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Sample records for underlying medical problems

  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. 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

  3. [Medical problems of musicians].

    Science.gov (United States)

    van de Wiel, Albert; Rietveld, Boni

    2010-01-01

    Most individuals enjoy making music, but pleasure may be diminished by physical complaints. The most common complaints in musicians include injuries of the upper part of the body including the shoulder and spine, skin disorders and hearing problems. Injuries are not so much related to the extent of rehearsing and playing but are mostly the result of a wrong position and misuse of the instrument. Adequate preparation before playing and professional coaching to avoid injuries or to detect problems at an early stage are exceptions rather than the rule. Because of the large number of amateur and professional musicians in the Netherlands, music medicine deserves a more prominent role.

  4. Statistical problems in medical research

    African Journals Online (AJOL)

    STORAGESEVER

    2008-12-29

    Dec 29, 2008 ... medical research, there are some common problems in using statistical methodology which may result ... optimal combination of diagnostic tests for osteoporosis .... randomization used include stratification and minimize-.

  5. Therminological problems in medical thermography

    International Nuclear Information System (INIS)

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

    1988-01-01

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

  6. Therminological problems in medical thermography

    Energy Technology Data Exchange (ETDEWEB)

    Rozenfel' d, L G; Kolotilov, N N

    1988-01-01

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

  7. Revisiting the medical diagnosis problem

    DEFF Research Database (Denmark)

    Ejersbo, Lisser Rye; Leron, Uri

    2014-01-01

    in the context of probability, with special focus on one case study – the Medical Diagnosis Problem – which figures prominently in the cognitive psychology research literature and in the so-called rationality debate. Our case study involves a combination of theory, design and experiment: Using the extensive...... 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...

  8. Medical Tests for Prostate Problems

    Science.gov (United States)

    ... walnut-shaped gland that is part of the male reproductive system. It has two or more lobes, or sections, ... treating problems of the urinary tract and the male reproductive system. Abdominal Ultrasound Ultrasound uses a device, called a ...

  9. The underinvestment problem under conglomeration

    Directory of Open Access Journals (Sweden)

    Jacques A. Schnabel

    2015-12-01

    Full Text Available This theoretical paper explores whether the underinvestment problem is aggravated or ameliorated by the formation of a pure conglomerate. It establishes that the answer depends critically on the volatility of corporate assets. If volatility is low, conglomeration ameliorates the underinvestment problem, whereas if volatility is high, conglomeration aggravates the underinvestment problem. These analytical results are then invoked as a potential explanation for the ambiguous conclusions of empirical studies that delve into the existence of a conglomerate discount.

  10. Testing Under Fire: Chicago's Problem.

    Science.gov (United States)

    Byrd, Manford, Jr.

    The history and development of city-wide testing programs in Chicago since 1936 are reviewed and placed in context with the impact on testing of Sputnik and the passage of the National Defense Education Act of 1958. Current testing problems include the time lag between events and curricular changes and new test construction, the time lag between…

  11. Medical problems of survivors of nuclear war

    International Nuclear Information System (INIS)

    Abrams, H.L.; Von Kaenel, W.E.

    1981-01-01

    The nature of the medical problems that may confront survivors of a nuclear war are discussed with emphasis on infection and the spread of communicable disease. Factors which will increase the risk and severity of infection include: radiation, trauma and burns, malnutrition and starvation, dehydration, exposure, and hardship. Factors which will increase the spread of disease include: crowded shelter conditions, poor sanitation, insects, corpses, free-roaming diseased animals. Shortages of physicians, the destruction of laboratories, and the general disorganization sure to follow the attack will also contribute to the problems. The authors recommend further study in this area

  12. 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

  13. Ancient medical texts, modern reading problems

    Directory of Open Access Journals (Sweden)

    Maria Carlota Rosa

    2006-12-01

    Full Text Available The word tradition has a very specific meaning in linguistics: the passing down of a text, which may have been completed or corrected by different copyists at different times, when the concept of authorship was not the same as it is today. When reading an ancient text the word tradition must be in the reader's mind. To discuss one of the problems an ancient text poses to its modern readers, this work deals with one of the first printed medical texts in Portuguese, the Regimento proueytoso contra ha pestenença, and draws a parallel between it and two related texts, A moche profitable treatise against the pestilence, and the Recopilaçam das cousas que conuem guardar se no modo de preseruar à Cidade de Lixboa E os sãos, & curar os que esteuerem enfermos de Peste. The problems which arise out of the textual structure of those books show how difficult is to establish a tradition of another type, the medical tradition. The linguistic study of the innumerable medieval plague treatises may throw light on the continuities and on the disruptions of the so-called hippocratic-galenical medical tradition.

  14. Organizing of medical ensurance of human population under extreme conditions. Summaries of reports of scientific-practical conference

    International Nuclear Information System (INIS)

    1994-01-01

    Summary of reports are presented of Scientific-Practical conference on the organizing of medical ensurance of human population under extreme conditions including radiation accidents. The conference held in Moscow in October, 1994. It covered problems of organizing medical ensurance of population, medical surveillance problems, sanitary-hygienic and epidemiological problems (including radiation protection), and medical provision problems under extreme conditions

  15. Safety problems with the use of medical equipment/devices

    NARCIS (Netherlands)

    Rademakers, C.

    2009-01-01

    In the past decennia medical technology has rapidly developed. Nowadays it plays an important role in all medical fields. It introduced technologic solutions for many medical problems and it definitely increased the possibilities in the medical field to increase the quality of life. However with

  16. Narrow Lead Aprons under Medical Fluoroscopy Procedures

    International Nuclear Information System (INIS)

    Ben-Shlomo, A.

