, interviewees pointed to a range of benefits of women adopting these roles, and proposed a range of interventions that would support more women entering formal medical leadership roles. Conclusions While women make up more than half of medical graduates in Australia today, significant barriers restrict their entry into formal medical leadership roles. These constraints have internalised, interpersonal and structural elements that can be addressed through a range of strategies for advancing the role of women in medical leadership. These findings have implications for individual medical practitioners and health services, as well as professional colleges and associations

  19. Survey of Barriers and Research Problems from the Viewpoint of Faculty Members of Ardabil University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    A Naghizadeh Baghi

    2015-09-01

    Full Text Available Background & objectives: The most obvious indicators of a country's growth and development are technological capabilities and its scientific research . Therefore, any attempt to clarify the status of research and facing obstacles is important. The aim of this study is to investigate the problems and obstacles of knowledge from the viewpoint of faculty members of Ardabil University of Medical Sciences.   Methods: In a descriptive and survey study, sample contains 126 faculty members in Ardabil University of Medical Sciences were selected using Morgan and Krejcie table of sample size determination. The instrument used in this study was a questionnaire with two parts, i.e. demographic information and the Questionnaire of Research Barriers by Sotoodehasl et al. (2014 including 39 items on a 5 point Likert Scale continuum. A One-Sample T-Test, an independent samples T-Test, and an ANOVA test were used for the data analysis.   Results: The mean of the area of problems related to preparation of research project and development was 2.86 which is less than the conceptual mean but is not statistically significant (p=0.056. However in the other three areas, i.e. the means of problems in the implementation of the project, administrative and managerial problems, and individual problems were greater than the conceptual mean and the differences were statistically significant (p≤0.05. The mean of questions in the four areas was 3.23 which is greater than the conceptual mean and the difference is also significant (p=0.001.   Conclusion: In the investigation of areas, the most important problems and research barriers from the viewpoint of faculty members are weak teamwork at the university, large bulk of work and different expectations from the faculty members and lack of proper research environment.

  20. A comparison of course-related stressors in undergraduate problem-based learning (PBL versus non-PBL medical programmes

    Directory of Open Access Journals (Sweden)

    Ross Elizabeth E

    2009-09-01

    Full Text Available Abstract Background Medical students report high levels of stress related to their medical training as well as to other personal and financial factors. The aim of this study is to investigate whether there are differences in course-related stressors reported by medical students on undergraduate problem-based learning (PBL and non-PBL programmes in the UK. Method A cross-sectional study of second-year medical students in two UK medical schools (one PBL and one non-PBL programme was conducted. A 16-question self-report questionnaire, derived from the Perceived Medical Student Stress Scale and the Higher Education Stress Inventory, was used to measure course-related stressors. Following univariate analysis of each stressor between groups, multivariate logistic regression was used to determine which stressors were the best predictors of each course type, while controlling for socio-demographic differences between the groups. Results A total of 280 students responded. Compared to the non-PBL students (N = 197, the PBL students (N = 83 were significantly more likely to agree that: they did not know what the faculty expected of them (Odds Ratio (OR = 0.38, p = 0.03; there were too many small group sessions facilitated only by students resulting in an unclear curriculum (OR = 0.04, p Conclusion There are significant differences in the perceived course-related stressors affecting medical students on PBL and non-PBL programmes. Course designers and student support services should therefore tailor their work to minimise, or help students cope with, the specific stressors on each course type to ensure optimum learning and wellbeing among our future doctors.

  1. [Problems in career planning for novice medical technologists in Japanese national hospitals].

    Science.gov (United States)

    Ogasawara, Shu; Tsutaya, Shoji; Akimoto, Hiroyuki; Kojima, Keiya; Yabaka, Hiroyuki

    2012-12-01

    Skills and knowledge regarding many different types of test are required for medical technologists (MTs) to provide accurate information to help doctors and other medical specialists. In order to become an efficient MT, specialized training programs are required. Certification in specialized areas of clinical laboratory sciences or a doctoral degree in medical sciences may help MTs to realize career advancement, a higher earning potential, and expand the options in their career. However, most young MTs in national university hospitals are employed as part-time workers on a three-year contract, which is too short to obtain certifications or a doctoral degree. We have to leave the hospital without expanding our future. We need to take control of our own development in order to enhance our employability within the period. As teaching and training hospitals, national university hospitals in Japan are facing a difficult dilemma in nurturing MTs. I hope, as a novice medical technologist, that at least university hospitals in Japan create an appropriate workplace environment for novice MTs.

  2. Medication errors—an enduring problem for children and elderly patients

    Czech Academy of Sciences Publication Activity Database

    Zakharov, S.; Navrátil, Tomáš; Pelclová, D.

    2012-01-01

    Roč. 117, č. 2012 (2012), s. 309-317 ISSN 2000-1967 R&D Projects: GA AV ČR IAA400400806; GA ČR GAP206/11/1638 Institutional research plan: CEZ:AV0Z40400503 Keywords : grug overdose * improper route of administration * medication errors Subject RIV: CG - Electrochemistry

  3. What the Classroom Teacher Needs to Know about Children with Chronic Medical Problems.

    Science.gov (United States)

    Frieman, Barry B.; Settel, Joanne

    1994-01-01

    Explains the causes and symptoms of four chronic diseases (asthma, diabetes, epilepsy, and sickle cell anemia) that afflict large numbers of children, and discusses specific classroom medical procedures that teachers can use to help children with these diseases. Also provides suggestions for working with parents of chronically ill children and…

  4. Electric Car Users’ Time of Charging Problem under Peak Load Pricing When Delay in Charging Time Involves Uncertain Cost

    DEFF Research Database (Denmark)

    Fetene, Gebeyehu Manie

    ). Peak load pricing (PLP) is an attempt to shift demand, or consumption of the good, to accommodate supply. While peak load problem and PLP are well documented in the literature, this paper, to the authors’ knowledge, is the first to analyze the EV users time of charg- ing decision problem under PLP...... such as electricity, transport (con- gestion), water and telecommunication. Linear and non-linear peak load pricing alternatives have been suggested to curb this problem, particularly when demand is cyclical (Mohsenian-Rad and Leon-Garcia, 2010; Tan and Varaiya, 1993; Chao et al., 1986; Finsinger; Roberts, 1979...... the battery becomes flat (which usually occurs when EV users return back to home from work at which energy consumption is also at its peak, and thus worsen the peak load problem) under uniform pricing of electricity even when they do not have planned trips. 2) Unless either the duration of time at which...

  5. The Association between Sleep Problems, Sleep Medication Use, and Falls in Community-Dwelling Older Adults: Results from the Health and Retirement Study 2010

    Directory of Open Access Journals (Sweden)

    Yaena Min

    2016-01-01

    Full Text Available Background. Very few studies have assessed the impact of poor sleep and sleep medication use on the risk of falls among community-dwelling older adults. The objective of this study was to evaluate the association between sleep problems, sleep medication use, and falls in community-dwelling older adults. Methods. The study population comprised a nationally representative sample of noninstitutionalized older adults participating in the 2010 Health and Retirement Study. Proportion of adults reporting sleep problems, sleep medication use, and fall was calculated. Multiple logistic regression models were constructed to examine the impact of sleep problems and sleep medication use on the risk of falls after controlling for covariates. Results. Among 9,843 community-dwelling older adults, 35.8% had reported a fall and 40.8% had reported sleep problems in the past two years. Sleep medication use was reported by 20.9% of the participants. Older adults who do have sleep problems and take sleep medications had a significant high risk of falls, compared to older adults who do not have sleep problems and do not take sleep medications. The other two groups also had significantly greater risk for falls. Conclusion. Sleep problems added to sleep medication use increase the risk of falls. Further prospective studies are needed to confirm these observed findings.

  6. The Association between Sleep Problems, Sleep Medication Use, and Falls in Community-Dwelling Older Adults: Results from the Health and Retirement Study 2010

    Science.gov (United States)

    2016-01-01

    Background. Very few studies have assessed the impact of poor sleep and sleep medication use on the risk of falls among community-dwelling older adults. The objective of this study was to evaluate the association between sleep problems, sleep medication use, and falls in community-dwelling older adults. Methods. The study population comprised a nationally representative sample of noninstitutionalized older adults participating in the 2010 Health and Retirement Study. Proportion of adults reporting sleep problems, sleep medication use, and fall was calculated. Multiple logistic regression models were constructed to examine the impact of sleep problems and sleep medication use on the risk of falls after controlling for covariates. Results. Among 9,843 community-dwelling older adults, 35.8% had reported a fall and 40.8% had reported sleep problems in the past two years. Sleep medication use was reported by 20.9% of the participants. Older adults who do have sleep problems and take sleep medications had a significant high risk of falls, compared to older adults who do not have sleep problems and do not take sleep medications. The other two groups also had significantly greater risk for falls. Conclusion. Sleep problems added to sleep medication use increase the risk of falls. Further prospective studies are needed to confirm these observed findings. PMID:27547452

  7. Peers experience of delivering a problem-solving programme to enhance antipsychotic medication adherence for individuals with schizophrenia.

    Science.gov (United States)

    Boardman, G; Kerr, D; McCann, T

    2015-08-01

    No research has been conducted into the experience of peer support in improving adherence with oral antipsychotic medication for consumers with schizophrenia. Altruism influences peers to participate in peer support. Engagement in peer support can be challenging and rewarding for peers, and helps improve their own confidence and well-being. Many consumers with schizophrenia are reluctant to take their prescribed antipsychotic medications; however, non-adherence can lead to relapse. The aim of this study was to evaluate peers' perspectives of their participation in a problem-solving peer support programme to enhance adherence in consumers who are reluctant to take antipsychotic medication. Peers contacted consumers by a weekly telephone call for 8 weeks, and used a problem-solving approach to inform their discussion about medication adherence. Semi-structured qualitative interviews were used to evaluate peers' perspectives of their involvement in the programme. Three main themes were abstracted from the data: motivation to participate in the study, experience of peer support programme, and rewards and challenges of the peer experience. Helping others was an important motivator for peers in agreeing to participate in the study. Telephone delivery was a convenient way to deliver the peer support programme. However, at times, it was difficult to contact consumers by telephone and this caused some frustration. Despite these difficulties, peers recognized that being involved in the programme increased their confidence and made them feel worthwhile. The findings have implications for the use of peer support as an adjunct intervention to promote medication adherence in consumers with schizophrenia. © 2015 John Wiley & Sons Ltd.

  8. Grace Under Pressure: a drama-based approach to tackling mistreatment of medical students.

    Science.gov (United States)

    Scott, Karen M; Berlec, Špela; Nash, Louise; Hooker, Claire; Dwyer, Paul; Macneill, Paul; River, Jo; Ivory, Kimberley

    2017-03-01

    A positive and respectful learning environment is fundamental to the development of professional identities in healthcare. Yet medical students report poor behaviour from healthcare professionals that contradict professionalism teaching. An interdisciplinary group designed and implemented a drama-based workshop series, based on applied theatre techniques, to help students develop positive professional qualities and interpersonal skills to deal with challenges in the healthcare setting. We piloted the workshops at the University of Sydney in 2015. Attendees completed evaluation questionnaires and participated in a focus group or interview. Of 30 workshop attendances, there were 29 completed questionnaires and three participants attended a focus group or interview. Workshop activities were rated as 'very good' or 'good' by 21/22 (95.5%). Thematic analysis of qualitative data highlighted the rationale for participation (to deal with bullying, prevent becoming a bully, learn social skills), workshop benefits (express emotions, learn about status dynamics and deconstructing personalities, empathy, fun), challenges (meeting participants' expectations, participants' need for further practice) and implications for medical education (need to develop awareness of others' perspectives). Our research has shown that there is momentum to challenge mistreatment in medical education. While a multipronged approach is needed to generate systemic change, this pilot offers a positive and creative innovation. It helps students improve their interpersonal skills and sense of self to deal with challenges in the healthcare setting, including mistreatment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  9. Audit in Belarus under new law and in new environment: first results, problems, prospects

    Directory of Open Access Journals (Sweden)

    S.L. Korotayev

    2016-07-01

    Full Text Available The article analyzes the first results of application of the new law of the Republic of Belarus «On audit activity» since the 01.01.2014. The authors identify the problems inherent in auditing, propose specific measures to solve these problems, and to create the necessary conditions for the further development of audit.

  10. The influence of tutor qualification on the process and outcome of learning in a problem-based course of basic medical pharmacology.

    Science.gov (United States)

    Matthes, Jan; Marxen, Bent; Linke, Ralph-Mario; Antepohl, Wolfram; Coburger, Silke; Christ, Hildegard; Lehmacher, Walter; Herzig, Stefan

    2002-07-01

    Limited access to expert tutors is a problem that can be addressed by using tutors from different stages of medical or non-medical (under-, post-) graduate education. To address whether such differences in qualification affect the results of process evaluation by participants or their learning outcome (exam results), we analysed the data of a 4-year prospective study performed with 787 3rd-year medical students (111 groups of 5-10 participants) taking an obligatory problem-based learning (PbL)-course of basic pharmacology. We compared peer tutors (undergraduate medical students, >/=4th year), non-expert (junior) staff tutors (physicians, pharmacists, veterinarians, biologists, or chemists during postgraduate education), and expert (senior) staff tutors (completed postgraduate education). Evaluation scores related to PbL gave the highest values for senior staff-led groups. The tutor's performance score of peer-led groups did not differ from those of staff-led groups, but the score obtained from groups tutored by junior staff was lower than that obtained with senior staff tutors. Students' weekly preparation time tended to be lower in peer-led groups, while learning time spent specifically on exam preparation seemed to be increased compared to PbL-groups of staff tutors. As a putative confounding variable, tutors' experience in coaching PbL-groups was also investigated. Groups led by experienced tutors, defined as tutors with at least one term of previous PbL tutoring, were found to have significantly higher evaluation scores. Interestingly, neither tutors' subject-matter expertise (peer students, junior staff, or senior staff) nor their teaching-method expertise showed any influence on PbL-groups' mean test scores in a written exam. This indicates that the effect of tutor expertise on the learning process is not associated with a difference in learning outcome when just factual knowledge is assessed by traditional methods.

  11. DDeveloping and solving a bi-objective joint replenishment problem under storing space constraint

    Directory of Open Access Journals (Sweden)

    ommolbanin yousefi

    2011-03-01

    Full Text Available In this research, a bi-objective joint replenishment problem has been developed and solved with the assumption of one restricted resource. The proposed model has a storing space constraint and tries to optimize two objective functions simultaneously. They include minimizing annual holding and setup costs and minimizing annual inventory investment. Then, for solving this problem, a multi-objective genetic algorithm (MOGA has been developed. In order to analyze the algorithm efficiency, its performance has been examined in solving 1600 randomly produced problems using parameters extracted from literature. The findings imply that the proposed algorithm is capable of producing a good set of Pareto optimal solutions. Finally, the application of the problem solving approach and the findings of the proposed algorithm have been illustrated for a special problem, which has been randomly produced.

  12. The Examining Mathematical Word Problems Solving Ability under Efficient Representation Aspect

    Directory of Open Access Journals (Sweden)

    Maryam Sajadi

    2013-02-01

    Full Text Available Word problem solving is complex process for students. Efficient instruction of word problem solving needed to efficient strategies. One of these strategies is using representation. Some students apply key words or numbers only but when they face complex word problems then they cannot apply the keywords. Therefore teachers have to teach efficient strategy such as representation. In this research is tried whether using efficient representation can lead to efficient solution. Through cluster sampling method, forty one students are selected at girly elementary school. Through math exam, their solutions are studied. Through Spearman test, results indicate that there is significant relation between efficient representation and efficient word problem solving ability. At second grade, students have used of representation, have gotten to high means and inverse, students have not used of representation, have not gotten to high means. Therefore there is significant and direct relation between efficient representation and efficient word problem solving ability.

  13. An approach to enrich online medical Problem-Based Learning with tacit healthcare knowledge.

    Science.gov (United States)

    Cheah, Yu-N; Rashid, Faridah Abdul; Abidi, Syed Sibte Raza

    2003-01-01

    Existing Problem-Based Learning (PBL) problems, though suitable in their own right for teaching purposes, are limited in their potential to evolve by themselves and to create new knowledge. Presently, they are based on textbook examples of past cases and/or cases that have been transcribed by a clinician. In this paper, we present (a) a tacit healthcare knowledge representation formalism called Healthcare Scenarios, (b) the relevance of healthcare scenarios in PBL in healthcare and medicine, (c) a novel PBL-Scenario-based tacit knowledge explication strategy and (d) an online PBL Problem Composer and Presenter (PBL-Online) to facilitate the acquisition and utilisation of expert-quality tacit healthcare knowledge to enrich online PBL. We employ a confluence of healthcare knowledge management tools and Internet technologies to bring tacit healthcare knowledge-enriched PBL to a global and yet more accessible level.

  14. Evaluating sociodemographic and medical conditions of patients under home care service

    Directory of Open Access Journals (Sweden)

    Tolga Önder

    2015-09-01

    Full Text Available Objective: In our study, we aimed to reveal medical conditions and the sociodemographic conditions of patients under home care service. Methods: Our study is planned on 52 patients who are under home care service at Sarıkamış State Hospital between June 2013 and May 2014. Patients' sex, education, social security status, comorbid diseases and general health status were recorded. Results: Fifty-two patients enrolled. 21 of them (40.4% were men, 31 of them (59.6 % were women. It is revealed that In 36 patients (69.2% did not receive formal education throughout their lives, while16 (30.8% of them had only primary education. All female patients were housewives. The most frequent diseases in home care patients were cerebrovascular disease in 18 (34.6% subjects, Alzheimer's disease in 9 (17.3%, and chronic obstructive pulmonary disease in 4 (7.7% d. 38 patients (73.1% needed routine follow-up. Most of the patients (61.5% had green card health insurance. Only 6 patients (11.5% were in need of narcotic analgesics. Thirteen patients had pressure ulcers due to immobilization. Evaluating the exercise capacity of the patients; 43 (82.7% could not dressed themselves, 38 (73.1% could not use phone. Thirty-two patients had urinary incontinence and 31 had fecal incontinence. Conclusion: Today, population of patients who need home care service is increasing due to ease access to home care service and increase in survival. For a better care of patients, home care providers should be well educated and differences on features of patients and medical conditions it should be taken into consideration.

  15. Stakeholder Perspectives on Changes in Hypertension Care Under the Patient-Centered Medical Home

    Science.gov (United States)

    O’Donnell, Alison J.; Kellom, Katherine; Miller-Day, Michelle; McClintock, Heather F. de Vries; Kaye, Elise M.; Gabbay, Robert; Cronholm, Peter F.