    2014-01-01

    Lead aprons are the major protective item of the medical staff whose work involves x-ray exposure. Heart catheterization and angiography procedures represent the most common exposures of the medical staff. The lead equivalent thickness of lead aprons worn by the medical staff is defined by many national standards. The frontal side of the aprons should be 0.25 mm lead equivalent at working conditions under 100 kV, 0.35 mm for working conditions above 100 kV, and 0.5 mm for heart catheterization and angiography. The back side of the body needs less protection and usually is covered by 0.25 mm of lead equivalent. The lead equivalent thickness is defined at the 80 kV level

  17. Contraception in women with medical problems

    Science.gov (United States)

    Dhanjal, Mandish K

    2008-01-01

    Women with medical disease have a higher incidence of maternal mortality compared with healthy women, with cardiac disease now being the most common cause of maternal death in the UK. A handful of medical conditions exist where pregnancy is not recommended due to mortality rates approaching 50%. It is imperative that such women have the most reliable methods of contraception available. Contraceptive agents may themselves affect medical disease, or may interact with medications used by such women. There may be a range of contraceptive agents suitable for each medical condition. The contraceptive selected should be tailored to suit the individual. The following points should be considered when deciding on the most appropriate contraceptive agent: efficacy, thrombotic risk (oestrogen containing contraceptives), arterial risks (oestrogen containing contraceptives), infective risk (e.g. insertion of intrauterine device [IUD]), vagal stimulation (e.g. insertion of IUD, ESSURE®), bleeding risks with patients on anticoagulants, interaction with concomitant drugs, effects of anaesthesia and ease of use. This review aims to cover the different contraceptive agents available and the best ones to use for certain medical illnesses. PMID:27582790

  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. Statistical Problems In Medical Research | Okeh | East African ...

    African Journals Online (AJOL)

    Given the main role of a general practitioner as a biostatistician, I thought it would be of interest to enumerate statistical problems in assessing methods of medical diagnosis in general terms. In conducting and reporting of medical research, there are some common problems in using statistical methodology which may result ...

  20. 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.

  1. 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.

  2. 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.

  3. Medical device problem reporting for the betterment of healthcare.

    Science.gov (United States)

    1998-08-01

    Given that there are nearly 5,000 individual classes of medical devices, tens of thousands of medical device suppliers, and millions of healthcare providers around the world, device-related problems are bound to happen. But effective problem reporting can help reduce or eliminate many of these problems--not only within an institution, but also potentially around the world. In this article, we trace the problem reporting process from its beginnings in the hospital to its global impact in making critical information available throughout the healthcare community.

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

    African Journals Online (AJOL)

    characteristics, psychiatric illness, and some types of physical illness. ... to poor sleep qualities are significant problems among medical students in our institution. Caffeine and .... prepare for post graduation and also get to play a role (albeit a.

  5. Bladder Control Problems: Medications for Treating Urinary Incontinence

    Science.gov (United States)

    ... control problems, including how they work to treat urinary incontinence and possible side effects. By Mayo Clinic Staff ... a look at medications commonly prescribed to treat urinary incontinence and their possible side effects. Keep in mind ...

  6. 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.

  7. 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.

  8. Radiotherapy problem under fuzzy theoretic approach

    International Nuclear Information System (INIS)

    Ammar, E.E.; Hussein, M.L.

    2003-01-01

    A fuzzy set theoretic approach is used for radiotherapy problem. The problem is faced with two goals: the first is to maximize the fraction of surviving normal cells and the second is to minimize the fraction of surviving tumor cells. The theory of fuzzy sets has been employed to formulate and solve the problem. A linguistic variable approach is used for treating the first goal. The solutions obtained by the modified approach are always efficient and best compromise. A sensitivity analysis of the solutions to the differential weights is given

  9. 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 ...

  10. Self-Assessment of Problem Solving Disposition in Medical Students

    OpenAIRE

    Olivares-Olivares, Silvia Lizett; López-Cabrera, Mildred Vanessa

    2014-01-01

    Medical schools are committed to both students and society to develop capabilities required to succeed in health care environments. Present diagnosis and treatment methods become obsolete faster, demanding that medical schools incorporate competency-based education to keep pace with future demands. This study was conducted to assess the problem solving disposition of medical students. A three-subcategory model of the skill is proposed. The instrument was validated on content by a group of 17 ...

  11. Problems of radiation protection at medical use of radiation equipment

    International Nuclear Information System (INIS)

    Larwin, K.

    1979-01-01

    For medical use of radiation equipment man is not only operator, but also object (patient). The question, if or how much it is necessary to expose the patient, is a medical problem and therefore not to be discussed here. For the user of medical equipments we have often special conditions. For many diagnostic applications the physician has to stay in the application room in contact with the patient. As a typical example for the problems of radiation protection there is discussed the situation on a well known fluoroscopic unit for lung and stomach examinations. (author)

  12. 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

  13. Effect of smartphone overuse on sleep problems in medical students

    OpenAIRE

    Pairoj Boonluksiri

    2018-01-01

    Background: Smartphones are used worldwide. Consequently, it does seem to be having an impact on health-related problems if overused. However, it is uncertain whether it is associated with sleep problems or poor learning. Objective: To determine the association between smartphone overuse and sleep problems in medical students as primary outcome and poor learning as secondary outcome. Methods: A cross-sectional study was conducted in 89 students having their own smartphones, at Hatyai...

  14. 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.

  15. Self-Assessment of Problem Solving Disposition in Medical Students

    Directory of Open Access Journals (Sweden)

    Silvia Lizett Olivares-Olivares

    2014-01-01

    Full Text Available Medical schools are committed to both students and society to develop capabilities required to succeed in health care environments. Present diagnosis and treatment methods become obsolete faster, demanding that medical schools incorporate competency-based education to keep pace with future demands. This study was conducted to assess the problem solving disposition of medical students. A three-subcategory model of the skill is proposed. The instrument was validated on content by a group of 17 experts in medical education and applied to 135 registered students on the sixth year of the M.D. Physician Surgeon program at a private medical school. Cronbach’s alpha indicated an internal consistency of 0.751. The findings suggest that selected items have both homogeneity and validity. The factor analysis resulted in components that were associated with three problem-solving subcategories. The students’ perceptions are higher in the pattern recognition and application of general strategies for problem solving subcategories of the Problem solving disposition model.

  16. 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.

  17. 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.

  18. [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

  19. Effect of smartphone overuse on sleep problems in medical students

    Directory of Open Access Journals (Sweden)

    Pairoj Boonluksiri

    2018-05-01

    Full Text Available Background: Smartphones are used worldwide. Consequently, it does seem to be having an impact on health-related problems if overused. However, it is uncertain whether it is associated with sleep problems or poor learning. Objective: To determine the association between smartphone overuse and sleep problems in medical students as primary outcome and poor learning as secondary outcome. Methods: A cross-sectional study was conducted in 89 students having their own smartphones, at Hatyai Medical Education Centre, Thailand. The habits of using smartphone were obtained. Smartphone overuse during bedtime was defined as using longer than 1 hour according to Smartphone Addiction Scale (SAS. The primary outcome was napping in a classroom that was defined as a problem if it happened more than 20% of the time attending class. Sleep problems using Pittsburgh Sleep Quality Index (PSQI and Epworth Sleepiness Scale (ESS were obtained by self-assessment. Learning outcome measured by grade point average was the secondary outcome. Multivariable analysis was performed for the association between smartphone overuse and sleep problems. Results: Of all students, 77.5% had sleep problems and 43.6% had napped in the classroom. No personal characteristics, daily life behaviours, and physical environments were associated with sleep problems. 70.8% of all students found to over use smartphones during bedtime. The Facebook website was the most popular. Smartphone overuse was significantly associated with poor sleep quality (odds ratio= 3.46 and napping in the classroom (odds ratio=4.09 but not grade point average. Conclusion: Smartphone overuse during bedtime in medical students is associated with sleep problems but not learning achievement.

  20. 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.

  1. Medical Problem-Solving: A Critique of the Literature.

    Science.gov (United States)

    McGuire, Christine H.

    1985-01-01

    Prescriptive, decision-analysis of medical problem-solving has been based on decision theory that involves calculation and manipulation of complex probability and utility values to arrive at optimal decisions that will maximize patient benefits. The studies offer a methodology for improving clinical judgment. (Author/MLW)

  2. 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

  3. Sleep-related problems in common medical conditions.

    Science.gov (United States)

    Parish, James M

    2009-02-01

    Common medical problems are often associated with abnormalities of sleep. Patients with chronic medical disorders often have fewer hours of sleep and less restorative sleep compared to healthy individuals, and this poor sleep may worsen the subjective symptoms of the disorder. Individuals with lung disease often have disturbed sleep related to oxygen desaturations, coughing, or dyspnea. Both obstructive lung disease and restrictive lung diseases are associated with poor quality sleep. Awakenings from sleep are common in untreated or undertreated asthma, and cause sleep disruption. Gastroesophageal reflux is a major cause of disrupted sleep due to awakenings from heartburn, dyspepsia, acid brash, coughing, or choking. Patients with chronic renal disease commonly have sleep complaints often due to insomnia, insufficient sleep, sleep apnea, or restless legs syndrome. Complaints related to sleep are very common in patients with fibromyalgia and other causes of chronic pain. Sleep disruption increases the sensation of pain and decreases quality of life. Patients with infectious diseases, including acute viral illnesses, HIV-related disease, and Lyme disease, may have significant problems with insomnia and hypersomnolence. Women with menopause have from insomnia, sleep-disordered breathing, restless legs syndrome, or fibromyalgia. Patients with cancer or receiving cancer therapy are often bothered by insomnia or other sleep disturbances that affect quality of life and daytime energy. The objective of this article is to review frequently encountered medical conditions and examine their impact on sleep, and to review frequent sleep-related problems associated with these common medical conditions.

  4. PROBLEMS OF IT DEPARTMENT IN A MEDICAL UNIVERSITY

    Directory of Open Access Journals (Sweden)

    V. Ya Gelman

    2017-01-01

    Full Text Available The aim of the study is the analysis of the problems faced by heads and staff of IT departments in medical universities. Methodology and research methods. The methods involve expert estimation, analysis and generalization of practical work experience of IT departments. Results and scientific novelty. The main aspects and specifics of professional activity of IT departments of modern medical schools are designated. The approaches to the definition of the hierarchy of goals in the professional activities of the department, as well as quantitative and qualitative indicators that assess the effectiveness of their achievements are analyzed. The contradictions arising between long-term and short-term goals of the IT department are highlighted. The main challenges which heads of IT departments can deal with in the course of day-to-day management work planning are described. The problems arising in educational, educational-methodical and scientific work of department, in its economic activity, solution of personnel affairs, and aspects of material support are considered. The possible solutions to these problems are proposed. Practical significance. The results of the analysis, proposed approaches and practical recommendations will enable to better organize the work of the IT department in a medical school. The advantage of the proposed approaches consists in their versatility: with some adjustment, they can be used by other departments, regardless of the specifics and the type of educational institution.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. [Problems in organization of medical criminological registration and personality identification for subjects occupationally exposed to life risk].

    Science.gov (United States)

    Shcherbakov, V V

    2000-01-01

    The paper discusses problems in organization of identification studies under conditions of mass deaths as exemplified by forensic medical records of medical criminological identification studies of subjects killed during war conflict in Chechnya. The evolution of the organization model of identification studies is shown transformation of organization philosophy, formation of expert algorithms, formalization and technologic realization of expert solutions.

  11. 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.

  12. The agency problem and medical acting: an example of applying economic theory to medical ethics.

    Science.gov (United States)

    Langer, Andreas; Schröder-Bäck, Peter; Brink, Alexander; Eurich, Johannes

    2009-03-01

    In this article, the authors attempt to build a bridge between economic theory and medical ethics to offer a new perspective to tackle ethical challenges in the physician-patient encounter. They apply elements of new institutional economics to the ethically relevant dimensions of the physician-patient relationship in a descriptive heuristic sense. The principal-agent theory can be used to analytically grasp existing action problems in the physician-patient relationship and as a basis for shaping recommendations at the institutional level. Furthermore, the patients' increased self-determination and modern opportunities for the medical laity to inform themselves lead to a less asymmetrical distribution of information between physician and patient and therefore require new interaction models. Based on the analysis presented here, the authors recommend that, apart from the physician's necessary individual ethics, greater consideration should be given to approaches of institutional ethics and hence to incentive systems within medical ethics.

  13. 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.

  14. 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

  15. Three-player quantum Kolkata restaurant problem under decoherence

    Science.gov (United States)

    Ramzan, M.

    2013-01-01

    Effect of quantum decoherence in a three-player quantum Kolkata restaurant problem is investigated using tripartite entangled qutrit states. Different qutrit channels such as, amplitude damping, depolarizing, phase damping, trit-phase flip and phase flip channels are considered to analyze the behaviour of players payoffs. It is seen that Alice's payoff is heavily influenced by the amplitude damping channel as compared to the depolarizing and flipping channels. However, for higher level of decoherence, Alice's payoff is strongly affected by depolarizing noise. Whereas the behaviour of phase damping channel is symmetrical around 50% decoherence. It is also seen that for maximum decoherence ( p = 1), the influence of amplitude damping channel dominates over depolarizing and flipping channels. Whereas, phase damping channel has no effect on the Alice's payoff. Therefore, the problem becomes noiseless at maximum decoherence in case of phase damping channel. Furthermore, the Nash equilibrium of the problem does not change under decoherence.