    2016-01-01

    Introduction Hypertension is a major modifiable risk factor for cardiovascular and kidney disease, yet the proportion of adults whose hypertension is controlled is low. The patient-centered medical home (PCMH) is a model for care delivery that emphasizes patient-centered and team-based care and focuses on quality and safety. Our goal was to investigate changes in hypertension care under PCMH implementation in a large multipayer PCMH demonstration project that may have led to improvements in hypertension control. Methods The PCMH transformation initiative conducted 118 semistructured interviews at 17 primary care practices in southeastern Pennsylvania between January 2011 and January 2012. Clinicians (n = 47), medical assistants (n = 26), office administrators (n = 12), care managers (n = 11), front office staff (n = 7), patient educators (n = 4), nurses (n = 4), social workers (n = 4), and other administrators (n = 3) participated in interviews. Study personnel used thematic analysis to identify themes related to hypertension care. Results Clinicians described difficulties in expanding services under PCMH to meet the needs of the growing number of patients with hypertension as well as how perceptions of hypertension control differed from actual performance. Staff and office administrators discussed achieving patient-centered hypertension care through patient education and self-management support with personalized care plans. They indicated that patient report cards were helpful tools. Participants across all groups discussed a team- and systems-based approach to hypertension care. Conclusion Practices undergoing PCMH transformation may consider stakeholder perspectives about patient-centered, team-based, and systems-based approaches as they work to optimize hypertension care. PMID:26916899

  16. [Biodiversity and evolution of circulating bacteria and virus populations. Novel problems of medical microbiology].

    Science.gov (United States)

    Zhebrun, A V; Mukomolov, S L; Narvskaia, O V; Tseneva, G Ia; Kaftyreva, L A; Mokrousov, I V

    2011-01-01

    Biodiversity and evolution of circulating bacteria and virus populations is a serious scientific problem, solving this problem is necessary for effective prophylaxis of infectious diseases. Principal trends of development in this field of science are described. Results of studies that were carried out and investigated biodiversity of principal pathogens in Russia and St. Petersburg in particular are presented. Risk of infectious security of society caused by increasing diversity of pathogenic microorganisms is described, and priority trends of research development in this field are specified.

  17. Electric Car Users’ Time of Charging Problem under Peak Load Pricing When Delay in Charging Time Involves Uncertain Cost

    DEFF Research Database (Denmark)

    Fetene, Gebeyehu Manie

    such as electricity, transport (con- gestion), water and telecommunication. Linear and non-linear peak load pricing alternatives have been suggested to curb this problem, particularly when demand is cyclical (Mohsenian-Rad and Leon-Garcia, 2010; Tan and Varaiya, 1993; Chao et al., 1986; Finsinger; Roberts, 1979......). Peak load pricing (PLP) is an attempt to shift demand, or consumption of the good, to accommodate supply. While peak load problem and PLP are well documented in the literature, this paper, to the authors’ knowledge, is the first to analyze the EV users time of charg- ing decision problem under PLP...

  18. Psychoanalysis and analytic psychotherapy in the NHS--a problem for medical ethics.

    OpenAIRE

    Wilkinson, G

    1986-01-01

    I question the place of psychoanalysis and psychoanalytically oriented psychotherapy in the National Health Service (NHS), with reference to published material; and, particularly, in relation to primary care, health economics and medical ethics. I argue that there are pressing clinical, research, economic, and ethical reasons in support of the contention that an urgent review of the extent and impact of psychoanalytic practices in the health service is called for.

  19. Psychoanalysis and analytic psychotherapy in the NHS--a problem for medical ethics.

    Science.gov (United States)

    Wilkinson, G

    1986-01-01

    I question the place of psychoanalysis and psychoanalytically oriented psychotherapy in the National Health Service (NHS), with reference to published material; and, particularly, in relation to primary care, health economics and medical ethics. I argue that there are pressing clinical, research, economic, and ethical reasons in support of the contention that an urgent review of the extent and impact of psychoanalytic practices in the health service is called for. PMID:3735363

  20. Health problems and medical utilization associated with gambling disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

    Science.gov (United States)

    Morasco, Benjamin J; Pietrzak, Robert H; Blanco, Carlos; Grant, Bridget F; Hasin, Deborah; Petry, Nancy M

    2006-01-01

    Pathologic gambling is believed to be associated with adverse health consequences, but no prior studies have rigorously evaluated these relationships. We sought to examine medical disorders and health service utilization associated with problem and pathologic gambling. A total of 43,093 adults aged 18 years and older were evaluated in the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions. Self-reported medical diagnoses and past-year medical services used were assessed. Pathologic gamblers were more likely than low-risk individuals to have been diagnosed with tachycardia (odds ratio [OR] = 1.77; 95% confidence interval [CI] = 1.05-2.97), angina (OR = 2.35; 95% CI = 1.33-4.15), cirrhosis (OR = 3.90; 95% CI = 1.11-13.72), and other liver disease (OR = 2.98; 95% CI = 1.07-8.26). Gambling severity was also associated with higher rates of medical utilization with pathologic gamblers more likely than low-risk individuals to have been treated in the emergency room in the year before the survey (OR = 1.98; 95% CI = 1.27-3.09). Significant effects of gambling severity remained even after controlling for demographic characteristics (age, gender, ethnicity, marital status, education, income, and region of the country) and behavioral risk factors such as body mass index, alcohol abuse and dependence, nicotine dependence, and mood and anxiety disorders. A lifetime diagnosis of pathologic gambling is associated with several medical disorders and increased medical utilization, perhaps leading to a burden on healthcare costs in the United States.

  1. An investigation into drug-related problems identifiable by commercial medication review software

    Directory of Open Access Journals (Sweden)

    Colin Curtain

    2013-05-01

    Full Text Available BackgroundAccredited pharmacists conduct home medicines reviews (HMRs to detect and resolve potential drug-related problems (DRPs. A commercial expert system, Medscope Review Mentor (MRM, has been developed to assist pharmacists in the detection and resolution of potential DRPs.AimsThis study compares types of DRPs identified with the commercial system which uses multiple classification ripple down rules (MCRDR with the findings of pharmacists.Method HMR data from 570 reviews collected from accredited pharmacists was entered into MRM and the DRPs were identified. A list of themes describing the main concept of each DRP identified by MRM was developed to allow comparison with pharmacists. Theme types, frequencies, similarity and dissimilarity were explored.ResultsThe expert system was capable of detecting a wide range of potential DRPs: 2854 themes; compared to pharmacists: 1680 themes. The system identified the same problems as pharmacists in many patient cases. Ninety of 119 types of themes identifiable by pharmacists were also identifiable by software. MRM could identify the same problems in the same patients as pharmacists for 389 problems, resulting in a low overlap of similarity with an averaged Jaccard Index of 0.09. ConclusionMRM found significantly more potential DRPs than pharmacists. MRM identified a wide scope of DRPs approaching the range of DRPs that were identified by pharmacists. Differences may be associated with system consistency and perhaps human oversight or human selective prioritisation. DRPs identified by the system were still considered relevant even though the system identified a larger number of problems.

  2. Solving the Bilevel Facility Location Problem under Preferences by a Stackelberg-Evolutionary Algorithm

    Directory of Open Access Journals (Sweden)

    José-Fernando Camacho-Vallejo

    2014-01-01

    Full Text Available This research highlights the use of game theory to solve the classical problem of the uncapacitated facility location optimization model with customer order preferences through a bilevel approach. The bilevel model provided herein consists of the classical facility location problem and an optimization of the customer preferences, which are the upper and lower level problems, respectively. Also, two reformulations of the bilevel model are presented, reducing it into a mixed-integer single-level problem. An evolutionary algorithm based on the equilibrium in a Stackelberg’s game is proposed to solve the bilevel model. Numerical experimentation is performed in this study and the results are compared to benchmarks from the existing literature on the subject in order to emphasize the benefits of the proposed approach in terms of solution quality and estimation time.

  3. Implementation of Problem-Based Learning by Faculty Members at 12 U.S. Medical and Dental Schools.

    Science.gov (United States)

    Abdelkarim, Ahmad; Schween, Dorothy; Ford, Timothy

    2016-11-01

    The aim of this study was to assess the perspectives of medical and dental faculty members regarding implementation of problem-based learning (PBL). A survey instrument was designed with demographic questions and two open-ended questions to investigate faculty members' perceptions of the most suitable subjects or courses in which to use PBL and examples of how they incorporated PBL into their instruction. The survey was sent to 12 U.S. medical and dental schools known to use PBL, and 73 medical faculty members and 88 dental faculty members completed the survey (n=161), for an overall response rate of 28% of those who were sent the survey at each school (not each's total faculty). In the results, 41% of the medical faculty respondents and 22% of the dental faculty respondents stated that PBL is applicable for all subjects. Members of both groups perceived that PBL is primarily applicable in clinical education, including clinical courses or the clinical applications of courses. The respondents' perceptions about PBL implementation varied significantly, and both groups reported a wide range of approaches in which they implement PBL in their instruction, some of which were not consistent with the purpose of PBL.

  4. Language barrier, funding, communication and time management problems found in the Medical Journal of Indonesia, 1995 - 2001

    Directory of Open Access Journals (Sweden)

    Isnani A. Suryono

    2001-12-01

    Full Text Available The objective of this study is to assess the problems encountered in the management of Medical Journal of Indonesia and whether any progress has been achieved during the past 7 years. A retrospective descriptive study was done in the MJI. Available data used as parameters were: number of articles submitted and author's home institution, number of articles submitted and rejected, cause/criteria of rejection, qualification of reviewers and editors, duration of manuscript processing, and whether pre-scheduled time is met in the Med J Indones. For this purpose, all manuscripts from January 1995- January 2001 were evaluated. In addition, recent problems encountered were noted. Problems encountered were limited supply of manuscript that might be due to language barrier, decrease in circulation due to limited budget, communication problems due to seniority, and increase in average processing time that might be due to restriction in the time allocated for MJI Number of articles submitted by authors originating from national versus foreign institutions in 1995-1997 was 101 versus 16, and in 1998 - 2000 were 124 versus 84. Articles rejected were ±26.4 % (1999-2001 and the most frequent causes of rejection were insignificancy of substance and improper data analysis. As for the qualification of editors there was an increase in the number of PhDs and professors. Average processing time is approximately 1.5 times the scheduled time. It seems that the 4 main problems encountered were (1 Language barrier, (2 Funding, (3 Communication problems and (4 Time management; and though not impressive, there are definitely positive changes in the number of manuscipts submitted, qualification of editors and peer reviewers. Average processing time is about the same, and the prescheduled time of editing is yet to be met. (Med J  Indones 2001; 10: 252-8Keywords: language barrier, funding, communication problems, time management

  5. A case study of methods used to tackle a common pedagogic problem in medical and dental education: time pressure.

    Science.gov (United States)

    Zakrzewska, J M; Fry, H; Larkin, K E

    2003-07-01

    This case study describes how the common problems of time shortage, factual overload and curriculum overcrowding were tackled in one context, using good practice guidelines. It examines the impact of two hours of intensive, interactive teaching on the knowledge and attitudes of senior medical undergraduates at one United Kingdom school, and the effectiveness of two different ways of presenting information. The session raised student awareness of the importance to medical practice of the topic. There were statistically significant increases in the ability and knowledge of students over the period, as self-rated by students and assessed by the teacher; results of the impact on learning outcomes of different versions of a handout were not statistically significant. Further research on modes of presentation of information and their impact on forming and accessing illness scripts is suggested. Minority subjects in potentially overcrowded, time-pressured curricula can be effectively introduced in short time slots.

  6. Virtue ethics - an old answer to a new dilemma? Part 1. Problems with contemporary medical ethics.

    Science.gov (United States)

    Misselbrook, David

    2015-02-01

    The commonest practical model used in contemporary medical ethics is Principlism. Yet, while Principlism is a widely accepted consensus statement for ethics, the moral theory that underpins it faces serious challenges in its attempt to provide a coherent and accepted system of moral analysis. This inevitably challenges the stability of such a consensus statement and makes it vulnerable to attack by competitors such as preference consequentialism. This two-part paper proposes an inclusive version of virtue theory as a more grounded system of moral analysis. © The Royal Society of Medicine.

  7. Medical care and drug-related problems: Do doctors and pharmacists speak the same language?

    Science.gov (United States)

    Foppe van Mil, J W; Westerlund, Tommy; Brown, Lawrence; Chen, Timothy F; Henman, Martin; Hersberger, Kurt; McElnay, James; Schulz, Martin

    2016-04-01

    Optimal communication between physicians and pharmacists is important for patient care. However, pharmacists and doctors do not always seem to understand each other. They have been professionalized differently, and do not always speak the same language. Especially in the areas of prescribing, medication review, and medicine use, there can be differences in views. This contribution clarifies some essential concepts that doctors and pharmacists use. Thus we hope that our commentary contributes to a better understanding of each other's role and the importance of interprofessional cooperation for the benefit of the patient.

  8. Bridging problems and models in medical ethics: four images of local ethics committees.

    Science.gov (United States)

    Incorvati, G

    In the context of the continuing debate about how ethics committees in Italy should be structured (see Bulletin 160) Professor Incorvati, from the Comitato Nazionale per la Bioetica in Rome, considers four theoretical models of how such committees may be arranged, and why one in particular looks better placed to face the growing ethical problems that are emerging as a result of current developments in medicine.

  9. [Impact of problem-based learning on the cognitive processes of medical students].

    Science.gov (United States)

    Urrutia Aguilar, María Esther; Hamui-Sutton, Alicia; Castañeda Figueiras, Sandra; Fortoul van der Goes, Teresa Imelda; Guevara-Guzmán, Rosalinda

    2011-01-01

    The problem based learning (PBL) method was conceived as a teaching strategy to be applied in different areas or disciplines, thus several universities adopted it, among which was the Universidad Nacional Autónoma de México, best known as UNAM. The Faculty of Medicine of UNAM implemented this innovative teaching method of medicine for its learner-centered educational method tendency (patient-centered practice). This method develops also several abilities in the students, such as active and significant learning, seeking and data selection and autoanalysis and synthesis, knowledge integration of, mind's logic for the detection and solution of problems, among others. The aim was to evaluate the PBL impact on pedagogical and cognitive processes through the students' critical thinking and the significance of the experience on students and teachers which were working with PBL; in addition, study strategies and self-regulation in students were considered variables for the study. Our findings indicated that PBL was perceived differently among students and teachers, and it influenced in a positive and significant way the students' perception to solve problems and their motivation to achieve a good academic performance (p < 0.005). These results suggest that PBL is a useful strategy in the teaching and learning process and it is clear that the pedagogical process and other variables can potentially influence the results obtained.

  10. Electrostatic point charge fitting as an inverse problem: Revealing the underlying ill-conditioning

    Energy Technology Data Exchange (ETDEWEB)

    Ivanov, Maxim V.; Talipov, Marat R.; Timerghazin, Qadir K., E-mail: qadir.timerghazin@marquette.edu [Department of Chemistry, Marquette University, Milwaukee, Wisconsin 53201-1881 (United States)

    2015-10-07

    Atom-centered point charge (PC) model of the molecular electrostatics—a major workhorse of the atomistic biomolecular simulations—is usually parameterized by least-squares (LS) fitting of the point charge values to a reference electrostatic potential, a procedure that suffers from numerical instabilities due to the ill-conditioned nature of the LS problem. To reveal the origins of this ill-conditioning, we start with a general treatment of the point charge fitting problem as an inverse problem and construct an analytical model with the point charges spherically arranged according to Lebedev quadrature which is naturally suited for the inverse electrostatic problem. This analytical model is contrasted to the atom-centered point-charge model that can be viewed as an irregular quadrature poorly suited for the problem. This analysis shows that the numerical problems of the point charge fitting are due to the decay of the curvatures corresponding to the eigenvectors of LS sum Hessian matrix. In part, this ill-conditioning is intrinsic to the problem and is related to decreasing electrostatic contribution of the higher multipole moments, that are, in the case of Lebedev grid model, directly associated with the Hessian eigenvectors. For the atom-centered model, this association breaks down beyond the first few eigenvectors related to the high-curvature monopole and dipole terms; this leads to even wider spread-out of the Hessian curvature values. Using these insights, it is possible to alleviate the ill-conditioning of the LS point-charge fitting without introducing external restraints and/or constraints. Also, as the analytical Lebedev grid PC model proposed here can reproduce multipole moments up to a given rank, it may provide a promising alternative to including explicit multipole terms in a force field.

  11. Electrostatic point charge fitting as an inverse problem: Revealing the underlying ill-conditioning

    International Nuclear Information System (INIS)

    Ivanov, Maxim V.; Talipov, Marat R.; Timerghazin, Qadir K.

    2015-01-01

    Atom-centered point charge (PC) model of the molecular electrostatics—a major workhorse of the atomistic biomolecular simulations—is usually parameterized by least-squares (LS) fitting of the point charge values to a reference electrostatic potential, a procedure that suffers from numerical instabilities due to the ill-conditioned nature of the LS problem. To reveal the origins of this ill-conditioning, we start with a general treatment of the point charge fitting problem as an inverse problem and construct an analytical model with the point charges spherically arranged according to Lebedev quadrature which is naturally suited for the inverse electrostatic problem. This analytical model is contrasted to the atom-centered point-charge model that can be viewed as an irregular quadrature poorly suited for the problem. This analysis shows that the numerical problems of the point charge fitting are due to the decay of the curvatures corresponding to the eigenvectors of LS sum Hessian matrix. In part, this ill-conditioning is intrinsic to the problem and is related to decreasing electrostatic contribution of the higher multipole moments, that are, in the case of Lebedev grid model, directly associated with the Hessian eigenvectors. For the atom-centered model, this association breaks down beyond the first few eigenvectors related to the high-curvature monopole and dipole terms; this leads to even wider spread-out of the Hessian curvature values. Using these insights, it is possible to alleviate the ill-conditioning of the LS point-charge fitting without introducing external restraints and/or constraints. Also, as the analytical Lebedev grid PC model proposed here can reproduce multipole moments up to a given rank, it may provide a promising alternative to including explicit multipole terms in a force field

  12. The regulatory framework of special medical group students' physical education: identifying the problem.

    Directory of Open Access Journals (Sweden)

    Mazur Valerij Anatol'evich

    2011-09-01

    Full Text Available The question of regulatory framework for special medical group students' physical education, and their physical condition in particular is elaborated. It is found that in the current program the identified question is missing, although the assessment of individual performance standards for the physical condition of the students was envisaged in the programs of 1977 and 1982. The need for such an assessment is indicated by the large number of Ukrainian and foreign pediatricians and specialists in therapeutic physical culture. At the same time the standards for assessing these indicators are not developed. It complicates the formation of positive motivation of students to regular classes, and does not promote their self-confidence, capabilities and effectiveness of monitoring the effectiveness of exercise in various forms. The findings suggest the need to define the optimal composition of the bulk of tests and functional tests to assess the physical condition of special medical group students with various diseases and to develop appropriate indicators for their evaluation standards.

  13. Problems associated with simulated light sensitometry for low-crossover medical x-ray films.

    Science.gov (United States)

    Haus, A G; Dickerson, R E

    1990-01-01

    Over the past ten years the evolution of medical x-ray films has been toward films with reduced intensifying-screen light crossover in order to reduce blur and obtain higher spatial resolution. For films with very low crossover, misleading and incorrect sensitometric data may be obtained for film contrast evaluation and processor control if a simulated light sensitometer with a single-sided, light-exposing device is used. Screen light exposures were made using an inverse square, intensity-scale sensitometer. Simulated light exposures were made using a widely used single-sided, simulated-light sensitometer commonly used for film processor quality control, and a new simulated-light sensitometer capable of producing either single- or double-sided sensitometric exposures. The films used included one single-emulsion film and three double-emulsion medical x-ray films with light-crossover values ranging from approximately 3% to 30%. Sensitometric data showed a significant distortion (bump) in the characteristic curve for the 3% light-crossover film exposed with the single-sided, simulated-light sensitometer.

  14. Medical student perceptions of factors affecting productivity of problem-based learning tutorial groups: does culture influence the outcome?

    Science.gov (United States)

    Das Carlo, Mandira; Swadi, Harith; Mpofu, Debbie

    2003-01-01

    The popularization of problem-based learning (PBL) has drawn attention to the motivational and cognitive skills necessary for medical students in group learning. This study identifies the effect of motivational and cognitive factors on group productivity of PBL tutorial groups. A self-administered questionnaire was completed by 115 students at the end of PBL tutorials for 4 themes. The questionnaire explored student perceptions about effect of motivation, cohesion, sponging, withdrawal, interaction, and elaboration on group productivity. We further analyzed (a) differences in perceptions between male and female students, (b) effect of "problems," and (c) effect of student progress over time on group productivity. There were linear relations between a tutorial group's success and the factors studied. Significant differences were noted between male and female student groups. Students and tutors need to recognize symptoms of ineffective PBL groups. Our study emphasizes the need to take into account cultural issues in setting ground rules for PBL tutorials.

  15. Evaluation of a Computerized Problem-Oriented Medical Record in a Hospital Department: Does it Support Daily Clinical Practice?

    DEFF Research Database (Denmark)

    Bossen, Claus

    2007-01-01

    with physicians and nurses (6 participants; duration 1½ hours) was conducted as well as 13 open-ended interviews (5 nurses, 2 social- and health assistants, 4 physicians, 2 IT-people; duration: 16-42 minutes; average of 29 minutes). The interviewees formed the core group using the CPOMRResults: Use of the CPOMR...... in the CPOMR. The study is base on participant observation and interviews. Before and during the test period the author attended project planning meetings, a training workshop in the use of the CPOMR for nurses and physicians and local coordination meetings. After the test, 1 focus-group discussion...... led to more time spent documenting clinical work, fragmentation of patient situation into separate problems, and lack of overview.Conclusion: The problem-oriented method for structuring a computerized medical record may provide a description of how physicians think or ought to think, but does...

  16. Medical students' preferences for problem-based learning in relation to culture and personality: a multicultural study.

    Science.gov (United States)

    Holen, Are; Manandhar, Kedar; Pant, Devendra S; Karmacharya, Biraj M; Olson, Linda M; Koju, Rajendra; Mansur, Dil I

    2015-07-19

    The aim of this study was to explore positive and negative preferences towards problem-based learning in relation to personality traits and socio-cultural context. The study was an anonymous and voluntary cross-sectional survey of medical students (N=449) in hybrid problem-based curricula in Nepal, Norway and North Dakota. Data was collected on gender, age, year of study, cohabitation and medical school. The PBL Preference Inventory identified students' positive and negative preferences in relation to problem-based learning; the personality traits were detected by the NEO Five-Factor Inventory. The determinants of the two kinds of preferences were analyzed by hierarchical multiple linear regressions. Positive preferences were mostly determined by personality; associations were found with the traits Extra-version, Openness to experience, Conscientiousness and Neuroticism; the first three are related to sociability, curiosity and orderliness, the last, to mental health. The learn-ing environments of such curricula may be supportive for some and unnerving for others who score high on Neuroticism. Negative preferences were rather determined by culture, but also, they correlated with Neuroticism and Conscientiousness. Negative preferences were lower among females and students living in symmetrical relationships. Some high on Conscientiousness disliked group work, and the negative correlation with Agreeableness indicated that less sociable students were not predisposed to this kind of learning activity. Preferences related to problem-based learning were significantly and independently determined both by personality traits and culture. More insights into the nature of students' preferences may guide aspects of curriculum modifications and the daily facilitation of groups.

  17. An efficient heuristic method for dynamic portfolio selection problem under transaction costs and uncertain conditions

    Science.gov (United States)

    Najafi, Amir Abbas; Pourahmadi, Zahra

    2016-04-01

    Selecting the optimal combination of assets in a portfolio is one of the most important decisions in investment management. As investment is a long term concept, looking into a portfolio optimization problem just in a single period may cause loss of some opportunities that could be exploited in a long term view. Hence, it is tried to extend the problem from single to multi-period model. We include trading costs and uncertain conditions to this model which made it more realistic and complex. Hence, we propose an efficient heuristic method to tackle this problem. The efficiency of the method is examined and compared with the results of the rolling single-period optimization and the buy and hold method which shows the superiority of the proposed method.

  18. An adaptive large neighborhood search heuristic for solving the reliable multiple allocation hub location problem under hub disruptions

    Directory of Open Access Journals (Sweden)

    S. K. Chaharsooghi

    2017-04-01

    Full Text Available The hub location problem (HLP is one of the strategic planning problems encountered in different contexts such as supply chain management, passenger and cargo transportation industries, and telecommunications. In this paper, we consider a reliable uncapacitated multiple allocation hub location problem under hub disruptions. It is assumed that every open hub facility can fail during its use and in such a case, the customers originally assigned to that hub, are either reassigned to other operational hubs or they do not receive service in which case a penalty must be paid. The problem is modeled as two-stage stochastic program and a metaheuristic algorithm based on the adaptive large neighborhood search (ALNS is proposed. Extensive computational experiments based on the CAB and TR data sets are conducted. Results show the high efficiency of the proposed solution method.

  19. The contribution of patient interviews to the identification of drug-related problems in home medication review.

    Science.gov (United States)

    Kwint, H F; Faber, A; Gussekloo, J; Bouvy, M L

    2012-12-01

    To determine to what extent patient interviews contribute to the identification of drug-related problems (DRPs) in home medication reviews, in terms of number, type and clinical relevance. We performed a cross-sectional study within the intervention arm of a randomized controlled trial. Patients were recruited from 10 Dutch community pharmacies. Patients were eligible if they were home-dwelling, aged 65 years and over and used five or more different drugs, including at least one cardiovascular or antidiabetic drug. The community pharmacist interviewed the patient at home about the medicines and identified potential DRPs in combination with medication and clinical records. This medication review was assessed and modified by an independent pharmacist reviewers' panel. Outcomes were the number and type of DRPs and recommendations and percentage of clinical relevant DRPs. Clinical relevance of DRPs was assessed by DRPs assigned a high priority, DRPs followed by recommendations for drug change and DRPs followed by implemented recommendations for drug change. A total of 1565 potential DRPs and recommendations (10 per patient).were identified for 155 patients (median age, 76 years; 54% women). Fifty-eight per cent of all recommendations involved a drug change; 27% of all DRPs were identified during patient interviews and 74% from medication and clinical records. Compared to DRPs identified from patient medication and clinical records, DRPs identified during patient interviews were more frequently assigned a high priority (OR = 1.8 [1.4-2.2]), were more frequently associated with recommendations for drug change (OR = 2.4 [1.9-3.1]) and were implemented recommendations for drug change (OR = 2.8 [2.1-3.7]). This study shows that more than a quarter of all DRPs were identified during patient interviews. DRPs identified during patient interviews were more frequently assigned a higher clinical relevance. © 2012 Blackwell Publishing Ltd.

  20. Contextual considerations in implementing problem-based learning approaches in a Brazilian medical curriculum: the UNAERP experience

    Directory of Open Access Journals (Sweden)

    Reinaldo Bulgarelli Bestetti

    2014-06-01

    Full Text Available Background: Despite being a well-established pedagogical approach in medical education, the implementation of problem-based learning (PBL approaches hinges not only on educational aspects of the medical curriculum but also on the characteristics and necessities of the health system and the medical labor market within which it is situated. Aim: To report our experiences implementing a PBL-based approach in a region of Brazil where: 1 all pre-university education and the vast majority of medical courses are based on traditional, lecture-based instructions; and 2 students’ career interests in primary care, arguably the prototypical PBL trainee, are heavily disfavored because of economics. Results: Brazilian guidelines require that clinical training take place during the last 2 years of the medical program and include intensive, supervised, inpatient and outpatient rotations in pediatrics, family medicine, obstetrics and gynecology, internal medicine, and surgery. Throughout the pre-clinical curriculum, then, students learn to deal with progressively more difficult and complex cases – typically through the use of PBL tutors in a primary care context. However, because of curricular time constraints in the clerkships, and students’ general preoccupation with specialty practice, the continuation of PBL-based approaches in the pre-clinical years – and the expansion of PBL into the clerkships – has become exceedingly difficult. Discussion and conclusion: Our experience illustrates the importance of context (both cultural and structural in implementing certain pedagogies within one Brazilian training program. We plan to address these barriers by: 1 integrating units, whenever possible, within a spiral curriculum; 2 introducing real patients earlier in students’ pre-clinical coursework (primarily in a primary care setting; and 3 using subject experts as PBL tutors to better motivate students.

  1. Contextual considerations in implementing problem-based learning approaches in a Brazilian medical curriculum: the UNAERP experience.

    Science.gov (United States)

    Bestetti, Reinaldo Bulgarelli; Couto, Lucélio Bernardes; Romão, Gustavo Salata; Araújo, Guilherme Teixeira; Restini, Carolina Baraldi A

    2014-01-01

    Despite being a well-established pedagogical approach in medical education, the implementation of problem-based learning (PBL) approaches hinges not only on educational aspects of the medical curriculum but also on the characteristics and necessities of the health system and the medical labor market within which it is situated. To report our experiences implementing a PBL-based approach in a region of Brazil where: 1) all pre-university education and the vast majority of medical courses are based on traditional, lecture-based instructions; and 2) students' career interests in primary care, arguably the prototypical PBL trainee, are heavily disfavored because of economics. Brazilian guidelines require that clinical training take place during the last 2 years of the medical program and include intensive, supervised, inpatient and outpatient rotations in pediatrics, family medicine, obstetrics and gynecology, internal medicine, and surgery. Throughout the pre-clinical curriculum, then, students learn to deal with progressively more difficult and complex cases--typically through the use of PBL tutors in a primary care context. However, because of curricular time constraints in the clerkships, and students' general preoccupation with specialty practice, the continuation of PBL-based approaches in the pre-clinical years--and the expansion of PBL into the clerkships--has become exceedingly difficult. Our experience illustrates the importance of context (both cultural and structural) in implementing certain pedagogies within one Brazilian training program. We plan to address these barriers by: 1) integrating units, whenever possible, within a spiral curriculum; 2) introducing real patients earlier in students' pre-clinical coursework (primarily in a primary care setting); and 3) using subject experts as PBL tutors to better motivate students.

  2. Problems of communicative competence in multi-cultural medical encounters in South African health services.

    Science.gov (United States)

    Grant, T

    2006-11-01

    Research in health communication shows communicative competence to be an important aspect of successful health-care. Definitions of competence involve more than the participants, however; the position and status of these participants in terms of the medical hierarchy and accepted paradigm, the language of choice, educational levels and a host of other variables affect relationships and perceptions of competence. This article grapples with a number of issues that impact on communicative competence in the health-care professions, given the multi-lingual and -cultural society within South Africa as well as emerging shifts that foreground this debate. In particular, the thorny question around language use, the hegemonies of the past regarding a dominant lingua franca and subsequent issues involving translation and interpretation are discussed.

  3. Future perspective of medical radionuclide production and related educational problems in developing countries

    International Nuclear Information System (INIS)

    Uenak, Turan

    1999-01-01

    The radionuclide applications are continuously escalation in nuclear medicine. Especially, the development of positron emission tomography (PET) technique has increased very rapidly the use of short-lived radioisotopes in this field, and this has caused the development of compact medical cyclotrons. About 30 cyclotrons operated in the world wide are actually found in the developing countries. In parallel of this progress, the basic nuclear sciences, especially nuclear chemistry and radiopharmaceutical chemistry will probably very important fields in the next new century for nuclear science and technology applications in health care sector. For this reason, the developing countries should eventually revise their academic educational and training programs aiming to ensure the formation of qualified basic nuclear scientists such as nuclear chemist, nuclear physicist, radiopharmacist, etc. (author)

  4. Emergency medical service systems research: problems of the past, challenges of the future.

    Science.gov (United States)

    Spaite, D W; Criss, E A; Valenzuela, T D; Guisto, J

    1995-08-01

    Out-of-hospital emergency care was designed around the concept of a system of interrelated events that combine to offer a patient the best care possible outside the hospital. However, in contrast to the actual operations of emergency medical service (EMS) systems, research has not typically used systems-based models as the method for evaluation. In this discussion we outline the weaknesses of component-based research models in EMS evaluation and attempt to provide a "systems-analysis" framework that can be used for future research. Incorporation of this multidiscipline approach into EMS research is essential if there is to be any hope of finding answers to many of the important questions that remain in the arena of out-of-hospital health care.

  5. The radioiodine problem following the Chernobyl accident: ecology, dosimetry and medical effects

    International Nuclear Information System (INIS)

    Zvonova, I.A.

    1991-01-01

    Following the Chernobyl accident radioisotopes of iodine constituted the main dose-forming factor among the people who stayed on in the radioactively contaminated areas, and in a number of places the effective doses to the thyroid gland were up to two orders of magnitude higher than the whole-body dose stemming from uniform internal and external irradiation. We consider the mechanisms involved in the radioiodine contribution to the doses in the human organism, depending on intake path, life style and social and ecological factors. We illustrate, by means of examples, thyroid gland dose distribution for various age groups in the population, and discuss the medical effects and predict the long-term risks for the population of exposure to radioisotopes of iodine. (author)

  6. 75 FR 74063 - Supplemental Funding Under the Food and Drug Administration's Convener of Active Medical Product...

    Science.gov (United States)

    2010-11-30

    ... dissemination of Patient Medication Information (PMI). With this FOA, FDA proposes to further expand the scope... paragraphs. Patient Medication Information (PMI) To be able to use prescription medications safely, consumers... Guides. Such changes to the delivery of PMI may require changes to the Federal Food, Drug, and Cosmetics...

  7. Problems of training chemical engineers of the European model under Bologna process

    Directory of Open Access Journals (Sweden)

    S. Rakhmadiyeva

    2012-03-01

    Full Text Available Article deals with problems of training for chemical and petrochemical industries in the western three-stage model of the Bologna process and curriculum development of educational programs in chemical engineering in the framework of the EU Tempus.

  8. About the linear-quadratic regulator problem under a fractional Brownian perturbation and complete observation

    OpenAIRE

    Kleptsyna, Marina; Le Breton, Alain; Viot, Michel

    2002-01-01

    In this report we solve the basic fractional analogue of the classical linear-quadratic Gaussian regulator problem in continuous-time. For a completely observable controlled linear system driven by a fractional Brownian motion, we describe explicitely the optimal control policy which minimizes a quadratic performance criterion.

  9. What underlies succesful word problem solving: A path analysis in sixth grade students

    NARCIS (Netherlands)

    Boonen, A.J.H.; van der Schoot, M.; van Wesel, F.; de Vries, M.H.; Jolles, J.

    2013-01-01

    Two component skills are thought to be necessary for successful word problem solving: (1) the production of visual-schematic representations and (2) the derivation of the correct relations between the solution-relevant elements from the text base. The first component skill is grounded in the

  10. CDC Vital Signs: Binge Drinking a Serious, Under-Recognized Problem Among Women and Girls

    Science.gov (United States)

    ... frequently – about 3 times a month – and have about 6 drinks per binge. There are effective actions communities can take to prevent binge drinking among women and girls. *Binge drinking for women is defined as consuming 4 ormore alcohol drinks (beer, wine, or liquor) on an occasion. Problem Drinking too ...

  11. Numerical Modeling of Inverse Problems under Uncertainty for Damage Detection in Aircraft Structures

    Science.gov (United States)

    2013-08-01

    the nature of the physics involved, from the point of view of the inverse problem, the direct model is only a “black box ” to obtain numerical...Campos, Brasil . As results directly related to this research, several publications and monographs were published and /or are being prepared, as

  12. Modeling and Optimization of the Multiobjective Stochastic Joint Replenishment and Delivery Problem under Supply Chain Environment

    Directory of Open Access Journals (Sweden)

    Lin Wang

    2013-01-01

    Full Text Available As a practical inventory and transportation problem, it is important to synthesize several objectives for the joint replenishment and delivery (JRD decision. In this paper, a new multiobjective stochastic JRD (MSJRD of the one-warehouse and n-retailer systems considering the balance of service level and total cost simultaneously is proposed. The goal of this problem is to decide the reasonable replenishment interval, safety stock factor, and traveling routing. Secondly, two approaches are designed to handle this complex multi-objective optimization problem. Linear programming (LP approach converts the multi-objective to single objective, while a multi-objective evolution algorithm (MOEA solves a multi-objective problem directly. Thirdly, three intelligent optimization algorithms, differential evolution algorithm (DE, hybrid DE (HDE, and genetic algorithm (GA, are utilized in LP-based and MOEA-based approaches. Results of the MSJRD with LP-based and MOEA-based approaches are compared by a contrastive numerical example. To analyses the nondominated solution of MOEA, a metric is also used to measure the distribution of the last generation solution. Results show that HDE outperforms DE and GA whenever LP or MOEA is adopted.

  13. Quality of medication use in primary care - mapping the problem, working to a solution: a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Willson Alan

    2009-09-01

    be routine monitoring of adherence, clinical effectiveness and hospital admissions. Conclusion By adopting the whole system approach from a management perspective we have found where failures in quality occur in medication use in primary care in the UK, and where weaknesses occur in the associated evidence base. Quality management approaches have allowed us to develop a coherent change and research agenda in order to tackle these, so far, fairly intractable problems.

  14. Prevalence and incidence of mental health problems among Dutch medical students and the study-related and personal risk factors: a longitudinal study.

    Science.gov (United States)

    Borst, Jorien M; Frings-Dresen, Monique H W; Sluiter, Judith K

    2016-11-01

    A high prevalence of mental health problems (i.e. depression and/or anxiety) has been found in medical students in comparison with the general population. Therefore, the objective was first to study the prevalence and 1-year incidence of symptoms of depression, anxiety and any mental health problems among Dutch medical students and, second, to study which study-related and personal factors present a risk of these mental health problems. A 1-year prospective longitudinal study was performed among medical students of two medical faculties in the Netherlands (n=951). Health problems and study-related and personal factors were measured with an online questionnaire. Mental health problems were assessed by depression and/or anxiety symptoms (BSI-DEP and BSI-ANG). Univariate and multivariate hierarchical logistic regression analyses were performed to examine which of the study-related and personal factors predict mental health problems. At follow-up, 36%, 28% and 48% of the medical students reported symptoms of depression, anxiety and mental health problems, respectively. The incidence between 2010 and 2011 for depression was 20%, 17% for anxiety and 25% for mental health problems. Students who are worried about their own health during medical education are at an increased risk of future mental health problems (OR 2.0 [1.3-2.9], p=0.00). Excessive drinking behavior is a protective factor in this study (OR 0.7 [0.5-0.9], p=0.02). This study shows that only two out of nine factors are significantly associated with mental health problems among Dutch medical students, one risk factor and one protective factor.