  16. 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.

  17. 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

  18. Approximation Algorithms for the Highway Problem under the Coupon Model

    Science.gov (United States)

    Hamane, Ryoso; Itoh, Toshiya; Tomita, Kouhei

    When a store sells items to customers, the store wishes to decide the prices of items to maximize its profit. Intuitively, if the store sells the items with low (resp. high) prices, the customers buy more (resp. less) items, which provides less profit to the store. So it would be hard for the store to decide the prices of items. Assume that the store has a set V of n items and there is a set E of m customers who wish to buy the items, and also assume that each item i ∈ V has the production cost di and each customer ej ∈ E has the valuation vj on the bundle ej ⊆ V of items. When the store sells an item i ∈ V at the price ri, the profit for the item i is pi = ri - di. The goal of the store is to decide the price of each item to maximize its total profit. We refer to this maximization problem as the item pricing problem. In most of the previous works, the item pricing problem was considered under the assumption that pi ≥ 0 for each i ∈ V, however, Balcan, et al. [In Proc. of WINE, LNCS 4858, 2007] introduced the notion of “loss-leader, ” and showed that the seller can get more total profit in the case that pi < 0 is allowed than in the case that pi < 0 is not allowed. In this paper, we consider the line highway problem (in which each customer is interested in an interval on the line of the items) and the cycle highway problem (in which each customer is interested in an interval on the cycle of the items), and show approximation algorithms for the line highway problem and the cycle highway problem in which the smallest valuation is s and the largest valuation is l (this is called an [s, l]-valuation setting) or all valuations are identical (this is called a single valuation setting).

  19. 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.

  20. 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.

  1. Minimization under entropy conditions, with applications in lower bound problems

    International Nuclear Information System (INIS)

    Toft, Joachim

    2004-01-01

    We minimize the functional f->∫ afdμ under the entropy condition E(f)=-∫ f log fdμ≥E, ∫ fdμ=1 and f≥0, where E is a member of R is fixed. We prove that the minimum is attained for f=e -sa /∫ e -sa dμ, where s is a member of R is chosen such that E(f)=E. We apply the result on minimizing problems in pseudodifferential calculus, where we minimize the harmonic oscillator

  2. Robust Optimization Model for Production Planning Problem under Uncertainty

    Directory of Open Access Journals (Sweden)

    Pembe GÜÇLÜ

    2017-01-01

    Full Text Available Conditions of businesses change very quickly. To take into account the uncertainty engendered by changes has become almost a rule while planning. Robust optimization techniques that are methods of handling uncertainty ensure to produce less sensitive results to changing conditions. Production planning, is to decide from which product, when and how much will be produced, with a most basic definition. Modeling and solution of the Production planning problems changes depending on structure of the production processes, parameters and variables. In this paper, it is aimed to generate and apply scenario based robust optimization model for capacitated two-stage multi-product production planning problem under parameter and demand uncertainty. With this purpose, production planning problem of a textile company that operate in İzmir has been modeled and solved, then deterministic scenarios’ and robust method’s results have been compared. Robust method has provided a production plan that has higher cost but, will result close to feasible and optimal for most of the different scenarios in the future.

  3. Quality Assessment of Medical Apps that Target Medication-Related Problems.

    Science.gov (United States)

    Loy, John Shiguang; Ali, Eskinder Eshetu; Yap, Kevin Yi-Lwern

    2016-10-01

    The advent of smartphones has enabled a plethora of medical apps for disease management. As of 2012, there are 40,000 health care-related mobile apps available in the market. Since most of these medical apps do not go through any stringent quality assessment, there is a risk of consumers being misinformed or misled by unreliable information. In this regard, apps that target medication-related problems (MRPs) are not an exception. There is little information on what constitutes quality in apps that target MRPs and how good the existing apps are. To develop a quality assessment tool for evaluating apps that target MRPs and assess the quality of such apps available in the major mobile app stores (iTunes and Google Play). The top 100 free and paid apps in the medical categories of iTunes and Google Play stores (total of 400 apps) were screened for inclusion in the final analysis. English language apps that targeted MRPs were downloaded on test devices to evaluate their quality. Apps intended for clinicians, patients, or both were eligible for evaluation. The quality assessment tool consisted of 4 sections (appropriateness, reliability, usability, privacy), which determined the overall quality of the apps. Apps that fulfilled the inclusion criteria were classified based on the presence of any 1 or more of the 5 features considered important for apps targeting MRPs (monitoring, interaction checker, dose calculator, medication information, medication record). Descriptive statistics and Mann-Whitney tests were used for analysis. Final analysis was based on 59 apps that fulfilled the study inclusion criteria. Apps with interaction checker (66.9%) and monitoring features (54.8%) had the highest and lowest overall qualities. Paid apps generally scored higher for usability than free apps (P = 0.006) but lower for privacy (P = 0.003). Half of the interaction checker apps were unable to detect interactions with herbal medications. Blood pressure and heart rate monitoring apps

  4. 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".

  5. 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".

  6. Teaching nutrition to medical students: a community-based problem-solving approach.

    Science.gov (United States)

    Bhattacharji, S; Joseph, A; Abraham, S; Muliyil, J; John, K R; Ethirajan, N

    1990-01-01

    This paper presents a community-based problem-solving educational programme which aims at teaching medical and other health science students the importance of nutrition and its application. Through community surveys students assess the nutritional status of children under five using different anthropometric methods. They understand the cultural beliefs and customs related to food fads and the reasons for them. They also acquire the skill to educate the community using the information gathered. They use epidemiological methods such as case control study to find associations between malnutrition and other causative factors. Feedback from students has been positive and evaluation of students' knowledge before and after the programme has shown significant improvement.