  15. Indian medical students’ perspectives on problem-based learning experiences in the undergraduate curriculum: One size does not fit all

    Directory of Open Access Journals (Sweden)

    Bijli Nanda

    2013-10-01

    Full Text Available Purpose: Problem-based learning (PBL is a well-established method for facilitating the learning of basic science concepts in the context of clinical cases. Relevant evidence is lacking regarding PBL’s effectiveness and acceptability as perceived by students accustomed to classical traditional teaching in India. Hence, this study gathered students’ opinions on PBL versus Traditional teaching methods to generate a foundation for institutional policymaking and ultimately, changes in the policy of regulatory bodies. Methods: A total of 773 first year medical students admitted from 2007-2010 in Kasturba Medical College Manipal, Manipal University, India were asked to respond to a 15-item questionnaire evaluating their preferences for PBL or traditional methods such as lectures after undergoing a systematically conducted PBL session in physiology. Their responses were analyzed with an unpaired t-test. Their comments were also collected. Results: PBL scored significantly higher for most items in the questionnaire for “learning efficiency” and “student-teacher relationship”. The students’ comments highlighted the importance of a trained tutor/facilitator to enhance the learning process. Conclusion: Our students are willing to adapt to the PBL method, although they recognize certain benefits of traditional pedagogy. For learning efficiency and the student-teacher relationship, the students feel that neither method holds an advantage. We recommend that the future medical curriculum in India be a hybrid form of PBL and traditional methods with specific training on the unfamiliar PBL approach for both faculty and students.

  16. Brazilian medical students’ perceptions of expert versus non-expert facilitators in a (non problem-based learning environment

    Directory of Open Access Journals (Sweden)

    Lucélio B. Couto

    2015-04-01

    Full Text Available Background: In problem-based learning (PBL, the facilitator plays an important role in guiding the student learning process. However, although content expertise is generally regarded as a useful but non-essential prerequisite for effective PBL facilitation, the perceived importance of content knowledge may be subject to cultural, contextual, and/or experiential influences. Aim: We sought to examine medical students’ perceptions of subject-matter expertise among PBL facilitators in a region of the world (Brazil where such active learning pedagogies are not widely used in university or pre-university settings. Results: Of the 252 Brazilian medical students surveyed, significantly (p≤0.001 greater proportions viewed content expert facilitators to be more effective than their non-expert counterparts at building knowledge (95% vs. 6%, guiding the learning process (93% vs. 7%, achieving cognitive learning (92% vs. 18%, generating learning goals (87% vs. 15%, and motivating self-study (80% vs. 15%. Discussion/conclusion: According to Brazilian medical students, subject-matter expertise among PBL facilitators is essential to the learning process. We believe this widespread perception is due, in large part, to the relative lack of prior educational exposure to such pedagogies.

  17. Brazilian medical students' perceptions of expert versus non-expert facilitators in a (non) problem-based learning environment.

    Science.gov (United States)

    Couto, Lucélio B; Bestetti, Reinaldo B; Restini, Carolina B A; Faria, Milton; Romão, Gustavo S

    2015-01-01

    In problem-based learning (PBL), the facilitator plays an important role in guiding the student learning process. However, although content expertise is generally regarded as a useful but non-essential prerequisite for effective PBL facilitation, the perceived importance of content knowledge may be subject to cultural, contextual, and/or experiential influences. We sought to examine medical students' perceptions of subject-matter expertise among PBL facilitators in a region of the world (Brazil) where such active learning pedagogies are not widely used in university or pre-university settings. Of the 252 Brazilian medical students surveyed, significantly (p≤0.001) greater proportions viewed content expert facilitators to be more effective than their non-expert counterparts at building knowledge (95% vs. 6%), guiding the learning process (93% vs. 7%), achieving cognitive learning (92% vs. 18%), generating learning goals (87% vs. 15%), and motivating self-study (80% vs. 15%). According to Brazilian medical students, subject-matter expertise among PBL facilitators is essential to the learning process. We believe this widespread perception is due, in large part, to the relative lack of prior educational exposure to such pedagogies.

  18. Qat use in North Yemen and the problem of addiction: a study in medical anthropology.

    Science.gov (United States)

    Kennedy, J G; Teague, J; Fairbanks, L

    1980-12-01

    Travelers to North Yemen nearly invariably report that Yemeni people are universally addicted to the drug qat and that the problems of the country are related to this. On the other hand, the majority of Yemenis claim that qat is not only harmless, but that it has many virtues. After describing the chemistry of the drug and the customs of use, this paper addresses the question of the concept of addiction in terms of data gathered during an extensive field study of qat use. Questions of latency, tolerance and availability are discussed, while particular attention and data are devoted to an examination of the "analgesic hypothesis." It is concluded that a more complex theory is needed to deal with drug "dependencies" and that social and cultural perspectives must be added to concepts of the physiological and psychological effects of drugs if progress is to be made toward understanding institutional drug use such as is found with regard to qat.

  19. Health payment-induced poverty under China's New Cooperative Medical Scheme in rural Shandong.

    Science.gov (United States)

    Sun, Xiaoyun; Sleigh, Adrian C; Carmichael, Gordon A; Jackson, Sukhan

    2010-09-01

    To measure the incidence and severity of health payment-induced poverty of rural households under the New Cooperative Medical Scheme (NCMS) in rural Shandong, China. We collected primary data from a household survey to identify catastrophic health payments and measure associated health payment-induced poverty in a county of Shandong province. From a stratified random cluster sample of 3101 households, 375 households that might be at risk of catastrophic payments were identified and interviewed. A validity test of the screening method was conducted, from which we obtained the adjusted total number of households with catastrophic payments in the sample of 3101. The health payment-induced poverty incidence and severity were compared without and with NCMS reimbursements. Before the NCMS intervention, 5.06% of the sample households fell below the national poverty line due to health payments in 2004, compared with 4.03% after reimbursements. With NCMS reimbursements, the health payment-induced poverty gap of those households still remaining below the Chinese national poverty line dropped by 19.2% to an average of 977.2 Yuan. Out-of-pocket health payments remain a severe burden for rural households. Financial protection from the NCMS was limited.

  20. Modified task-based learning program promotes problem-solving capacity among Chinese medical postgraduates: a mixed quantitative survey.

    Science.gov (United States)

    Tian, Yanping; Li, Chengren; Wang, Jiali; Cai, Qiyan; Wang, Hanzhi; Chen, Xingshu; Liu, Yunlai; Mei, Feng; Xiao, Lan; Jian, Rui; Li, Hongli

    2017-09-07

    Despite great advances, China's postgraduate education faces many problems, for example traditional lecture-based learning (LBL) method provides fewer oppotunities to apply knowledge in a working situation. Task-based learning (TBL) is an efficient strategy for increasing the connections among skills, knowledge and competences. This study aimed to evaluate the effect of a modified TBL model on problem-solving abilities among postgraduate medical students in China. We allocated 228 first-year postgraduate students at Third Military Medical University into two groups: the TBL group and LBL group. The TBL group was taught using a TBL program for immunohistochemistry. The curriculum consisted of five phases: task design, self-learning, experimental operations, discussion and summary. The LBL group was taught using traditional LBL. After the course, learning performance was assessed using theoretical and practical tests. The students' preferences and satisfaction of TBL and LBL were also evaluated using questionnaires. There were notable differences in the mean score rates in the practical test (P 80) in the TBL group was higher than that in the LBL group. We observed no substantial differences in the theoretical test between the two groups (P > 0.05). The questionnaire results indicated that the TBL students were satisfied with teaching content, teaching methods and experiment content. The TBL program was also beneficial for the postgraduates in completing their research projects. Furthermore, the TBL students reported positive effects in terms of innovative thinking, collaboration, and communication. TBL is a powerful educational strategy for postgraduate education in China. Our modified TBL imparted basic knowledge to the students and also engaged them more effectively in applying knowledge to solve real-world issues. In conclusion, our TBL established a good foundation for the students' future in both medical research and clinical work.

  1. [Health insurance discount contracts: problems and risks for the general practitioner in the medical care of patients with chronic illness].

    Science.gov (United States)

    Leutgeb, R; Mahler, C; Laux, G; Weschnetz, Artenetz; Szecsenyi, J

    2009-01-01

    The German federal Health Insurance law to strengthen competition between the pharmaceutical companies commits pharmacies to hand out drugs from discount contract drug suppliers of a patient's health insurance company. Thus patients are confronted with constantly changing drug packets. This study aimed at exploring whether patients have been properly informed about the new discount contracts and if they have experienced changes and problems in their long- term medications. Between May and June 2008 male and female patients older than 50 years who had a statutory health insurance and had been diagnosed with coronary heart disease for at least one year answered a standardized questionnaire filled in by doctors' assistants or general practitioners in the doctors' network "Weschnitztal". Of the 188 patients participated in this study 63,8% were informed about health insurance discount contracts. 31,3% of the patients reported that a positive effect due to the discount contracts was that they were discharged from paying the drug prescription fee, 22,2% mentioned that cost saving for the health insurance could also be positive. 120 patients (63,8%) knew that the names of their long-term drugs could change.101 of the questioned patients (53,7%) identified a change in their long-term drugs, 51,5% felt insecure about the permanent changes. 21,7% experienced adverse e effects due to the new drugs. 19% of the patients had serious problems regarding medication intake. This study demonstrates that the information which patients have on the new health insurance law is not adequate enough. Many of them felt insecure because of the changes of long-term medications. One fifth of the patients reported errors in their drug intake or their confusion about their drugs. There is a high risk that these circumstances may trigger further diseases or complications. The cost savings as intended by the health insurance companies may therefore not be achieved by discount contracts.

  2. Anti-plane problem analysis for icosahedral quasicrystals under shear loadings

    International Nuclear Information System (INIS)

    Li Wu; Chai Yu-Zhen

    2014-01-01

    The present paper is concerned with the longitudinal shear elasticity of three-dimensional icosahedral quasicrystals. By virtue of the Dugdale hypothesis along with the method of complex potential theory, it involves two defect problems of the icosahedral quasicrystals. The first one is the calculation of stress intensity factors and the size of the cohesive force zone in a half-infinite crack. Meanwhile, the crack tip tearing displacements can be exactly derived. The other is the demonstration of the generalized stress intensity factors induced by a sharp V-notch as an extension of a crack. The generalized E-integral around the notch tip gives the energy release rate when the V-notch degenerates into a crack. Apart from their own usefulness in carrying out some simplified crack analyses, the results obtained in this work can particularly serve as a basis for fracture mechanics of anti-plane defect problems of icosahedral quasicrystals. (condensed matter: structural, mechanical, and thermal properties)

  3. Anti-plane problem analysis for icosahedral quasicrystals under shear loadings

    Science.gov (United States)

    Li, Wu; Chai, Yu-Zhen

    2014-11-01

    The present paper is concerned with the longitudinal shear elasticity of three-dimensional icosahedral quasicrystals. By virtue of the Dugdale hypothesis along with the method of complex potential theory, it involves two defect problems of the icosahedral quasicrystals. The first one is the calculation of stress intensity factors and the size of the cohesive force zone in a half-infinite crack. Meanwhile, the crack tip tearing displacements can be exactly derived. The other is the demonstration of the generalized stress intensity factors induced by a sharp V-notch as an extension of a crack. The generalized E-integral around the notch tip gives the energy release rate when the V-notch degenerates into a crack. Apart from their own usefulness in carrying out some simplified crack analyses, the results obtained in this work can particularly serve as a basis for fracture mechanics of anti-plane defect problems of icosahedral quasicrystals.

  4. Action minimizers under topological constraints in the planar equal-mass four-body problem

    Science.gov (United States)

    Yan, Duokui

    2018-04-01

    It is shown that in the planar equal-mass four-body problem, there exist two sets of action minimizers connecting two planar boundary configurations with fixed symmetry axes and specific order constraints: a double isosceles configuration and an isosceles trapezoid configuration, while order constraints are introduced on the boundary configurations. By applying the level estimate method, these minimizers are shown to be collision-free and they can be extended to two new sets of periodic or quasi-periodic orbits.

  5. A Hybrid Optimization Method for Solving Bayesian Inverse Problems under Uncertainty.

    Directory of Open Access Journals (Sweden)

    Kai Zhang

    Full Text Available In this paper, we investigate the application of a new method, the Finite Difference and Stochastic Gradient (Hybrid method, for history matching in reservoir models. History matching is one of the processes of solving an inverse problem by calibrating reservoir models to dynamic behaviour of the reservoir in which an objective function is formulated based on a Bayesian approach for optimization. The goal of history matching is to identify the minimum value of an objective function that expresses the misfit between the predicted and measured data of a reservoir. To address the optimization problem, we present a novel application using a combination of the stochastic gradient and finite difference methods for solving inverse problems. The optimization is constrained by a linear equation that contains the reservoir parameters. We reformulate the reservoir model's parameters and dynamic data by operating the objective function, the approximate gradient of which can guarantee convergence. At each iteration step, we obtain the relatively 'important' elements of the gradient, which are subsequently substituted by the values from the Finite Difference method through comparing the magnitude of the components of the stochastic gradient, which forms a new gradient, and we subsequently iterate with the new gradient. Through the application of the Hybrid method, we efficiently and accurately optimize the objective function. We present a number numerical simulations in this paper that show that the method is accurate and computationally efficient.

  6. Modeling and solving the dynamic patient admission scheduling problem under uncertainty.

    Science.gov (United States)

    Ceschia, Sara; Schaerf, Andrea

    2012-11-01

    Our goal is to propose and solve a new formulation of the recently-formalized patient admission scheduling problem, extending it by including several real-world features, such as the presence of emergency patients, uncertainty in the length of stay, and the possibility of delayed admissions. We devised a metaheuristic approach that solves both the static (predictive) and the dynamic (daily) versions of this new problem, which is based on simulated annealing and a complex neighborhood structure. The quality of our metaheuristic approach is compared with an exact method based on integer linear programming. The main outcome is that our method is able to solve large cases (up to 4000 patients) in a reasonable time, whereas the exact method can solve only small/medium-size instances (up to 250 patients). For such datasets, the two methods obtain results at the same level of quality. In addition, the gap between our (dynamic) solver and the static one, which has all information available in advance, is only 4-5%. Finally, we propose (and publish on the web) a large set of new instances, and we discuss the impact of their features in the solution process. The metaheuristic approach proved to be a valid search method to solve dynamic problems in the healthcare domain. Copyright © 2012 Elsevier B.V. All rights reserved.

  7. Fractionating the neural correlates of individual working memory components underlying arithmetic problem solving skills in children.

    Science.gov (United States)

    Metcalfe, Arron W S; Ashkenazi, Sarit; Rosenberg-Lee, Miriam; Menon, Vinod

    2013-10-01

    Baddeley and Hitch's multi-component working memory (WM) model has played an enduring and influential role in our understanding of cognitive abilities. Very little is known, however, about the neural basis of this multi-component WM model and the differential role each component plays in mediating arithmetic problem solving abilities in children. Here, we investigate the neural basis of the central executive (CE), phonological (PL) and visuo-spatial (VS) components of WM during a demanding mental arithmetic task in 7-9 year old children (N=74). The VS component was the strongest predictor of math ability in children and was associated with increased arithmetic complexity-related responses in left dorsolateral and right ventrolateral prefrontal cortices as well as bilateral intra-parietal sulcus and supramarginal gyrus in posterior parietal cortex. Critically, VS, CE and PL abilities were associated with largely distinct patterns of brain response. Overlap between VS and CE components was observed in left supramarginal gyrus and no overlap was observed between VS and PL components. Our findings point to a central role of visuo-spatial WM during arithmetic problem-solving in young grade-school children and highlight the usefulness of the multi-component Baddeley and Hitch WM model in fractionating the neural correlates of arithmetic problem solving during development. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. A problem-based approach to teaching research methodology to medical graduates in Iran

    Directory of Open Access Journals (Sweden)

    Mehrdad Jalalian Hosseini

    2009-08-01

    Full Text Available Physicians are reticent to participate in research projects for avariety of reasons. Facilitating the active involvement ofdoctors in research projects is a high priority for the IranianBlood Transfusion Organization (IBTO. A one-month trainingcourse on research methodology was conducted for a groupof physicians in Mashhad, in northeast Iran. The participantswere divided in ten groups. They prepared a researchproposal under the guidance of a workshop leader. Thequality of the research proposals, which were prepared by allparticipants, went beyond our expectations. All of theresearch proposals were relevant to blood safety. In this briefreport we describe our approach.

  9. Composition of emergency medical services teams and the problem of specialisation of emergency medical services physicians in the opinions of occupationally active paramedics

    Directory of Open Access Journals (Sweden)

    Dorota Rębak

    2015-01-01

    Full Text Available Introduction: Emergency medicine includes prevention, prehospital care, specialised treatment, rehabilitation, and education. Aim of the research: The objective of the analysis was to determine the opinions of paramedics concerning the problem of the composition of emergency medical services (EMS teams and specialisation of EMS system physicians according to their education level and sense of coherence. Material and methods: The study was conducted among 336 occupationally active paramedics working in EMS teams delivering prehospital care in selected units in Poland. The study was conducted at Ambulance Stations and in Hospital Emergency Departments, which within their structure had an out-of-hospital EMS team. The study was conducted by the method of a diagnostic survey, and the research instrument was the Orientation to Life Questionnaire SOC-29 and a questionnaire designed by the author. Results: The respondents who had licentiate education relatively more frequently indicated paramedics with licentiate education level as persons most suitable to undertake medical actions (26.32% rather than physicians (21.05%. Paramedics with 2-year post-secondary school education relatively more often mentioned physicians (33.07% than those with licentiate education (17.32%. As many as 89.58% of the paramedics reported the need for a physician in the composition of the EMS team delivering prehospital care, while only 10.42% of them expressed an opinion that there should be teams composed of paramedics only. According to 30.65% of respondents, EMS team delivering prehospital care should include a physician with the specialty in emergency medicine, whereas 8.04% of respondents reported the need for a physician, irrespective of specialisation. However, 42.56% of the paramedics expressed an opinion that a physician is needed only in a specialist team with a specialisation in emergency medicine. The opinions of the paramedics concerning the need for a

  10. Effect of problem based approach on medical students’ learning satisfaction and understanding in the histology course topics

    Directory of Open Access Journals (Sweden)

    MJ Rezaie

    2013-05-01

    Full Text Available Background and purpose: Problem-based learning (PBL is a term used within education for a range of teaching approaches that encourage students to learn through the structured exploration of a problem. Histology comes early in the curriculum and the medical students seem unable to see the value of the content, they don't appear to be motivated to learn the content. This project used PBL to help the students make the connection between the content and clinical aspects.Methods: Thirty six undergraduate medical students, 22 female and 14 male, enrolled in the histology course during the spring semester of 2008. A survey which collected information relative to gender, course load, and workload and study time was used. The subjects were accessory glands of digestive system histology. The course is designed into four units: tree units of salivary glands, pancreas and gall bladder histology, were presented in a traditional lecture format; the fourth unit, liver was presented in a problem-based format that used clinical practice. Assessment focused on three issues of a. student engagement, b. lesson assessment in terms of clarity, interest and usefulness and c. student understanding.Results: Student comments collected during PBL class periods indicate engagement in the topic. In PBL method of teaching most of responses were consistent with the aim of teaching but in traditional classes few responses relate to the objectives at hand. Students had more active partnership in PBL class. Students found PBL class more useful, interesting and clear in terms of subject material than traditional method.Conclusions: In this project student comments collected during PBL class periods indicated more engagement in the topic. Students’ understanding of material were significantly higher and students’ partnership in PBL class was more than traditional classes.Keywords: PBL,HISTOLOGY, STUDENT PARTICIPATION

  11. [Structure, organization and capacity problems in emergency medical services, emergency admission and intensive care units].