  7. Treatment countermeasures for common problems in dacryocystorhinostomy under nasal endoscope

    Directory of Open Access Journals (Sweden)

    Zhong-Ling Luo

    2014-04-01

    Full Text Available AIM: To discuss the common problems and treatment countermeasures in dacryocystorhinostomy under nasal endoscope.METHODS: The clinical data of 37 cases(43 eyesof postoperative dacryocystorhinostomy under nasal endoscope, by using high-frequency electric knife to open the nasal mucosa, hemostasis in surgery, burning fixed lacrimal sac mucosal flap and nasal mucosal flap, methylene blue staining of the lacrimal sac, lacrimal drainage tube implanted and expansion foam support fixed anastomotic methods were reviewed in our hospital from Mar. 2011 to June. 2013. The effects of surgery were observed, and the intraoperative common questions and the treatments were discussed.RESULTS: In the 37 cases(43 eyes, 42 eyes(97.7%were cured, and 1 eye was improved, and the total efficiency was 100%. All operations were successfully completed without any serious complications during surgery.CONCLUSION: The common complication in dacryocystorhinostomy under nasal endoscope are effectively treated and the success rates of surgery are improved, by using high-frequency electric knife to open the nasal mucosa, hemostasis in surgery, burning fixed lacrimal sac mucosal flap and nasal mucosal flap, methylene blue staining of the lacrimal sac, lacrimal drainage tube implanted and expansion foam support fixed anastomotic methods. These methods are worthy of application and promotion.

  8. Professional development of medical students: problems and promises.

    Science.gov (United States)

    Wear, D

    1997-12-01

    Observers and critics of the medical profession, both within and without, urge that more attention be paid to the moral sensibilities, the characters, of medical students. Passing on particular moral values and actions to physicians has always been an essential core of medical training, and this call for renewal is not new in modern medicine. Some of the structures and characteristics of modern medical education, however, often work directly against the professionalism that the education espouses. For example, medical students are socialized into a hierarchy that has broad implications for relations among health care professionals, other health care workers, and patients, and academic medicine has not promoted and taught critical reflection about the values and consequences of this hierarchy. Further, behind the formal curriculum lies the "hidden curriculum" of values that are unconsciously or half-consciously passed on from the faculty and older trainees. Two resources for thinking anew about professional development for medical students are feminist standpoint theory and critical multicultural theory, each of which raises important and fundamental questions about defining the role of medicine in society and the role of the physician in medicine. The author discusses these two theories and their implications for medical education, showing how they can be used to move discussions of professional development into analysis of the widespread social consequences of how a society organizes its health care and into critical reflection on the nature of medical knowledge.

  9. [Problems of safety regulation under radioactive waste management in Russia].

    Science.gov (United States)

    Monastyrskaia, S G; Kochetkov, O A; Barchukov, V G; Kuznetsova, L I

    2012-01-01

    Analysis of the requirements of Federal Law N 190 "About radioactive waste management and incorporation of changes into some legislative acts of the Russian Federation", as well as normative-legislative documents actual and planned to be published related to provision of radiation protection of the workers and the public have been done. Problems of safety regulation raised due to different approaches of Rospotrebnadzor, FMBA of Russia, Rostekhnadzor and Minprirody with respect to classification and categorization of the radioactive wastes, disposal, exemption from regulatory control, etc. have been discussed in the paper. Proposals regarding improvement of the system of safety regulation under radioactive waste management and of cooperation of various regulatory bodies have been formulated.

  10. 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

  11. Impact of Pharmacist-Conducted Comprehensive Medication Reviews for Older Adult Patients to Reduce Medication Related Problems.

    Science.gov (United States)

    Kiel, Whitney J; Phillips, Shaun W

    2017-12-31

    Older adults are demanding increased healthcare attention with regards to prescription use due in large part to highly complex medication regimens. As patients age, medications often have a more pronounced effect on older adults, negatively impacting patient safety and increasing healthcare costs. Comprehensive medication reviews (CMRs) optimize medications for elderly patients and help to avoid inappropriate medication use. Previous literature has shown that such CMRs can successfully identify and reduce the number of medication-related problems and improve acute healthcare utilization. The purpose of this pharmacy resident research study is to examine the impact of pharmacist-conducted geriatric medication reviews to reduce medication-related problems within a leading community health system in southwest Michigan. Furthermore, the study examines type of pharmacist interventions made during medication reviews, acute healthcare utilization, and physician assessment of the pharmacist's value. The study was conducted as a retrospective post-hoc analysis on ambulatory patients who received a CMR by a pharmacist at a primary care practice. Inclusion criteria included patients over 65 years of age with concurrent use of at least five medications who were a recent recipient of a CMR. Exclusion criteria included patients with renal failure, or those with multiple providers involved in primary care. The primary outcome was the difference in number of medication-related problems, as defined by the START and STOPP Criteria (Screening Tool to Alert doctors to Right Treatment/Screening Tool of Older Persons' Prescriptions). Secondary outcomes included hospitalizations, emergency department visits, number and type of pharmacist interventions, acceptance rate of pharmacist recommendations, and assessment of the pharmacist's value by clinic providers. There were a total of 26 patients that received a comprehensive medication review from the pharmacist and were compared to a

  12. Simple solution to the medical instrumentation software problem

    Science.gov (United States)

    Leif, Robert C.; Leif, Suzanne B.; Leif, Stephanie H.; Bingue, E.

    1995-04-01

    Medical devices now include a substantial software component, which is both difficult and expensive to produce and maintain. Medical software must be developed according to `Good Manufacturing Practices', GMP. Good Manufacturing Practices as specified by the FDA and ISO requires the definition and compliance to a software processes which ensures quality products by specifying a detailed method of software construction. The software process should be based on accepted standards. US Department of Defense software standards and technology can both facilitate the development and improve the quality of medical systems. We describe the advantages of employing Mil-Std-498, Software Development and Documentation, and the Ada programming language. Ada provides the very broad range of functionalities, from embedded real-time to management information systems required by many medical devices. It also includes advanced facilities for object oriented programming and software engineering.

  13. [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.

  14. 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.

  15. 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

  16. 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 ...

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

    African Journals Online (AJOL)

    The ranges of problems were extensive; neuro-anatomy in gross anatomy, slide review in histology, and cardiovascular embryology were amongst the most highlighted areas of concern. Most students attributed the problems in gross anatomy to difficulty with accessing the area during dissection and inability to grasp the ...