    Science.gov (United States)

    Dick, W

    1994-01-01

    clinical pictures. Cost effectiveness is clearly in favor of emergency medicine. Future developments will be characterized by the consequences of new health care legislation and by effects of financial stringencies on the emergency medical services.

  12. Design and Development of Virtual Reality Simulation for Teaching High-Risk Low-Volume Problem-Prone Office-Based Medical Emergencies

    Science.gov (United States)

    Lemheney, Alexander J.

    2014-01-01

    Physicians' offices are not the usual place where emergencies occur; thus how staff remains prepared and current regarding medical emergencies presents an ongoing challenge for private practitioners. The very nature of low-volume, high-risk, and problem-prone medical emergencies is that they occur with such infrequency it is difficult for staff to…

  13. Effects of problem-based learning by learning style in medical education.

    Science.gov (United States)

    Chae, Su-Jin

    2012-12-01

    Although problem-based learning (PBL) has been popularized in many colleges, few studies have analyzed the relationship between individual differences and PBL. The purpose of this study was to analyze the relationship between learning style and the perception on the effects of PBL. Grasha-Riechmann Student Learning Style Scales was used to assess the learning styles of 38 students at Ajou University School of Medicine who were enrolled in a respiratory system course in 2011. The data were analyzed by regression analysis and Spearman correlation analysis. By regression analysis, dependent beta=0.478) and avoidant styles (beta=-0.815) influenced the learner's satisfaction with PBL. By Spearman correlation analysis, there was significant link between independent, dependent, and avoidant styles and the perception of the effect of PBL. There are few significant relationships between learning style and the perception of the effects of PBL. We must determine how to teach students with different learning styles and the factors that influence PBL.

  14. PREMATURE BIRTH AS A MEDICAL AND SOCIAL HEALTHCARE PROBLEM. PART 2

    Directory of Open Access Journals (Sweden)

    E. S. Sakharova

    2017-01-01

    Full Text Available Morbidity and mortality, like a frequency of long-term unfavourable psychomotor developmental outcomes is in inverse relationship with gestational age and birth weight. Now scientists give attention to the risk factors — the infection, preeclampsia, smoking, etc., to look for prevention of premature birth. The outcome of premature baby depends on the birth weight; the methodof labor and the hospital technical support also have an influence. The frequency of neurological impairments — infantile cerebral palsy, visual and hearing disorders, and probability of severe bronchopulmonary dysplasia are also in inverse relationship with gestational age and birth weight. Last decade there are many scientists give attention to the cognitive deficit and behavior disorders in adolescents, born premature. Premature infants with extremely low birth weight have developmental disorders at 8-13%. Not all of cognitive and behavioral problems have symptoms in the first years of life, but have delayed unfavourable effects. The severity of cognitive deficit not always corresponds with structural impairments of brain, detected in functional studies of premature baby in the first year of life.  

  15. ["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

    subjectively experienced pain-related impairment using the Pain Disability Index). Scores for subjective satisfaction with job-related information, medical care, socio-medical assessment, and the overall benefits of rehabilitation were significantly higher in the intervention group than in the control group. IG subjects moreover were better able to use the rehabilitation measure to clarify their occupational situation and exhibited significantly greater improvement of socio-medically relevant knowledge. Age proved to be an important predictor of change in a patient's subjective prognosis for gainful employment (SPE): A positive change in SPE was observed in both groups in subjects under 50, in those aged 50 and older, however, only in the intervention group. No differences between the two groups were observed in terms of functional and emotional parameters (e. g., disability through pain, anxiety, and depression). A total of 60% of the subjects received a recommendation at discharge to apply for vocational reintegration services, the proportion however was significantly higher in the IG. The Vocational Perspective programme met the patients' high demand for information on relevant socio-medical facilities and services regarding career change and facilitated communication between the doctor and patient by creating greater transparency. The improvement of subjective prognosis for gainful employment observed in the subgroup of older patients indicates that specialized interventions are needed in precisely this disadvantaged group in order to improve their own vocational expectations and thus to improve their chances of reintegration into work life. The high rate of recommendations to apply for vocational reintegration services suggests that rehabilitation teams already have a high awareness of job-related problems even under “usual care” conditions. © Georg Thieme Verlag KG Stuttgart · New York.

  16. What is the problem with medically unexplained symptoms for GPs? A meta-synthesis of qualitative studies.

    Science.gov (United States)

    Johansen, May-Lill; Risor, Mette Bech

    2017-04-01

    To gain a deeper understanding of challenges faced by GPs when managing patients with MUS. We used meta-ethnography to synthesize qualitative studies on GPs' perception and management of MUS. The problem with MUS for GPs is the epistemological incongruence between dominant disease models and the reality of meeting patients suffering from persistent illness. GPs have used flexible approaches to manage the situation, yet patients and doctors have had parallel negative experiences of being stuck, untrustworthy and helpless. In the face of cognitive incongruence, GPs have strived to achieve relational congruence with their patients. This has led to parallel positive experiences of mutual trust and validation. With more experience, some GPs seem to overcome the incongruences, and later studies point towards a reframing of the MUS problem. For GPs, the challenge with MUS is most importantly at an epistemological level. Hence, a full reframing of the problem of MUS for GPs (and for patients) implies broad changes in basic medical knowledge and education. Short-term: Improve management of patients with MUS by transferring experience-based, reality-adjusted knowledge from senior GPs to juniors. Long-term: Work towards new models of disease that integrate knowledge from all relevant disciplines. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. Review of Medical Malpractice Issues in Malaysia under Tort Litigation System

    Science.gov (United States)

    Hambali, Siti Naaishah; Khodapanahandeh, Solmaz

    2014-01-01

    Medical malpractice cases are a matter of much concern in many countries including Malaysia where several cases caught the attention of the public and authorities. Although comprehensive annual statistics on medical negligence claims are not available in Malaysia since such data are not collected systematically in this country there are indications of an upward trend. Medical malpractice cases have been publicized by the media, academic researchers and in government annual reports prompting government policy makers, oversight agencies and the medical profession itself to take appropriate action. The increasing dissatisfaction with the current tort litigation system requires exploring alternatives and new approaches for handling medical malpractice cases. This study aims to examine the difficulties inherent in the tort system in Malaysia for solving medical malpractice claims and evaluates the structure of this system from the perspective of effectiveness, fairness, compensation, accessibility, and accountability. PMID:24999124

  18. A review of medical malpractice issues in Malaysia under tort litigation system.

    Science.gov (United States)

    Hambali, Siti Naaishah; Khodapanahandeh, Solmaz

    2014-04-07

    Medical malpractice cases are a matter of much concern in many countries including Malaysia where several cases caught the attention of the public and authorities. Although comprehensive annual statistics on medical negligence claims are not available in Malaysia since such data are not collected systematically in this country there are indications of an upward trend. Medical malpractice cases have been publicized by the media, academic researchers and in government annual reports prompting government policy makers, oversight agencies and the medical profession itself to take appropriate action. The increasing dissatisfaction with the current tort litigation system requires exploring alternatives and new approaches for handling medical malpractice cases. This study aims to examine the difficulties inherent in the tort system in Malaysia for solving medical malpractice claims and evaluates the structure of this system from the perspective of effectiveness, fairness, compensation, accessibility, and accountability.

  19. Corrosion performance of Cr3C2-NiCr+0.2%Zr coated super alloys under actual medical waste incinerator environment

    Science.gov (United States)

    Ahuja, Lalit; Mudgal, Deepa; Singh, Surendra; Prakash, Satya

    2018-03-01

    Incineration techniques are widely used to dispose of various types of waste which lead to formation of very corrosive environment. Such corrosive environment leads to the degradation of the alloys used in these areas. To obviate this problem, zirconium modified Cr3C2-(NiCr) coating powder has been deposited on three superalloys namely Superni 718, Superni 600 and Superco 605 using Detonation gun technique. Corrosion test was conducted in actual medical waste incinerator environment. The samples were hung inside the secondary chamber operated at 1050°C for 1000h under cyclic condition. Corrosion kinetics was monitored using the weight gain measurements and thickness loss. Corrosion products were characterized using scanning electron microscopy, energy dispersive spectroscopy and X-ray diffraction technique. It was observed that coating is found to be successful in impeding the corrosion problem in superalloys.

  20. The Privacy Problem: Although School Librarians Seldom Discuss It, Students' Privacy Rights Are under Attack

    Science.gov (United States)

    Adams, Helen R.

    2011-01-01

    Every day in school libraries nationwide, students' privacy rights are under attack, but many principals, teachers, parents, and community members do not know much about these rights. Even though school librarians are among the strongest proponents of privacy, the subject is rarely discussed, probably because state and federal laws can be…

  1. Portfolio selection problem with liquidity constraints under non-extensive statistical mechanics

    International Nuclear Information System (INIS)

    Zhao, Pan; Xiao, Qingxian

    2016-01-01

    In this study, we consider the optimal portfolio selection problem with liquidity limits. A portfolio selection model is proposed in which the risky asset price is driven by the process based on non-extensive statistical mechanics instead of the classic Wiener process. Using dynamic programming and Lagrange multiplier methods, we obtain the optimal policy and value function. Moreover, the numerical results indicate that this model is considerably different from the model based on the classic Wiener process, the optimal strategy is affected by the non-extensive parameter q, the increase in the investment in the risky asset is faster at a larger parameter q and the increase in wealth is similar.

  2. An Optimization Approach for Hazardous Waste Management Problem under Stochastic Programming

    International Nuclear Information System (INIS)

    Abass, S.A.; Abdallah, A.S.; Gomaa, M.A.

    2008-01-01

    Hazardous waste is the waste which, due to their nature and quantity, is potentially hazardous to human health and/or the environment. This kind of waste requires special disposal techniques to eliminate or reduce thc hazardous. Hazardous waste management (HWM) problem is concerned in the basic with the disposal method. hi this paper we focus on incineration as an effective to dispose the waste. For this type of disposal, there arc air pollution standards imposed by the government. We will propose an optimization model satisfied the air pollution standards and based on the model of Emek and Kara with using random variable coefficients in the constraint

  3. Conjugate problems of transport phenomena under quasi-steady microaccelerations in realistic spaceflight.

    Science.gov (United States)

    Polezhaev, V I; Nikitin, S A

    2009-04-01

    A new model for spatial convective transport processes conjugated with the measured or calculated realistic quasi-steady microaccelerations is presented. Rotation around the mass center, including accelerated rotation, gravity gradient, and aerodynamical drag are taken into account. New results of the effect on mixing and concentration inhomogeneities of the elementary convective processes are presented. The mixing problem in spacecraft enclosures, concentration inhomogeneities due to convection induced by body forces in realistic spaceflight, and the coupling of this kind of convection with thermocapillary convection on the basis of this model are discussed.

  4. Electronic health records and online medical records: an asset or a liability under current conditions?

    Science.gov (United States)

    Allen-Graham, Judith; Mitchell, Lauren; Heriot, Natalie; Armani, Roksana; Langton, David; Levinson, Michele; Young, Alan; Smith, Julian A; Kotsimbos, Tom; Wilson, John W

    2018-02-01

    Objective The aim of the present study was to audit the current use of medical records to determine completeness and concordance with other sources of medical information. Methods Medical records for 40 patients from each of five Melbourne major metropolitan hospitals were randomly selected (n=200). A quantitative audit was performed for detailed patient information and medical record keeping, as well as data collection, storage and utilisation. Using each hospital's current online clinical database, scanned files and paperwork available for each patient audited, the reviewers sourced as much relevant information as possible within a 30-min time allocation from both the record and the discharge summary. Results Of all medical records audited, 82% contained medical and surgical history, allergy information and patient demographics. All audited discharge summaries lacked at least one of the following: demographics, medication allergies, medical and surgical history, medications and adverse drug event information. Only 49% of records audited showed evidence the discharge summary was sent outside the institution. Conclusions The quality of medical data captured and information management is variable across hospitals. It is recommended that medical history documentation guidelines and standardised discharge summaries be implemented in Australian healthcare services. What is known about this topic? Australia has a complex health system, the government has approved funding to develop a universal online electronic medical record system and is currently trialling this in an opt-out style in the Napean Blue Mountains (NSW) and in Northern Queensland. The system was originally named the personally controlled electronic health record but has since been changed to MyHealth Record (2016). In Victoria, there exists a wide range of electronic health records used to varying degrees, with some hospitals still relying on paper-based records and many using scanned medical records

  5. INDICATOR OF ENVIRONMENTAL PROBLEMS OF AGRICULTURAL SECTORS UNDER THE ENVIRONMENTAL MODELING

    Directory of Open Access Journals (Sweden)

    Pruethsan Sutthichaimethee

    2016-04-01

    Full Text Available The objective of this research is to propose an indicator to deal with environmental problems for agricultural sectors caused by goods and services production. The aspects to calculate the real benefit of agricultural sectors and environmental cost for analyzing are natural resources materials, energy and transportation, fertilizer and pesticides, and sanitary and similar service. From the research it was found that the highest environmental cost of natural resources materials was 026: charcoal and fire-wood, while the lowest was 010 coconut. The highest environmental cost for energy and transportation was 024: agricultural services, while the highest environmental cost for fertilizer and pesticides was 011: palm oil. lastly, 017: other agricultural products was found as the highest environmental cost for sanitary and similar service. As a result, 010: coconut gained the highest real benefit, while 024: agricultural services presented as the lowest read benefit for the company. If Thailand using environmental problem indicator, especially with the agricultural sector, it can help to formulate efficient policies and strategies for the country in 3 development areas, which are social, economic, and environmental development.

  6. Cascading peer dynamics underlying the progression from problem behavior to violence in early to late adolescence.

    Science.gov (United States)

    Dishion, Thomas J; Véronneau, Marie-Hélène; Myers, Michael W

    2010-08-01

    This study examined the peer dynamics linking early adolescent problem behavior, school marginalization, and low academic performance to multiple indices of late adolescent violence (arrests, parent report, and youth report) in an ethnically diverse sample of 998 males and females. A cascade model was proposed in which early adolescent risk factors assessed at age 11 to 12 predict gang involvement at age 13 to 14, which in turn, predicts deviancy training with friends at age 16 to 17, which then predicts violence by age 18 to 19. Each construct in the model was assessed with multiple measures and methods. Structural equation modeling revealed that the cascade model fit the data well, with problem behavior, school marginalization, and low academic performance significantly predicting gang involvement 2 years later. Gang involvement, in turn, predicted deviancy training with a friend, which predicted violence. The best fitting model included an indirect and direct path between early adolescent gang involvement and later violence. These findings suggest the need to carefully consider peer clustering into gangs in efforts to prevent individual and aggregate levels of violence, especially in youths who may be disengaged, marginalized, or academically unsuccessful in the public school context.

  7. Generalized stochastic target problems for pricing and partial hedging under loss constraints - Application in optimal book liquidation

    OpenAIRE

    Bouchard , Bruno; Dang , Ngoc Minh

    2013-01-01

    International audience; We consider a singular with state constraints version of the stochastic target problems studied in Soner and Touzi (2002) and more recently Bouchard, Elie and Touzi (2008), among others. This provides a general framework for the pricing of contingent claims under risk constraints. Our extended version perfectly suits to market models with proportional transaction costs and to order book liquidation issues. Our main result is a PDE characterization of the associated pri...

  8. 38 CFR 3.361 - Benefits under 38 U.S.C. 1151(a) for additional disability or death due to hospital care, medical...

    Science.gov (United States)

    2010-07-01

    .... Consent may be express (i.e., given orally or in writing) or implied under the circumstances specified in... of 38 U.S.C. 1151(a): (1) Hospital care or medical services furnished under a contract made under 38...

  9. Prevalence and incidence of mental health problems among Dutch medical students and the study-related and personal risk factors: a longitudinal study

    NARCIS (Netherlands)

    Borst, Jorien M.; Frings-Dresen, Monique H. W.; Sluiter, Judith K.

    2016-01-01

    A high prevalence of mental health problems (i.e. depression and/or anxiety) has been found in medical students in comparison with the general population. Therefore, the objective was first to study the prevalence and 1-year incidence of symptoms of depression, anxiety and any mental health problems

  10. Acute Medical conditions in under five year old children at a Public ...

    African Journals Online (AJOL)

    Objective: To determine the prevalence of childhood preventable and treatable medical conditions and the parent's/guardian's knowledge about the conditions and their management. Design: A descriptive cross-sectional study. Setting: Paediatric medical wards at Kenyatta National hospital Subjects: All children aged 0-60 ...

  11. using fuzzy-robust approach for minimizing transportation and fuel costs in location problem under uncertainty

    Directory of Open Access Journals (Sweden)

    hasan hosseini nasab

    2016-02-01

    Full Text Available Operations research is a commonly used method in many subjects nowadays. One applicable domain of operation research is the problem of facility layout and location. In this paper, a new mathematical programing model is developed for an optimal facility location and assignment. The model includes two objective functions. The first one minimizes the total material handling and fixed costs of facility location. Because of the importance of energy and the main role of fossil fuel in transportation, the second objective function, minimizes the total cost of fuel consumption. To consider the real condition in the proposed model, the cost of fuel, is considered to increase stepwise gradually. In the proposed model the coefficients of objective function are considered to be probabilistic and some of constraints to be fuzzy variables. Using a new approach, this model can be changed to a robust model. To prove the applicability of the model, it is examined for a real condition of facility location.

  12. Periodic boundary-value problems and the Dancer-Fucik spectrum under conditions of resonance

    Directory of Open Access Journals (Sweden)

    David A. Bliss

    2011-08-01

    Full Text Available We prove the existence of solutions to the nonlinear $2 pi$-periodic problem $$displaylines{ u''(x+mu u^+(x-u u^-(x+g(x,u(x=f(x,,quad xin (0,2pi,,cr u(0-u(2pi =0 ,, quad u'(0 - u'(2pi=0, }$$ where the point $(mu,u$ lies in the Dancer-Fucik spectrum, with $$ 0< frac{4}{9}mu leqslant u

  13. The standard of medical care under the Australian Civil Liability Acts: ten years on.

    Science.gov (United States)

    Lee, Joseph

    2014-12-01

    It has been more than a decade since the modified Bolam test was legislatively enacted.by the Australian States following the medical indemnity crisis. Since its implementation, the modified Bolam test has been configured by judges as a defence to the common law standard of care in medical diagnosis and treatment. The article argues against this interpretation and suggests an alternative way of implementing this statutory test. It is proposed that the modified Bolam test ought to have been applied as a single yardstick to determine the required standard of care in diagnosis and treatment. Changes are also recommended to reform the test with a view to striking a balance between the interests of patients and doctors in medical disputes, and strengthening judicial supervision of the medical profession. These proposed reforms could resolve the shortcomings of the common law more effectively. They may also enhance the standard of medical care in Australia in the long run.

  14. USMLE performances in a predominantly Asian and Pacific Islander population of medical students in a problem-based learning curriculum.

    Science.gov (United States)

    Kasuya, Richard T; Naguwa, Gwen S; Guerrero, Anthony P S; Hishinuma, Earl S; Lindberg, Marlene A; Judd, Nanette K

    2003-05-01

    To compare the USMLE performances of students of various ethnicities, predominantly Pacific Islander and Asian, at one medical school and to examine the predictive validity of MCAT scores for USMLE performance. A total of 258 students in the graduating classes of 1996-2000 at the University of Hawai'i School of Medicine were classified by ethnicity. Demographic and performance characteristics of the groups were examined, and MCAT scores with and without undergraduate science GPA were used to predict USMLE performance. Under- and over-prediction rates were computed for each ethnic group. Ethnic groups did not differ significantly by gender or undergraduate GPA. Chinese, Caucasian, and Other Asian students tended to have higher MCAT scores than Hawaiian/other Pacific Islander, and Filipino students. Ethnic groups did not differ significantly in prediction of USMLE Step 1 performance. For Step 2, MCAT scores significantly over-predicted performance of Filipino students and tended to under-predict performance of Caucasian students. Although MCAT scores and science GPA were good predictors of USMLE performance, ethnic differences were found in the degrees of their predictive validity. These findings both replicate and extend results of earlier studies, and again point to the importance of exploring additional predictor variables. The authors encourage future research on the effects of the following factors on success in medical school: reading and test-taking skills, socio-cultural and environmental influences on learning, communication styles, primary language use, family support, and family responsibilities.

  15. Community of learners: charting learning in first year graduate entry medical students during problem-based learning (PBL) study.

    Science.gov (United States)

    Orsmond, Paul; Zvauya, R

    2015-05-01

    This study considers social learning practices within and outside the overt curriculum. A thematic approach was used to analyse data from six focus group interviews with 11 graduate entry medical students from a UK university over a year of study. The results indicate that: (1) during their first year of study students form a community of learning practice, (2) this community of practice influences learning inside and outside the overt curriculum, (3) there is a changing community profile over the year of practice, (4) the students' engagement in problem-based learning (PBL) as part of their overt curriculum strongly influences the development of a community of practice and hence learning both inside and outside the overt curriculum. Findings are discussed in terms of Wenger's community of practice framework, the role of distributed cognition and social learning. It is concluded that PBL is an effective approach for academics to enrich students' social learning practices.

  16. 20 CFR 725.702 - Claims for medical benefits only under section 11 of the Reform Act.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Claims for medical benefits only under section 11 of the Reform Act. 725.702 Section 725.702 Employees' Benefits EMPLOYMENT STANDARDS... Reform Act. (a) Section 11 of the Reform Act directs the Secretary of Health, Education and Welfare to...

  17. Medication and parent training in children with pervasive developmental disorders and serious behavior problems: results from a randomized clinical trial.

    Science.gov (United States)

    Aman, Michael G; McDougle, Christopher J; Scahill, Lawrence; Handen, Benjamin; Arnold, L Eugene; Johnson, Cynthia; Stigler, Kimberly A; Bearss, Karen; Butter, Eric; Swiezy, Naomi B; Sukhodolsky, Denis D; Ramadan, Yaser; Pozdol, Stacie L; Nikolov, Roumen; Lecavalier, Luc; Kohn, Arlene E; Koenig, Kathleen; Hollway, Jill A; Korzekwa, Patricia; Gavaletz, Allison; Mulick, James A; Hall, Kristy L; Dziura, James; Ritz, Louise; Trollinger, Stacie; Yu, Sunkyung; Vitiello, Benedetto; Wagner, Ann

    2009-12-01

    Many children with pervasive developmental disorders (PDDs) have serious, functionally impairing behavioral problems. We tested whether combined treatment (COMB) with risperidone and parent training (PT) in behavior management is superior to medication alone (MED) in improving severe behavioral problems in children with PDDs. This 24-week, three-site, randomized, parallel-groups clinical trial enrolled 124 children, aged 4 through 13 years, with PDDs, accompanied by frequent tantrums, self-injury, and aggression. The children were randomized 3:2 to COMB (n = 75) or MED (n = 49). The participants received risperidone monotherapy from 0.5 to 3.5 mg/day (with switch to aripiprazole if risperidone was ineffective). Parents in the COMB group (n = 75; 60.5%) received a mean of 10.9 PT sessions. The primary measure of compliance was the Home Situations Questionnaire (HSQ) score. Primary: intent-to-treat random effects regression showed that COMB was superior to MED on HSQ (p = .006) [effect size at week 24 (d) = 0.34]. The HSQ score declined from 4.31 (± 1.67) to 1.23 (± 1.36) for COMB compared with 4.16 (± 1.47) to 1.68 (± 1.36) for MED. Secondary: groups did not differ on Clinical Global Impressions-Improvement scores at endpoint; compared with MED, COMB showed significant reductions on Aberrant Behavior Checklist Irritability (d = 0.48; p = .01), Stereotypic Behavior (d = 0.23; p = .04), and Hyperactivity/Noncompliance subscales (d = 0.55; p = .04). Final risperidone mean dose for MED was 2.26 mg/day (0.071 mg/kg), compared with 1.98 mg/day for COMB (0.066 mg/kg) (p = .04). Medication plus PT resulted in greater reduction of serious maladaptive behavior than MED in children with PDDs, with a lower risperidone dose.

  18. An algorithm to improve diagnostic accuracy in diabetes in computerised problem orientated medical records (POMR compared with an established algorithm developed in episode orientated records (EOMR

    Directory of Open Access Journals (Sweden)

    Simon de Lusignan

    2015-06-01

    Full Text Available An algorithm that detects errors in diagnosis, classification or coding of diabetes in primary care computerised medial record (CMR systems is currently available.  However, this was developed on CMR systems that are “Episode orientated” medical records (EOMR; and don’t force the user to always code a problem or link data to an existing one.  More strictly problem orientated medical record (POMR systems mandate recording a problem and linking consultation data to them.  

  19. Some problems of biological effects under the combined action of nitrogen oxides, their metabolites and radiation

    International Nuclear Information System (INIS)

    Malenchenko, A.F.

    1985-01-01

    The progress of power engineering envisages the intensive construction of nuclear-energy plants, where an organic or nuclear fuel is used. Nowadays the concept of nuclear-energy plant with the coolant based on dissociating N 2 O 4 is being developed. A great deal of radioactive and chemical products escapes into surroundings as the result of the power plants being in service. Their action on organisms is performed simultaneously, that could have an essential effect on the quantitative and qualitative regularities of response. The estimation of the combined effect of nitrogen oxides, sodium nitrite and nitrate and radiation has been carried out on the base of the investigation into methemoglobin formation, genetic effects and the pathomorphological changes in lungs. The formation of methemoglobin has been studied on rats in 1, 3, 7 and 15 days after the single total irradiation of 300 and 700 R doses at the gamma-installation (UGU-420) using a radioactive 60 Co. Methemoglobin was determined in the interval of 15-180 min after NaNO 2 administration in the dosage of 7.0 mg per 100 g body weight. The irradiation essentially affects the process of methemoglobin formation and its reduction. The methemoglobin content in the blood of radiation exposed animals exceeds the value, that could be expected to obtain by summing up its concentration under the separate effects of nitrite and irradiation. The genetic effects of sodium nitrite and nitrate and X-radiation have been studied on the Drosophila. The one-day flies were exposed to the radiation dose of 1500 R in the medium with the sodium nitrite or nitrate contents of 0.1 or 1.0 g/l, respectively. The combined action estimated through the frequency of the dominant lethal mutation, recessive coupled with a lethal mutation sex, viability and fecundity definitely differs from the expected summing values of the separate effect indices of radiation and toxic factors. The morpho- and functional changes in the rat lungs (the

  20. Impact of Telephone-Based Problem-Solving Treatment on the Use of Medical and Psychological Services in the Military.

    Science.gov (United States)

    Richardson, John S; Fann, Jesse R; Bell, Kathleen R; Temkin, Nancy

    To explore the impact of problem-solving treatment (PST) for mild traumatic brain injury in active duty service members on the use of medical and psychological services. Service members who had a mild traumatic brain injury during their last deployment and enrolled in the CONcussion Treatment After Combat Trauma (CONTACT) study. Secondary analysis of a randomized clinical trial. Participants were assigned to telephone-based PST, or e-mailed or mailed education only over the course of 6 months. Self-reported health service utilization from months 4 through 6 and 10 through 12 after initiation of treatment, using the Cornell Service Index. In months 4 to 6, participants receiving PST had 6.17 times the odds of an emergency department visit or hospitalization than those receiving education only (95% confidence interval = 1.92-19.8; P value = .0023). These estimates, however, were not significant using a conservative Bonferroni correction (P value threshold < .0014). There were no other significant differences for other medical or psychological services received in months 4 to 6 or 10 to 12. Telephone-based PST was designed to complement clinical care, and this study showed that it may increase emergency department utilization. Future evaluations of PST with more accurate and complete measures of health service utilization are needed.

  1. Problem-based, small-group tutorial learning in clinical neurology for second-year medical students.

    Science.gov (United States)

    Yu, H Y; Wu, Z A; Su, M S; Yen, D J; Luk, H R; Chao, Y C; Liao, K K; Lin, K P; Yu, S M; Liu, H C

    2000-08-01

    Problem-based learning (PBL) in small-group tutorials has been a trend in medical education. Chinese students are known to be reserved and passive; thus, they may not be adaptable to PBL. Neuroanatomy, important to clinical neurology, is difficult to learn. We incorporated clinical neurology with PBL, complementary to the traditional neuroanatomy curriculum, to evaluate the feasibility of PBL for Chinese students in Taiwan. Forty-two second-year medical students and seven tutors participated in the clinical neurology PBL small-group tutorials. Twelve case reports were discussed weekly beginning in February, 1999. Each case was designed to meet the progressive curriculum of the neuroanatomy course. The tutors evaluated the students by the degree of their preparation, participation, key-point comprehension and interaction. All tutors and students filled out questionnaires at the end of each session. The majority of the students and tutors agreed that the case materials were clearly written. Ninety percent of the students agreed that the case materials matched the traditional content of neuroanatomy. Eighty-five percent of students and 71% of tutors were satisfied and found the class rewarding. Ninety-one percent of students and 74% of tutors were in favor of PBL being continued. This preliminary PBL, small-group tutorial learning in clinical neurology showed satisfactory results and was, indeed, complementary to a traditional neuroanatomy course. The students, as early as during the second year of their medical school education, were able to learn through the PBL. More integration of basic and clinical sciences by PBL may be considered in future curricula designs.

  2. Under-Researched Demographics: Heavy Episodic Drinking and Alcohol-Related Problems Among Asian Americans.

    Science.gov (United States)

    Iwamoto, Derek Kenji; Kaya, Aylin; Grivel, Margaux; Clinton, Lauren

    2016-01-01

    Asian Americans represent the fastest- growing population in the United States (Le 2010). At the same time, there is evidence that problematic drinking rates are increasing among young-adult Asian Americans (Grant et al. 2004). Accordingly, it is essential to understand the etiological determinants and mechanisms of risk that may help explain this growth in problematic alcohol use among this group. The high prevalence of the ALDH2*2 and ADH1B*2 alleles in a large percentage of Asian subgroups has been studied as a potential protective factors against alcohol abuse, yet some individuals who possess these genes still engage in problematic alcohol use (Wall et al. 2001). Other social and psychological factors may account for this discrepancy. Thus, some factors, such as negative physiological alcohol expectancies, are protective against alcohol abuse in this population (Hendershot et al. 2009). Sociocultural factors such as acculturation and nativity also may help explain drinking patterns among this group. The literature suggests that vast and significant within-group differences exist among Asian Americans, such that individuals who were born in the United States and/or are more acculturated are at elevated risk for alcohol abuse and related problems (Hahm et al. 2003). Differences also have been observed among Asian-American ethnic subgroups, with some groups (e.g., Japanese, Korean, and multi-Asian Americans) reporting higher rates of drinking compared with others (e.g., Chinese and Vietnamese Americans) (Iwamoto et al. 2012). Furthermore, Asian Americans who report higher levels of depressive symptoms, psychological distress, and perceived discrimination seem to be at a heightened risk for abusing alcohol (Iwamoto et al. 2011a; Nishimura et al. 2005; Yoo et al. 2010). Finally, an emerging body of research examining gender-relevant factors, including feminine and masculine norms, may help explain within-group differences among Asian-American women and men. Thus

  3. Medical Humanitarianism Under Atmospheric Violence: Health Professionals in the 2013 Gezi Protests in Turkey.

    Science.gov (United States)

    Aciksoz, Salih Can

    2016-06-01

    During the 2013 Gezi protests in Turkey, volunteering health professionals provided on-site medical assistance to protesters faced with police violence characterized by the extensive use of riot control agents. This led to a government crackdown on the medical community and the criminalization of "unauthorized" first aid amidst international criticisms over violations of medical neutrality. Drawing from ethnographic observations, in-depth interviews with health care professionals, and archival research, this article ethnographically analyzes the polarized encounter between the Turkish government and medical professionals aligned with social protest. I demonstrate how the context of "atmospheric violence"-the extensive use of riot control agents like tear gas-brings about new politico-ethical spaces and dilemmas for healthcare professionals. I then analyze how Turkish health professionals framed their provision of health services to protestors in the language of medical humanitarianism, and how the state dismissed their claims to humanitarian neutrality by criminalizing emergency care. Exploring the vexed role that health workers and medical organizations played in the Gezi protests and the consequent political contestations over doctors' ethical, professional, and political responsibilities, this article examines challenges to medical humanitarianism and neutrality at times of social protest in and beyond the Middle East.

  4. Responses of discretized systems under narrow band nonstationary random excitations. Part 1: linear problems

    Science.gov (United States)

    Chen, Z.; To, C. W. S.

    2005-10-01

    The extended stochastic central difference (ESCD) method is proposed as a viable alternative for computing linear responses of discretized multi-degrees-of-freedom (mdof) systems under narrow band stationary and nonstationary random disturbances. The method provides a means of controlling the center frequencies and bandwidths of narrow band stationary and nonstationary random excitation processes. It is suitable for larger-scale random response analysis of complicated structures idealized by the finite element method. Its additional important feature is that application of normal mode or complex normal mode analysis or direct numerical integration algorithms such as the fourth-order Runge-Kutta scheme is not required. Examples, including one of flow-induced vibration of a pipe containing a moving fluid are included to demonstrate: (1) the capability of the proposed method and difference between responses of discretized systems under narrow band and wide band random excitations, and (2) its accuracy and efficiency by way of comparison to the Monte Carlo simulation data. Generalization of the ESCD method for computation of responses of nonlinear mdof systems is presented in a companion paper.

  5. Under-utilization of controller medications and poor follow-up rates among hospitalized asthma patients.

    Science.gov (United States)

    Lintzenich, Annie; Teufel, Ronald J; Basco, William T

    2011-07-01

    Recommended preventive care following an asthma admission includes prescribing controller medications and encouraging outpatient follow-up. We sought to determine (1) the proportion of patients who receive controller medications or attend follow-up after asthma admission and (2) what factors predict these outcomes. South Carolina Medicaid data from 2007-2009 were analyzed. Patients who were included were 2 to 18 years old, and had at least one admission for asthma. Variables examined were: age, gender, race, and rural location. Outcome variables were controller medication prescription and follow-up appointment. Any claim for an inhaled corticosteroid (ICS) or ICS/long-acting beta-agonist in the 2 months after admission was considered appropriate. Any outpatient visit for asthma in the 2 months after admission was considered appropriate. Bivariate analyses used chi-square tests. Logistic regression models identified factors that predict controller medications and follow-up. Five hundred five patients were included, of whom 60% were male, 79% minority race/ethnicity, and 58% urban. Rates of receiving controller medications and attending follow-up appointments were low, and an even lower proportion received both. Overall, 52% received a controller medication, 49% attended follow-up, and 32% had both. Multivariable analyses demonstrated that patients not of minority race or ethnicity were more likely to receive controller medications (odds ratio, 1.7; 95% confidence interval, 1.1-2.6). Patients with asthma admitted for acute exacerbations in South Carolina have low rates of controller medication initiation and follow-up attendance. Minority race/ethnicity patients are less likely to receive controller medications. To decrease rates of future exacerbations, inpatient providers must improve the rates of preventive care delivery in the acute care setting with a focus on racial/ethnic minority populations.

  6. The Emergency Vehicle Routing Problem with Uncertain Demand under Sustainability Environments

    Directory of Open Access Journals (Sweden)

    Jin Qin

    2017-02-01

    Full Text Available The reasonable utilization of limited resources is critical to realize the sustainable developments. In the initial 72-h crucial rescue period after the disaster, emergency supplies have always been insufficient and the demands in the affected area have always been uncertain. In order to improve timeliness, utilization and sustainability of emergency service, the allocation of the emergency supplies and the emergency vehicle routes should be determined simultaneously. Assuming the uncertain demands follow normal distribution, an optimization model for the emergency vehicle routing, by considering the insufficient supplies and the uncertain demands, is developed. The objective function is applied to minimize the total costs, including the penalty costs induced by more or less supplies than the actual demands at all demand points, as well as the constraints of the time windows and vehicle load capacity taken into account. In more details, a solution method for the model, based on the genetic algorithm, is proposed, which solves the problem in two stages. A numerical example is presented to demonstrate the efficiency and validity of the proposed model and algorithm.

  7. Two-Stage Multiobjective Optimization for Emergency Supplies Allocation Problem under Integrated Uncertainty

    Directory of Open Access Journals (Sweden)

    Xuejie Bai

    2016-01-01

    Full Text Available This paper proposes a new two-stage optimization method for emergency supplies allocation problem with multisupplier, multiaffected area, multirelief, and multivehicle. The triplet of supply, demand, and the availability of path is unknown prior to the extraordinary event and is descriptive with fuzzy random variable. Considering the fairness, timeliness, and economical efficiency, a multiobjective expected value model is built for facility location, vehicle routing, and supply allocation decisions. The goals of proposed model aim to minimize the proportion of demand nonsatisfied and response time of emergency reliefs and the total cost of the whole process. When the demand and the availability of path are discrete, the expected values in the objective functions are converted into their equivalent forms. When the supply amount is continuous, the equilibrium chance in the constraint is transformed to its equivalent one. To overcome the computational difficulty caused by multiple objectives, a goal programming model is formulated to obtain a compromise solution. Finally, an example is presented to illustrate the validity of the proposed model and the effectiveness of the solution method.

  8. Source selection problem of competitive power plants under government intervention: a game theory approach

    Science.gov (United States)

    Mahmoudi, Reza; Hafezalkotob, Ashkan; Makui, Ahmad

    2014-06-01

    Pollution and environmental protection in the present century are extremely significant global problems. Power plants as the largest pollution emitting industry have been the cause of a great deal of scientific researches. The fuel or source type used to generate electricity by the power plants plays an important role in the amount of pollution produced. Governments should take visible actions to promote green fuel. These actions are often called the governmental financial interventions that include legislations such as green subsidiaries and taxes. In this paper, by considering the government role in the competition of two power plants, we propose a game theoretical model that will help the government to determine the optimal taxes and subsidies. The numerical examples demonstrate how government could intervene in a competitive market of electricity to achieve the environmental objectives and how power plants maximize their utilities in each energy source. The results also reveal that the government's taxes and subsidiaries effectively influence the selected fuel types of power plants in the competitive market.