  18. Self-reported competency ratings of graduates of a problem-leased medical curriculum

    NARCIS (Netherlands)

    van der Molen, H. T.

    Purpose. To study the self-reports of professional competencies by graduates of a problem-based medical curriculum. Method. All graduates from a medical school and a faculty of health sciences with a problem-based curriculum were sent a questionnaire asking them to compare their own performances in

  19. Self-reported competency ratings of graduates of a problem-based medical curriculum

    NARCIS (Netherlands)

    H.G. Schmidt (Henk); H.M. van der Molen

    2001-01-01

    textabstractPurpose. To study the self-reports of professional competencies by graduates of a problem-based medical curriculum. Method. All graduates from a medical school and a faculty of health sciences with a problem-based curriculum were sent a questionnaire asking them to compare their own

  20. 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.

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

    Science.gov (United States)

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

    2009-09-01

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

  2. 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.

  3. On a Heat Exchange Problem under Sharply Changing External Conditions

    Science.gov (United States)

    Khishchenko, K. V.; Charakhch'yan, A. A.; Shurshalov, L. V.

    2018-02-01

    The heat exchange problem between carbon particles and an external environment (water) is stated and investigated based on the equations of heat conducting compressible fluid. The environment parameters are supposed to undergo large and fast variations. In the time of about 100 μs, the temperature of the environment first increases from the normal one to 2400 K, is preserved at this level for about 60 μs, and then decreases to 300 K during approximately 50 μs. At the same periods of time, the pressure of the external environment increases from the normal one to 67 GPa, is preserved at this level, and then decreases to zero. Under such external conditions, the heating of graphite particles of various sizes, their phase transition to the diamond phase, and the subsequent unloading and cooling almost to the initial values of the pressure and temperature without the reverse transition from the diamond to the graphite phase are investigated. Conclusions about the maximal size of diamond particles that can be obtained in experiments on the shock compression of the mixture of graphite with water are drawn.

  4. An approach to solve replacement problems under intuitionistic fuzzy nature

    Science.gov (United States)

    Balaganesan, M.; Ganesan, K.

    2018-04-01

    Due to impreciseness to solve the day to day problems the researchers use fuzzy sets in their discussions of the replacement problems. The aim of this paper is to solve the replacement theory problems with triangular intuitionistic fuzzy numbers. An effective methodology based on fuzziness index and location index is proposed to determine the optimal solution of the replacement problem. A numerical example is illustrated to validate the proposed method.

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

    OpenAIRE

    Bowen, Robert A; Rogers, Anne; Shaw, Jennifer

    2009-01-01

    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 ...

  7. 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…

  8. Determinants of a successful problem list to support the implementation of the problem-oriented medical record according to recent literature

    NARCIS (Netherlands)

    Simons, S.M.; Cillessen, F.H.J.M.; Hazelzet, J.A.

    2016-01-01

    BACKGROUND: A problem-oriented approach is one of the possibilities to organize a medical record. The problem-oriented medical record (POMR) - a structured organization of patient information per presented medical problem- was introduced at the end of the sixties by Dr. Lawrence Weed to aid dealing

  9. 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' ...

  10. Information on actual medication use and drug-related problems in older patients: questionnaire or interview?

    Science.gov (United States)

    Willeboordse, Floor; Grundeken, Lucienne H; van den Eijkel, Lisanne P; Schellevis, François G; Elders, Petra J M; Hugtenburg, Jacqueline G

    2016-04-01

    Information on medication use and drug-related problems is important in the preparation of clinical medication reviews. Critical information can only be provided by patients themselves, but interviewing patients is time-consuming. Alternatively, patient information could be obtained with a questionnaire. In this study the agreement between patient information on medication use and drug-related problems in older patients obtained with a questionnaire was compared with information obtained during an interview. General practice in The Netherlands. A questionnaire was developed to obtain information on actual medication use and drug-related problems. Two patient groups ≥65 years were selected based on general practitioner electronic medical records in nine practices; I. polypharmacy and II. ≥1 predefined general geriatric problems. Eligible patients were asked to complete the questionnaire and were interviewed afterwards. Agreement on information on medication use and drug-related problems collected with the questionnaire and interview was calculated. Ninety-seven patients participated. Of all medications used, 87.6 % (95 % CI 84.7-90.5) was reported identically in the questionnaire and interview. Agreement for the complete medication list was found for 45.4 % (95 % CI 35.8-55.3) of the patients. On drug-related problem level, agreement between questionnaire and interview was 75 %. Agreement tended to be lower in vulnerable patients characterized by ≥4 chronic diseases, ≥10 medications used and low health literacy. Information from a questionnaire showed reasonable agreement compared with interviewing. The patients reported more medications and drug-related problems in the interview than the questionnaire. Taking the limitations into account, a questionnaire seems a suitable tool for medication reviews that may replace an interview for most patients.

  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. 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 ...

  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. 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...

  15. 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.

  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. 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...

  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. 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.

  20. The residual risk problem from the medical point of view

    International Nuclear Information System (INIS)

    Pott, F.

    1980-01-01

    Definitions of health and desease are discussed as well as the problems of establishing limits, especially as regards determining what are acceptable concentrations of pollutants in the environment and the workplace. It is obvious that individual protection cannot be fundamentally guaranteed. A further development and harmonization of the established ethically- and economically-based value system of individual needs as well as a coordination of this system with the requirements of society is necessary in order to be able to clearly define acceptable risks and detrimental effects. (orig.) [de

  1. 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.

  2. 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

  3. 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...

  4. 42 CFR 436.308 - Medically needy coverage of individuals under age 21.

    Science.gov (United States)

    2010-10-01

    ... THE VIRGIN ISLANDS Optional Coverage of the Medically Needy § 436.308 Medically needy coverage of... (b) of this section: (1) Who would not be covered under the mandatory medically needy group of... nursing facility services are provided under the plan to individuals within the age group selected under...

  5. 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.

  6. Uses of ionizing radiation and medical-care-related problems

    International Nuclear Information System (INIS)

    Smathers, J.B.