  9. Optimization of Production-Distribution Problem in Supply Chain Management under Stochastic and Fuzzy Uncertainties

    Directory of Open Access Journals (Sweden)

    Umit Sami Sakalli

    2017-01-01

    Full Text Available Production-Distribution Problem (PDP in Supply Chain Management (SCM is an important tactical decision. One of the challenges in this decision is the size and complexity of supply chain system (SCS. On the other side, a tactical operation is a mid-term plan for 6–12 months; therefore, it includes different types of uncertainties, which is the second challenge. In the literature, the uncertain parameters were modeled as stochastic or fuzzy. However, there are a few studies in the literature that handle stochastic and fuzzy uncertainties simultaneously in PDP. In this paper, the modeling and solution approaches of PDP which contain stochastic and fuzzy uncertainties simultaneously are investigated for a SCS that includes multiple suppliers, multiple products, multiple plants, multiple warehouses, multiple retailers, multiple transport paths, and multiple time periods, which, to the best of the author’s knowledge, is not handled in the literature. The PDP contains deterministic, fuzzy, fuzzy random, and random fuzzy parameters. To the best of the author’s knowledge, there is no study in the literature which considers all of them simultaneously in PDP. An analytic solution approach has been developed by using possibilistic programming and chance-constrained programming approaches. The proposed modeling and solution approaches are implemented in a numerical example. The solution has shown that the proposed approaches successfully handled uncertainties and produce robust solutions for PDP.

  10. Solution to a gene divergence problem under arbitrary stable nucleotide transition probabilities

    Science.gov (United States)

    Holmquist, R.

    1976-01-01

    A nucleic acid chain, L nucleotides in length, with the specific base sequence B(1)B(2) ... B(L) is defined by the L-dimensional vector B = (B(1), B(2), ..., B(L)). For twelve given constant non-negative transition probabilities that, in a specified position, the base B is replaced by the base B' in a single step, an exact analytical expression is derived for the probability that the position goes from base B to B' in X steps. Assuming that each base mutates independently of the others, an exact expression is derived for the probability that the initial gene sequence B goes to a sequence B' = (B'(1), B'(2), ..., B'(L)) after X = (X(1), X(2), ..., X(L)) base replacements. The resulting equations allow a more precise accounting for the effects of Darwinian natural selection in molecular evolution than does the idealized (biologically less accurate) assumption that each of the four nucleotides is equally likely to mutate to and be fixed as one of the other three. Illustrative applications of the theory to some problems of biological evolution are given.

  11. The operating room case-mix problem under uncertainty and nurses capacity constraints.

    Science.gov (United States)

    Yahia, Zakaria; Eltawil, Amr B; Harraz, Nermine A

    2016-12-01

    Surgery is one of the key functions in hospitals; it generates significant revenue and admissions to hospitals. In this paper we address the decision of choosing a case-mix for a surgery department. The objective of this study is to generate an optimal case-mix plan of surgery patients with uncertain surgery operations, which includes uncertainty in surgery durations, length of stay, surgery demand and the availability of nurses. In order to obtain an optimal case-mix plan, a stochastic optimization model is proposed and the sample average approximation method is applied. The proposed model is used to determine the number of surgery cases to be weekly served, the amount of operating rooms' time dedicated to each specialty and the number of ward beds dedicated to each specialty. The optimal case-mix selection criterion is based upon a weighted score taking into account both the waiting list and the historical demand of each patient category. The score aims to maximizing the service level of the operating rooms by increasing the total number of surgery cases that could be served. A computational experiment is presented to demonstrate the performance of the proposed method. The results show that the stochastic model solution outperforms the expected value problem solution. Additional analysis is conducted to study the effect of varying the number of ORs and nurses capacity on the overall ORs' performance.

  12. Medical students’ self-efficacy in problem-based learning and its relationship with self-regulated learning

    Directory of Open Access Journals (Sweden)

    Meral Demirören

    2016-03-01

    Full Text Available Background: Problem-based learning (PBL is most commonly used in medical education to enhance self-regulated learning (SRL skills. Self-efficacy beliefs affect students’ motivation through self-regulatory processes. The purpose of this study is to examine the relationship between medical students’ self-reported SRL skills and their self-efficacy in PBL. Methods: A cross-sectional study was conducted with second (286; 83.1% and third (275; 80.2% year students at the Ankara University School of Medicine. The SRL perception (SRLP scale and self-efficacy for problem-based learning (SPBL scale were used in the study. Results: The SRLP subscales were positively correlated with the SPBL subscales. There was a weak but meaningful correlation between the subscales of SRLP (with the exception of the lack of self-directedness scale and the subscales of SPBL and the students’ views on benefiting from PBL. The female students’ mean score was higher for the ‘planning and goal setting’ subscale of SRLP (p=0.017, and the second-year students’ mean score was higher than that of the third-year students for the ‘lack of self-directedness’ subscale of SRLP (p=0.001 with small effect sizes (Cohen's d is 0.17 and 0.27. There was no statistically significant difference between the year and subscales of SPBL. With regard to gender, the female students had higher scores than the male students on the ‘responsibility’ subscale of SPBL (p=0.003; Cohen's d=0.26. Conclusions: The study showed that medical students used SRL skills and believed in their ability to learn effectively in the PBL context and demonstrated the relationship between SRL skills and self-efficacy beliefs. Monitoring students’ development in these skills and giving them feedback could be beneficial for the cognitive achievement of students with learning difficulties and insufficient study skills. Further studies need to be undertaken to investigate issues such as the curriculum

  13. Medical students' self-efficacy in problem-based learning and its relationship with self-regulated learning.

    Science.gov (United States)

    Demirören, Meral; Turan, Sevgi; Öztuna, Derya

    2016-01-01

    Background Problem-based learning (PBL) is most commonly used in medical education to enhance self-regulated learning (SRL) skills. Self-efficacy beliefs affect students' motivation through self-regulatory processes. The purpose of this study is to examine the relationship between medical students' self-reported SRL skills and their self-efficacy in PBL. Methods A cross-sectional study was conducted with second (286; 83.1%) and third (275; 80.2%) year students at the Ankara University School of Medicine. The SRL perception (SRLP) scale and self-efficacy for problem-based learning (SPBL) scale were used in the study. Results The SRLP subscales were positively correlated with the SPBL subscales. There was a weak but meaningful correlation between the subscales of SRLP (with the exception of the lack of self-directedness scale) and the subscales of SPBL and the students' views on benefiting from PBL. The female students' mean score was higher for the 'planning and goal setting' subscale of SRLP (p=0.017), and the second-year students' mean score was higher than that of the third-year students for the 'lack of self-directedness' subscale of SRLP (p=0.001) with small effect sizes (Cohen's d is 0.17 and 0.27). There was no statistically significant difference between the year and subscales of SPBL. With regard to gender, the female students had higher scores than the male students on the 'responsibility' subscale of SPBL (p=0.003; Cohen's d=0.26). Conclusions The study showed that medical students used SRL skills and believed in their ability to learn effectively in the PBL context and demonstrated the relationship between SRL skills and self-efficacy beliefs. Monitoring students' development in these skills and giving them feedback could be beneficial for the cognitive achievement of students with learning difficulties and insufficient study skills. Further studies need to be undertaken to investigate issues such as the curriculum, learning environment, individual

  14. Medical students' self-efficacy in problem-based learning and its relationship with self-regulated learning.

    Science.gov (United States)

    Demirören, Meral; Turan, Sevgi; Öztuna, Derya

    2016-01-01

    Problem-based learning (PBL) is most commonly used in medical education to enhance self-regulated learning (SRL) skills. Self-efficacy beliefs affect students' motivation through self-regulatory processes. The purpose of this study is to examine the relationship between medical students' self-reported SRL skills and their self-efficacy in PBL. A cross-sectional study was conducted with second (286; 83.1%) and third (275; 80.2%) year students at the Ankara University School of Medicine. The SRL perception (SRLP) scale and self-efficacy for problem-based learning (SPBL) scale were used in the study. The SRLP subscales were positively correlated with the SPBL subscales. There was a weak but meaningful correlation between the subscales of SRLP (with the exception of the lack of self-directedness scale) and the subscales of SPBL and the students' views on benefiting from PBL. The female students' mean score was higher for the 'planning and goal setting' subscale of SRLP (p=0.017), and the second-year students' mean score was higher than that of the third-year students for the 'lack of self-directedness' subscale of SRLP (p=0.001) with small effect sizes (Cohen's d is 0.17 and 0.27). There was no statistically significant difference between the year and subscales of SPBL. With regard to gender, the female students had higher scores than the male students on the 'responsibility' subscale of SPBL (p=0.003; Cohen's d=0.26). The study showed that medical students used SRL skills and believed in their ability to learn effectively in the PBL context and demonstrated the relationship between SRL skills and self-efficacy beliefs. Monitoring students' development in these skills and giving them feedback could be beneficial for the cognitive achievement of students with learning difficulties and insufficient study skills. Further studies need to be undertaken to investigate issues such as the curriculum, learning environment, individual differences, and how these can affect the

  15. Medical students’ self-efficacy in problem-based learning and its relationship with self-regulated learning

    Science.gov (United States)

    Demirören, Meral; Turan, Sevgi; Öztuna, Derya

    2016-01-01

    Background Problem-based learning (PBL) is most commonly used in medical education to enhance self-regulated learning (SRL) skills. Self-efficacy beliefs affect students’ motivation through self-regulatory processes. The purpose of this study is to examine the relationship between medical students’ self-reported SRL skills and their self-efficacy in PBL. Methods A cross-sectional study was conducted with second (286; 83.1%) and third (275; 80.2%) year students at the Ankara University School of Medicine. The SRL perception (SRLP) scale and self-efficacy for problem-based learning (SPBL) scale were used in the study. Results The SRLP subscales were positively correlated with the SPBL subscales. There was a weak but meaningful correlation between the subscales of SRLP (with the exception of the lack of self-directedness scale) and the subscales of SPBL and the students’ views on benefiting from PBL. The female students’ mean score was higher for the ‘planning and goal setting’ subscale of SRLP (p=0.017), and the second-year students’ mean score was higher than that of the third-year students for the ‘lack of self-directedness’ subscale of SRLP (p=0.001) with small effect sizes (Cohen's d is 0.17 and 0.27). There was no statistically significant difference between the year and subscales of SPBL. With regard to gender, the female students had higher scores than the male students on the ‘responsibility’ subscale of SPBL (p=0.003; Cohen's d=0.26). Conclusions The study showed that medical students used SRL skills and believed in their ability to learn effectively in the PBL context and demonstrated the relationship between SRL skills and self-efficacy beliefs. Monitoring students’ development in these skills and giving them feedback could be beneficial for the cognitive achievement of students with learning difficulties and insufficient study skills. Further studies need to be undertaken to investigate issues such as the curriculum, learning

  16. Genetic Algorithm for Multiuser Discrete Network Design Problem under Demand Uncertainty

    Directory of Open Access Journals (Sweden)

    Wu Juan

    2012-01-01

    Full Text Available Discrete network design is an important part of urban transportation planning. The purpose of this paper is to present a bilevel model for discrete network design. The upper-level model aims to minimize the total travel time under a stochastic demand to design a discrete network. In the lower-level model, demands are assigned to the network through a multiuser traffic equilibrium assignment. Generally, discrete network could affect path selections of demands, while the results of the multiuser traffic equilibrium assignment need to reconstruct a new discrete network. An iterative approach including an improved genetic algorithm and Frank-Wolfe algorithm is used to solve the bi-level model. The numerical results on Nguyen Dupuis network show that the model and the related algorithms were effective for discrete network design.

  17. Salivary Testosterone Levels Under Psychological Stress and Its Relationship with Rumination and Five Personality Traits in Medical Students.

    Science.gov (United States)

    Afrisham, Reza; Sadegh-Nejadi, Sahar; SoliemaniFar, Omid; Kooti, Wesam; Ashtary-Larky, Damoon; Alamiri, Fatima; Aberomand, Mohammad; Najjar-Asl, Sedigheh; Khaneh-Keshi, Ali

    2016-11-01

    The purpose of this study was to evaluate the salivary testosterone levels under psychological stress and its relationship with rumination and five personality traits in medical students. A total of 58 medical students, who wanted to participate in the final exam, were selected by simple random sampling. Two months before the exam, in the basal conditions, the NEO Inventory short form, and the Emotional Control Questionnaire (ECQ) were completed. Saliva samples were taken from students in both the basal conditions and under exam stress. Salivary testosterone was measured by ELISA. Data was analyzed using multivariate analysis of variance with repeated measures, paired samples t-test, Pearson correlation and stepwise regression analysis. Salivary testosterone level of men showed a significant increase under exam stress (pstress. Salivary testosterone reactivity to stress can be determined by sexual differences, personality traits, and emotional control variables which may decrease or increase stress effects on biological responses, especially the salivary testosterone.

  18. Mutual benefit for foreign medical students and Chinese postgraduates: A mixed team-based learning method overcomes communication problems in hematology clerkship.

    Science.gov (United States)

    Chen, Xianling; Chen, Buyuan; Li, Xiaofan; Song, Qingxiao; Chen, Yuanzhong

    2017-03-04

    Hematology is difficult for students to learn. A beneficial education method for hematology clerkship training is required to help students develop clinical skills. Foreign medical students often encounter communication issues in China. To address this issue, Chinese post-graduates from our institute are willing to assist with educating foreign students. Therefore, we propose a mixed team-based learning method (MTBL) which might overcome communication problems in hematology clerkship. Twenty-two foreign medical Students attended a 2-week hematology clerkship in Fujian Medical University Union Hospital. Twenty-one foreign African medical students were assigned randomly into two groups. Fourteen foreign African medical students were assigned to MTBL group. Each MTBL team included two foreign African medical students and one Chinese post-graduate. Seven foreign African medical students were assigned to lecture-based learning method (LBL) group, which had a foreign medical classmate from Hong Kong or Chinese intern volunteers to serve as translators. The practice test scores of MTBL were significantly higher than LBL group (p Chinese post-graduates also benefited from this setting, as they found that this interaction improved their communication in the English language. The mixed team-based learning method overcomes communication problems in hematology clerkship. Foreign medical students and Chinese post-graduates alike can benefit from MTBL. © 2016 by The International Union of Biochemistry and Molecular Biology, 45(2):93-96, 2017. © 2016 The International Union of Biochemistry and Molecular Biology.

  19. History of Medical Physics.

    Science.gov (United States)

    Laughlin, John S.

    1983-01-01

    Traces the development of basic radiation physics that underlies much of today's medical physics and looks separately at the historical development of two major subfields of medical physics: radiation therapy and nuclear medicine. Indicates that radiation physics has made important contributions to solving biomedical problems in medical…

  20. Wolves, dogs, rearing and reinforcement: complex interactions underlying species differences in training and problem-solving performance.

    Science.gov (United States)

    Frank, Harry

    2011-11-01

    Frank and Frank et al. (1982-1987) administered a series of age-graded training and problem-solving tasks to samples of Eastern timber wolf (C. lupus lycaon) and Alaskan Malamute (C. familiaris) pups to test Frank's (Zeitschrift für Tierpsychologie 53:389-399, 1980) model of the evolution of information processing under conditions of natural and artificial selection. Results confirmed the model's prediction that wolves should perform better than dogs on problem-solving tasks and that dogs should perform better than wolves on training tasks. Further data collected at the University of Connecticut in 1983 revealed a more complex and refined picture, indicating that species differences can be mediated by a number of factors influencing wolf performance, including socialization regimen (hand-rearing vs. mother-rearing), interactive effects of socialization on the efficacy of both rewards and punishments, and the flexibility to select learning strategies that experimenters might not anticipate.

  1. [Problems of medical parasitology].

    Science.gov (United States)

    Sergiev, V P

    2013-01-01

    Situation on parasitic disease in Russia remains complex. Reduction of parasitology personnel had a negative impact on the quality of epidemiological control in the field of parasitic diseases and resulted in a decrease of awareness of physicians of therapeutic-prophylaxis institutions. The situation was aggravated by a lack of anti-malaria preparations and insufficient specter of anti-helminthic drugs. Uncontrolled increase of the number of domestic and stray dogs in cities was the reason for increase of morbidity by helminthoses and zoonoses--toxocarosis and dirofilariasis. Emergence in the south of Krasnodar Region of effective carriers Aedes aegypti, Aedes albopictus became a serious threat to biological safety of the country. These mosquitos are effective carriers of causative agents of mosquito viral fevers: yellow, Dengue, Chikungunya et al.

  2. A model of interprofessional problem-based learning for medical and nursing students: Implementation, evaluation and implications for future implementation.

    Science.gov (United States)

    Dreier-Wolfgramm, Adina; Homeyer, Sabine; Oppermann, Roman F; Hoffmann, Wolfgang

    2018-01-01

    Objective: In Germany there is little evidence of interprofessional problem-based learning (PBL) to date. For this reason a corresponding course for medical and nursing students was implemented. The goal was to analyse the feasibility and usefulness from the point of view of the students. Method: For the purposes of evaluation a quantitative observational study was conducted with a pre-course survey, a teaching evaluation and a post-course survey. The pre- and post-course surveys took place before the commencement of and after the conclusion of learning. The teaching evaluation was carried out after the conclusion of the interprofessional course. In total there were five medical students and five nursing students who took part. The descriptive data analysis was carried out using the statistics software package SPSS. The data from the open text fields was transcribed and evaluated using qualitative content analysis. Results: The students' assessment of the interprofessional PBL was predominantly positive. They stated that they were able to expand their knowledge of the roles of the other profession, that the interprofessional course had a positive effect in terms of mutual appreciation and that the tutor had a positive influence on the interprofessional PBL due to his cooperative learning support. Suggestions for improvement were concerned with the expansion of the interprofessional exchange and the establishment of a set timetable for the tutorials. Conclusion: The first study results of the Bildungscluster study can be used to make adjustments to the interprofessional PBL in order to be able to implement the course with a greater number of participants. Further studies are needed in order to comprehensively examine the learning effects and the impact on daily practice.

  3. Drug-related problems and changes in drug utilization after medication reviews in nursing homes in Oslo, Norway.

    Science.gov (United States)

    Fog, Amura Francesca; Kvalvaag, Gunnar; Engedal, Knut; Straand, Jørund

    2017-12-01

    We describe the drug-related problems (DRPs) identified during medication reviews (MRs) and the changes in drug utilization after MRs at nursing homes in Oslo, Norway. We explored predictors for the observed changes. Observational before-after study. Forty-one nursing homes. MRs performed by multidisciplinary teams during November 2011 to February 2014. In all, 2465 long-term care patients. DRPs identified by explicit criteria (STOPP/START and NORGEP) and drug-drug interaction database; interventions to resolve DRPs; drug use changes after MR. A total of 6158 DRPs were identified, an average of 2.6 DRPs/patient, 2.0 for regular and 0.6 for pro re nata (prn) drugs. Of these patients, 17.3% had no DRPs. The remaining 82.7% of the patients had on average 3.0 DRPs/patient. Use of unnecessary drugs (43.5%), excess dosing (12.5%) and lack of monitoring of the drug use (11%) were the most frequent DRPs. Opioids and psychotropic drugs were involved in 34.4% of all DRPs. The mean number of drugs decreased after the MR from 6.8 to 6.3 for regular drugs and from 3.0 to 2.6 for prn drugs. Patients with DRPs experienced a decrease of 1.1 drugs after MR (0.5 for regular and 0.6 for prn drugs). The reduction was most pronounced for the regular use of antipsychotics, antidepressants, hypnotics/sedatives, diuretics, antithrombotic agents, antacid drugs; and for prn use of anxiolytics, opioids, hypnotics/sedatives, metoclopramide and NSAIDs. The medication review resulted in less drug use, especially opioids and psychotropic drugs.

  4. [The topical problems pertaining to the performance of forensic medical expertise of the subjects suspected or accused of committing a crime and remaining in custody].

    Science.gov (United States)

    Pinchuk, P V; Ustiukhina, I A; Samchuk, V V

    2012-01-01

    The authors consider topical problems pertaining to the performance of forensic medical expertise of the subjects suspected or accused of committing a crime and remaining in custody. The discussion is focused on the organization of expertise and medical examination of such persons with the participation of personnel representing different clinical disciplines. The special emphasis is laid on the absence in the normative-legal basis of the well-specified criteria for the severity of disease, the degree of vital activity limitation, and duration of the treatment in specialized hospitals. The lack of such criteria hampers not only medical certification of the subjects suspected or accused of committing a crime and remaining in custody but also objective forensic medical estimation of their health status. Recommendations for addressing this problem and its resolution are proposed.

  5. Creating a Student-centered Learning Environment: Implementation of Problem-based Learning to Teach Microbiology to Undergraduate Medical Students

    Science.gov (United States)

    Basireddy, Parimala Reddy

    2018-01-01

    Introduction Medical education involves training necessary to become a physician or a surgeon. This includes various levels of training like undergraduate, internship, and postgraduate training. Medical education can be quite complex, since it involves training in pre-clinical subjects (anatomy, physiology, biochemistry), the para-clinical subjects (microbiology, pathology, pharmacology, and forensic medicine), and a discrete group of clinical subjects that include general medicine, surgery, obstetrics and gynaecology, ear, nose and throat specialization, paediatrics, cardiology, pulmonology, dermatology, ophthalmology, and orthopaedics, and many other clinical specializations and super specialities (cardio-thoracic surgery, neurosurgery, etc.). Training medical students involves both classroom teaching and practical applications. Classroom teaching is usually confined to didactic lectures, where the teacher unilaterally disseminates the information. This kind of teaching was recently noted to be not very effective in producing better quality medical graduates. The present study aims to introduce problem-based learning (PBL) to teach microbiology to undergraduate medical students and evaluate their perception towards such type of learning. Methods A total of 159 students were included in the study. An informed and oral consent was obtained from each participant, and the study was approved by the institutional ethical committee. All the students included in the study were grouped into 14 groups of 11-13 students. Students were carefully grouped ensuring that each group had a good mix that included different levels of achievers. Students were given a detailed introduction to the exercise before they started it. A questionnaire that consisted of 11 points was given to the students and they were asked to give feedback (strongly disagree, disagree, agree to some extent, agree, strongly agree) both on the functioning of PBL and the tutor performance during PBL

  6. Creating a Student-centered Learning Environment: Implementation of Problem-based Learning to Teach Microbiology to Undergraduate Medical Students.

    Science.gov (United States)

    Kandi, Venkataramana; Basireddy, Parimala Reddy

    2018-01-05

    Introduction Medical education involves training necessary to become a physician or a surgeon. This includes various levels of training like undergraduate, internship, and postgraduate training. Medical education can be quite complex, since it involves training in pre-clinical subjects (anatomy, physiology, biochemistry), the para-clinical subjects (microbiology, pathology, pharmacology, and forensic medicine), and a discrete group of clinical subjects that include general medicine, surgery, obstetrics and gynaecology, ear, nose and throat specialization, paediatrics, cardiology, pulmonology, dermatology, ophthalmology, and orthopaedics, and many other clinical specializations and super specialities (cardio-thoracic surgery, neurosurgery, etc.). Training medical students involves both classroom teaching and practical applications. Classroom teaching is usually confined to didactic lectures, where the teacher unilaterally disseminates the information. This kind of teaching was recently noted to be not very effective in producing better quality medical graduates. The present study aims to introduce problem-based learning (PBL) to teach microbiology to undergraduate medical students and evaluate their perception towards such type of learning. Methods A total of 159 students were included in the study. An informed and oral consent was obtained from each participant, and the study was approved by the institutional ethical committee. All the students included in the study were grouped into 14 groups of 11-13 students. Students were carefully grouped ensuring that each group had a good mix that included different levels of achievers. Students were given a detailed introduction to the exercise before they started it. A questionnaire that consisted of 11 points was given to the students and they were asked to give feedback (strongly disagree, disagree, agree to some extent, agree, strongly agree) both on the functioning of PBL and the tutor performance during PBL

  7. [Medical ethics under the bioethics' point of view: the moral surgical practice].

    Science.gov (United States)

    Antonio, Eliana Maria Restum; Fontes, Tereza Maria Pereira

    2011-01-01

    The professional practice of medicine today has a strong biological approach due to the increasing specialization of medical science. Often, science itself does not help to address and resolve a particular situation of a medical professional, and this is where human and social sciences, and especially other disciplines such as bioethics, can give a more humane and socialist approach, by systematically studying human behavior in the field of life and health sciences, considering moral values and principles. As part of this study, the segment that is limited to the analysis of ethical conflicts arising from the practice of medicine and patient care is known as medical ethics. Medical ethics, in the context of surgery, involves the integration of the surgical patient with the nature of the surgeon, influenced by his training and experience, his sensitivity to identify what is right. Ethics should not only be in the procedure, the surgery itself or in what happens in an operating room or even in the exercise of surgery as a specialty. Ethics must be in the life and conduct of the surgeon, so that all life and professional acts should be ethically valid.

  8. Bashing Positivism and Reversing a Medical Model under the Guise of Evidence

    Science.gov (United States)

    Wampold, Bruce E.

    2003-01-01

    In her advocacy of a model to train counseling psychologists as "evidence-based practitioners," Chwalisz (2003) (this issue) criticizes research based on positivism and advocates for methodological pluralism but ironically suggests the adoption of a medical model to influence the discourse on practice. In this comment, the author examines (a)…

  9. Los errores de medicación como un problema sanitario Medications errors as a health problem

    Directory of Open Access Journals (Sweden)

    María Antonieta Arbesú Michelena

    2008-08-01

    Full Text Available El error es inherente a la conducta humana y se debe a la concatenación de múltiples factores o fallos vinculados a los procesos y a los fallos latentes relacionados con los procederes de trabajo, los medios tecnológicos, las condiciones laborales, entre otras. Los errores de medicación son frecuentes, por lo que en este trabajo se realizó una descripción de reportes bibliográficos actualizados nacionales e internacionales con definiciones relacionadas con la temática, que demostró la importancia y la gravedad del problema para la seguridad del sistema sanitario, pues su detección y accionar mediante variadas iniciativas podrían disminuir su ocurrencia, ya que se sabe que una gran cantidad de los errores de medicación son triviales y no causan daño al paciente, sin embargo, sí constituyen un indicador de baja calidad de la asistencia sanitaria y por tanto, un problema sanitario.Errors are inherent to human behavior and they result from the concatenation of multiple factors or failures linked with the latent processes and deficiencies related to working procedures, technological means, labor conditions, etc. As the medication errors are common, a description of national and international updated bibliographic reports with definitions connected with this topic was made to show the importance and seriousness of the problem for the safety of the health system, since their detection and action by various initiatives could reduce their occurrence. It is known that a lot of errors are trivial and that they do not damage the patient; however, they are an indicator of low quality health care and, therefore, a health problem.

  10. Surgery or general medicine: a study of the reasons underlying the choice of medical specialty

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    Patrícia Lacerda Bellodi

    Full Text Available CONTEXT: The reality of medical services in Brazil points towards expansion and diversification of medical knowledge. However, there are few Brazilian studies on choosing a medical specialty. OBJECTIVE: To investigate and characterize the process of choosing the medical specialty among Brazilian resident doctors, with a comparison of the choice between general medicine and surgery. TYPE OF STUDY: Stratified survey. SETTING: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP. METHODS: A randomized sample of resident doctors in general medicine (30 and surgery (30 was interviewed. Data on sociodemographic characteristics and the moment, stability and reasons for the choice of specialty were obtained. RESULTS: The moment of choice between the two specialties differed. Surgeons (30% choose the specialty earlier, while general doctors decided progressively, mainly during the internship (43%. Most residents in both fields (73% general medicine, 70% surgery said they had considered another specialty before the current choice. The main reasons for general doctors' choice were contact with patients (50%, intellectual activities (30% and knowledge of the field (27%. For surgeons the main reasons were practical intervention (43%, manual activities (43% and the results obtained (40%. Personality was important in the choice for 20% of general doctors and for 27% of surgeons. DISCUSSION: The reasons found for the choice between general medicine and surgery were consistent with the literature. The concepts of wanting to be a general doctor or a surgeon are similar throughout the world. Personality characteristics were an important influencing factor for all residents, without statistical difference between the specialties, as was lifestyle. Remuneration did not appear as a determinant. CONCLUSION: The results from this group of Brazilian resident doctors corroborated data on choosing a medical specialty from other countries

  11. The system evaluation for report writing skills of summary by HGA-SVM with Ontology: Medical case study in problem based learning

    Science.gov (United States)

    Yenaeng, Sasikanchana; Saelee, Somkid; Samai, Wirachai

    2018-01-01

    The system evaluation for report writing skills of summary by Hybrid Genetic Algorithm-Support Vector Machines (HGA-SVM) with Ontology of Medical Case Study in Problem Based Learning (PBL) is a system was developed as a guideline of scoring for the facilitators or medical teacher. The essay answers come from medical student of medical education courses in the nervous system motion and Behavior I and II subject, a third year medical student 20 groups of 9-10 people, the Faculty of Medicine in Prince of Songkla University (PSU). The audit committee have the opinion that the ratings of individual facilitators are inadequate, this system to solve such problems. In this paper proposes a development of the system evaluation for report writing skills of summary by HGA-SVM with Ontology of medical case study in PBL which the mean scores of machine learning score and humans (facilitators) score were not different at the significantly level .05 all 3 essay parts contain problem essay part, hypothesis essay part and learning objective essay part. The result show that, the average score all 3 essay parts that were not significantly different from the rate at the level of significance .05.

  12. Collaborative diagramming during problem based learning in medical education: Do computerized diagrams support basic science knowledge construction?

    Science.gov (United States)

    De Leng, Bas; Gijlers, Hannie

    2015-05-01

    To examine how collaborative diagramming affects discussion and knowledge construction when learning complex basic science topics in medical education, including its effectiveness in the reformulation phase of problem-based learning. Opinions and perceptions of students (n = 70) and tutors (n = 4) who used collaborative diagramming in tutorial groups were collected with a questionnaire and focus group discussions. A framework derived from the analysis of discourse in computer-supported collaborative leaning was used to construct the questionnaire. Video observations were used during the focus group discussions. Both students and tutors felt that collaborative diagramming positively affected discussion and knowledge construction. Students particularly appreciated that diagrams helped them to structure knowledge, to develop an overview of topics, and stimulated them to find relationships between topics. Tutors emphasized that diagramming increased interaction and enhanced the focus and detail of the discussion. Favourable conditions were the following: working with a shared whiteboard, using a diagram format that facilitated distribution, and applying half filled-in diagrams for non-content expert tutors and\\or for heterogeneous groups with low achieving students. The empirical findings in this study support the findings of earlier more descriptive studies that diagramming in a collaborative setting is valuable for learning complex knowledge in medicine.

  13. Major health problems and their economic impact on beef cattle under two different feedlot systems in Brazil

    Directory of Open Access Journals (Sweden)

    Pedro Malafaia

    Full Text Available Abstract: This study aimed to describe the diagnosis of health problems and to evaluate the cost of their treatment for cattle raised in feedlots to be slaughtered or to be sold as sires for cow-calf systems. Bovine respiratory disease and digestive disorders were the main problems diagnosed in the feedlot for slaughter; the cost for treatment was high, accounting for 9.7 to 20.9 kg of live weight (LW or the equivalent of 7 to 15% of total LW gained over the days on feed. Due to the high intake of starch-rich concentrate, rumen and fecal pH was lower, whilst rumen osmolarity and blood lactate were higher in cattle fed for slaughter. Cattle affected by digestive disorders spent on average four additional days in the feedlot. Diseases and cost of treatments were associated with lower average daily gain and considerable economic losses. Health problems commonly observed in the feedlots for slaughter were not observed in the feedlots for males to be sold as sires. The most likely reason for this observation was the more careful nutrition and prophylactic health management in sire production systems, which produce animals of much higher selling price. Results from this study suggest that health problems found in feedlots for slaughter may not only reduce animal productivity and profitability, but also the welfare of the animals. The systemic understaffing of livestock cattle workers and veterinarians in large feedlots in Brazil results in under reporting of diseases and lack to understand epidemiological context and disease prevention.

  14. The politics of choice: roles of the medical profession under Nazi rule.

    Science.gov (United States)

    Lekisch, K; McDonald, J H

    1989-06-01

    In 1933, when Adolf Hitler took power, the German medical community was faced with intense crisis and change. Because social processes become more clearly defined in times of crisis, the days of Nazi rule offer an excellent opportunity to examine health care and moral issues. This article describes historical events that illustrate physicians' and medical students' role in the political process. In addition, we detail four types of responses made by physicians and students: flight, conformism, individual resistance, and group resistance. We conclude that if the role of physicians is to aid and protect patients against disease or experimentation on humans, then he or she must maintain heightened political awareness in order to deal with social crises before they overwhelm any response.

  15. Attitudes Towards Problem-Based Learning of Faculty Members at 12 U.S. Medical and Dental Schools: A Comparative Study.

    Science.gov (United States)

    Abdelkarim, Ahmad; Schween, Dorothy; Ford, Timothy

    2018-02-01

    Problem-based learning (PBL) is a teaching method used in medical and dental education to promote students' problem-solving skills. It may also be a viable tool for interprofessional education in which medical and dental students learn together, collaborate, and learn about, from, and with each other. The aim of this study was to compare medical and dental faculty members' attitudes about and perceptions of PBL at 12 U.S. medical and dental schools known to use PBL. In 2015, 111 medical and 132 dental faculty members (combined n=243) from six medical and six dental schools completed a survey containing ten statements and an open comment section. The response rate was 42% of those who received the survey. In the results, the medical faculty participants showed significantly higher enthusiasm for and agreement with PBL benefits than did the dental faculty participants (p˂0.05). The two groups agreed that PBL should be used to supplement conventional teaching (p>0.05). There were no opposite attitudes or contrasts found between the two groups with regards to PBL. The strongest themes expressed by both groups were that PBL should not be used as the sole method of instruction and that students needed a solid foundation in the subject prior to engaging in PBL.

  16. Incidence of childhood cancer among Mexican children registered under a public medical insurance program.

    Science.gov (United States)

    Rivera-Luna, Roberto; Correa-González, Cecilia; Altamirano-Alvarez, Eduardo; Sánchez-Zubieta, Fernando; Cárdenas-Cardós, Rocio; Escamilla-Asian, Gabriela; Olaya-Vargas, Alberto; Bautista-Marquez, Aurora; Aguilar-Romo, Manuel

    2013-04-01

    Prior to 2005, 51% of children in Mexico diagnosed with cancer received no standardized optimal multidisciplinary medical care. A government-subsidized national cancer treatment program was therefore created for these patients and a National Cooperative Childhood Cancer Treatment Group was consequently formed for these patients. Pediatric patients with a proven diagnosis of leukemia, lymphoma or solid tumor and who were registered in the Popular Medical Insurance (PMI) program from January 2007 to December 2010, are described in this report. These patients had been enrolled and registered in one of the 49 nationwide certified medical institutions in Mexico. The national incidence and frequency data for childhood cancers were analyzed for the whole program. At the end of a 4-year study, the analysis revealed that 8,936 children from across Mexico had been diagnosed with cancer. The incidence rate for the PMI patients was 150.3/million/year (2010) for children of 0-18 years. The highest age incidence rate was 51.9 between 0 and 4 years and boys were the predominant group for all types of cancer. The leukemia incidence was 75.3/million/year (2010), and an average frequency of 50.75% throughout the 4 years. The overall mortality rate was measured at 5.4/100,000/year (2010). This study demonstrates a high frequency and incidence of childhood cancer and a beneficial impact of the PMI program over the quality of life in these children. Copyright © 2012 UICC.

  17. Rheological analysis of irradiated crosslinkable and scissionable polymers used for medical devices under different radiation conditions

    Science.gov (United States)

    Satti, A. J.; Ressia, J. A.; Cerrada, M. L.; Andreucetti, N. A.; Vallés, E. M.

    2018-03-01

    The effects on different synthetic polymers of distinct types of radiation, gamma rays and electron beam, under different atmospheres are followed by changes in their viscoelastic behavior. Taking into account the two main radioinduced reactions, crosslinking and scissioning of polymeric chains, liquid polydimethylsiloxane has been used as example of crosslinkable polymer and semi crystalline polypropylene as example of scissionable polymer. Propylene - 1-hexene copolymers have been also evaluated, and the effects of both reactions were clearly noticed. Accordingly, samples of those aforementioned polymers have been irradiated with 60Co gamma irradiation in air and under vacuum, and also with electron beam, at similar doses. Sinusoidal dynamic oscillation experiments showed a significant increase in branching and crosslinking reactions when specimens are irradiated under vacuum, while scissioning reactions were observed for the different polymers when irradiation takes place under air with either gamma irradiation or electron beam.

  18. OFSETH: smart medical textile for continuous monitoring of respiratory motions under magnetic resonance imaging.

    Science.gov (United States)

    De Jonckheere, J; Narbonneau, F; Jeanne, M; Kinet, D; Witt, J; Krebber, K; Paquet, B; Depre, A; Logier, R

    2009-01-01

    The potential impact of optical fiber sensors embedded into medical textiles for the continuous monitoring of the patient during Magnetic Resonance Imaging is presented. We report on two pure optical sensing technologies for respiratory movements monitoring - a macro bending sensor and a Bragg grating sensor, designed to measure the elongation due to abdominal and thoracic motions during breathing. We demonstrate that the two sensors can successfully sense textile elongation between, 0% and 3%, while maintaining the stretching properties of the textile substrates for a good comfort of the patient.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-02-15

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

  20. A formative evaluation of problem-based learning as an instructional strategy in a medical laboratory technician course

    Science.gov (United States)

    Nelson, Diane Patricia

    2002-09-01

    This study is a formative evaluation of problem-based learning as an effective course delivery strategy in a second year introductory Medical Laboratory Technician discipline-specific hematology course. This strategy can serve two purposes in this type of course: discipline specific content knowledge and process skills learning. A needs study identified that students required additional workplace skills as they entered the clinical internship. Students tested well on the national registry examinations, discipline-specific content knowledge, but group process skills needed improvement in the areas of collaboration, communication, and critical reasoning. Problem-based learning was identified as an change intervention to help provide these skills. A search of the literature revealed that the Baker College cultural and physical environment would support this intervention. Twelve cases were written, situated in a clinical laboratory environment, addressing learning issues identified in a modified Delphi survey of laboratory personnel e.g. fiscal responsibility, turn-around time, invasiveness of laboratory techniques, and holistic view of healthcare environment. A hematology class of 13 students received the intervention. The cases were structured to proceed from instructor-centered (guided) learning issues to learner-centered learning issues. Observations of the in-group collaboration processes were documented, as well as oral presentations and critical reasoning, with students given periodic feedback on these skills. Student surveys provided data about satisfaction, attitude to PBL process, and self-efficacy. Multiple choice discipline-specific content examinations were given and compared with classes from the previous four years. The study found that students receiving the PBL treatment scored as well as or better than students from previous years on traditional multiple choice exams. Recall questions showed positive significance and application/analysis questions