    1988-01-01

    The uses of ionizing radiation in medicine are currently undergoing changes due to at least four major influences: (1) the constantly changing public perception of the hazards of radiation, (2) continuing technical innovation and development in equipment, (3) the imposition of diagnosis-related group funding by government health-care funding agencies, and (4) an increase in the average age of the U.S. population. The combined effect of these influences will probably result in a major increase in biplanar fluoroscopic examinations to support nonsurgical approaches such as percutaneous transluminal coronary angioplasty, percutaneous transluminal neuroembolism, and lithotripsy (the fracturing of kidney stones). As some of these examinations can result in 1.5 h of fluoroscopy, major doses to the patient and to the clinical staff can be expected. In addition, improved diagnostic techniques, such as using positron emission tomography (a combination of biochemistry and positron-emitting isotopes), can be expected to increase the number of small cyclotrons installed in medical centers. Counteracting these increases in radiation exposure is the development of digital radiography, which generally results in a lowering of the dose per diagnostic procedure. In the realm of therapeutic uses, one can expect higher-energy treatment accelerators, more patients being released from the hospital on therapeutic doses of isotopes, and a potential acceptance of neutron therapy as a cancer treatment modality. The latter treatment may take the form of boron capture therapy, 252Cf implant therapy, or external beam therapy using high-energy cyclotrons and the p,Be or the d,Be reaction to create the neutrons

  7. Protection of Bulgarian population in medical radiation diagnostic science after 1950. Some basic problems

    International Nuclear Information System (INIS)

    Ingilizova, Kr.

    2000-01-01

    The report presents summarized data on frequency and structure of X-ray and nuclear medical examinations carried out in Bulgaria during the period 1950-1995. The effective and the collective effective dose are calculated. Some on the basic problems concerning the protection of Bulgarian population during medical exposure are outlined

  8. Dialog about Psychosocial Issues in Problem-Based Learning Sessions in Medical Education

    Science.gov (United States)

    Adams, Nancy E.

    2016-01-01

    The purpose of this qualitative case study was two-fold: to investigate the dialog about psychosocial aspects of health care in problem based learning (PBL) groups in a single medical school; and to describe the factors that learners and PBL facilitators identify as influencing dialog about these issues in PBL groups. Medical education is a…

  9. Application of EGS and ETRAN to Problems in Medical Physics and Dosimetry

    CERN Document Server

    Nelson, W R

    1980-01-01

    The author looks at a few applications of Monte Carlo programs to problems of interest in medical physics and dosimetry. In particular, two areas are considered: 1) bremsstrahlung production from medical accelerators; 2) photon dosimetry at medium to low energies. (16 refs) .

  10. Beamforming Through Regularized Inverse Problems in Ultrasound Medical Imaging.

    Science.gov (United States)

    Szasz, Teodora; Basarab, Adrian; Kouame, Denis

    2016-12-01

    Beamforming (BF) in ultrasound (US) imaging has significant impact on the quality of the final image, controlling its resolution and contrast. Despite its low spatial resolution and contrast, delay-and-sum (DAS) is still extensively used nowadays in clinical applications, due to its real-time capabilities. The most common alternatives are minimum variance (MV) method and its variants, which overcome the drawbacks of DAS, at the cost of higher computational complexity that limits its utilization in real-time applications. In this paper, we propose to perform BF in US imaging through a regularized inverse problem based on a linear model relating the reflected echoes to the signal to be recovered. Our approach presents two major advantages: 1) its flexibility in the choice of statistical assumptions on the signal to be beamformed (Laplacian and Gaussian statistics are tested herein) and 2) its robustness to a reduced number of pulse emissions. The proposed framework is flexible and allows for choosing the right tradeoff between noise suppression and sharpness of the resulted image. We illustrate the performance of our approach on both simulated and experimental data, with in vivo examples of carotid and thyroid. Compared with DAS, MV, and two other recently published BF techniques, our method offers better spatial resolution, respectively contrast, when using Laplacian and Gaussian priors.

  11. The efficacy and usefulness of problem based learning in undergraduate medical school education of radiation oncology

    International Nuclear Information System (INIS)

    Uchino, Minako; Itazawa, Tomoko; Someya, Masanori; Nakamura, Satoaki

    2007-01-01

    The Japanese Association for Therapeutic Radiation Oncology (JASTRO) holds a seminar for medical students every summer, which has developed into a joint program with a session addressing radiation treatment planning. To clarify this topic for medical students, we have incorporated Problem Based Learning skills into the session. Not only has the students' comprehension improved but the instructors have also found this teaching experience valuable and productive in advancing their own clinical skills. Our experience suggests that the application of this Problem Based Learning session for radiation treatment planning in undergraduate medical school education has proven to be effective. (author)

  12. Teaching Biochemistry at a Medical Faculty with a Problem-Based Learning System.

    Science.gov (United States)

    Rosing, Jan

    1997-01-01

    Highlights the differences between classical teaching methods and problem-based learning. Describes the curriculum and problem-based approach of the Faculty of Medicine at the Maastricht University and gives an overview of the implementation of biochemistry in the medical curriculum. Discusses the procedure for student assessment and presents…

  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. 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.

  16. 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.

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

    OpenAIRE

    Eliana María González-Neira; Jairo R. Montoya-Torres; David Barrera

    2017-01-01

    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 co...

  18. [Problem areas and examples of best practice in intersectoral medication treatment--a literature review].

    Science.gov (United States)

    Mehrmann, Lena; Ollenschläger, Günter

    2014-01-01

    Transitions between the outpatient and inpatient sector are a critical phase in medication treatment. This article provides an overview of published problem areas and examples of best practice in the intersectoral medication treatment. Data with regard to related problem areas and examples of best practice was collected in August 2011 by a systematic literature research. The relevant literature was identified using the following databases and search engines: MEDLINE, The Cochrane Library, EMBASE, Google, and Google Scholar. Additionally, a hand search was done on the websites of SpringerLink and Thieme Connect. The initial search yielded a total of 4,409 records which were further selected in two screening steps and analysed according to their relevance. Of the remaining 63 records, 3 exclusively described problem areas, 11 of them examples of best practice, and 49 provided information on both problem areas and examples of best practice with regard to intersectoral medication treatment. Among other things, problem areas include varying legal regulations in inpatient and outpatient medication treatment, drug therapy interruptions after hospital discharge, or deficits in communication and continuity of care. Examples of best practice are projects, programmes, initiatives, recommendations, and points to consider with respect to medication reconciliation, pharmaceutical support, or transitions of care. Problem areas as well as examples of best practice are mainly focused on the transition from inpatient to outpatient care. Copyright © 2013. Published by Elsevier GmbH.

  19. 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...

  20. 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

  1. 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 ...

  2. 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.

  3. The cofiring problem of a power plant under policy regulations

    International Nuclear Information System (INIS)

    Kangas, Hanna-Liisa; Lintunen, Jussi; Uusivuori, Jussi

    2009-01-01

    Cofiring of fossil and renewable fuels can contribute to reaching tightening climate and renewable energy goals. The increase in biomass share in cofiring decreases the use of fossil fuel and increases renewable energy production. We study how energy and climate policies promote that increase. First, we present and solve an electricity producer's profit-maximization problem with detailed technical description of cofiring. We then study the effectiveness of policy instruments (e.g. feed-in laws and emission trading) on biomass utilization in cofiring. The study offers a novel approach to explore the cofiring problem, because of the endogenous fuel choice combined with the policy analysis. We study two different power plants that are located in two different European electricity market areas. Our analysis shows that both feed-in tariff and feed-in premium can have unexpected weaknesses, when they are introduced together with emission trading. Therefore decision-makers should be well informed and cautious when introducing these policies. (author)

  4. 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.

  5. Nurses' perceptions and problems in the usability of a medication safety app.

    Science.gov (United States)

    Ankem, Kalyani; Cho, Sookyung; Simpson, Diana

    2017-10-16

    The majority of medication apps support medication adherence. Equally, if not more important, is medication safety. Few apps report on medication safety, and fewer studies have been conducted with these apps. The usability of a medication safety app was tested with nurses to reveal their perceptions of the graphical user interface and to discover problems they encountered in using the app. Usability testing of the app was conducted with RN-BSN students and informatics students (n = 18). Perceptions of the graphical components were gathered in pretest and posttest questionnaires, and video recordings of the usability testing were transcribed. The significance of the difference in mean performance time for 8 tasks was tested, and qualitative analysis was deployed to identify problems encountered and to rate the severity of each problem. While all participants perceived the graphical user interface as easy to understand, nurses took significantly more time to complete certain tasks. More nurses found the medication app to be lacking in intuitiveness of user interface design, in capability to match real-world data, and in providing optimal information architecture. To successfully integrate mobile devices in healthcare, developers must address the problems that nurses encountered in use of the app.

  6. 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.

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

    Science.gov (United States)

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

    2015-01-01

    Summary Background 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. Objective 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. Methods 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. Results 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%. Conclusions 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. PMID:26171079

  8. 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.

  9. Under-Nutrition in Older People: A Serious and Growing Global Problem!

    Directory of Open Access Journals (Sweden)

    Visvanathan R

    2003-01-01

    Full Text Available Everyone agrees that adequate nutrient intake is important to all living things. Without food or water, life on earth would cease to exist. In the field of medical health, some gains have been made in meeting maternal and child nutritional needs. There is great community awareness regarding the importance of meeting the nutritional needs of the developing foetus and child. Malnutrition secondary to decreased intake in older people and weight loss is also a serious problem with unfortunately, very little notice from the community at large. As one ages, several physiological processes may contribute towards the development of protein energy malnutrition. Under-nutrition in older people is sadly far too common, even in developed countries. It is very likely that the same concerted effort used to address child malnutrition is required to combat under-nutrition in our elders. Protein energy malnutrition in older people comes at a significant cost to the individual, families, communities and the healthcare system. Failure to address this syndrome is not only unethical and unhealthy, but also costly. Vigilance and community awareness is important in ensuring that this important syndrome is detected and managed appropriately. This review mainly attempts to describe the pathophysiology, prevalence and consequences of under-nutrition and aims to highlight the importance of this clinical syndrome and the recent growth in our understanding of the processes behind its development. Some management strategies are also briefly described.

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

    CERN Document Server

    Podgorsak, Ervin B

    2014-01-01

    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.

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

    OpenAIRE

    Kassab, Salah; Hassan,Nahla; Abu-Hijleh,Marwan; P Sequeira,Reginald

    2016-01-01

    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. ...

  12. 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.

  13. [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.

  14. Transplant ethics under scrutiny - responsibilities of all medical professionals.

    Science.gov (United States)

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

    2013-02-01

    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.

  15. 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

  16. Impact of supply problems of preservative-free glaucoma medications on patients and hospital staff.

    Science.gov (United States)

    Shah, Shima; Theodossiades, Julia; Chapman, Kristin; Murdoch, Ian

    2015-03-01

    Glaucoma is a chronic ocular disease, which is usually managed with long-term daily medical therapy, in the form of eye drops. Patients who are intolerant to preservatives in topical medicines require preservative-free versions. From early 2011 patients attending Moorfields Eye Hospital, London, UK, started to report recurring problems with the supply of the following preservative-free glaucoma medications: Timolol 0.25% (Timoptol 0.25%, MSD UK); Dorzolamide (Trusopt, MSD UK); Dorzolamide and Timolol 0.5% (Cosopt, MSD UK). This study investigates the impact of the supply problems of these medications at Moorfields Eye Hospital from a patient, administrative and clinical perspective. Information was sought by interviewing both patients and hospital staff, and by a retrospective case note review between April 2010 and May 2013. Many hospital roles, both administrative and clinical, were involved in attempting to resolve the impact of the supply problems. All staff reported a considerable increase in their workload. At the peak of the problem, the glaucoma secretaries received about 150 enquiries per week. A review of 83 sets of patient notes, retrieved from a random sample of 125 patients, showed that 22% encountered a supply problem. Of these, more than one-third attended Moorfields Eye Hospital Accident & Emergency (A&E) for repeat supplies and 89% eventually had their medication changed. In telephone interviews with 39 of a random sample of 50 patients (a subset of the 83 notes retrieved), 59% of the interviewees reported a supply problem. Of these, one-third attended Moorfields Eye Hospital A&E for repeat supplies and half eventually required an alternative medication. Some patients reported going to considerable lengths to obtain ongoing supplies in the community. This study shows that medication supply problems can have a major impact on patients and hospital services. Supply problems occur across many fields of medicine and with increasing frequency. The

  17. The effects of problem-based learning during medical school on physician competency: a systematic review.

    Science.gov (United States)

    Koh, Gerald Choon-Huat; Khoo, Hoon Eng; Wong, Mee Lian; Koh, David

    2008-01-01

    Systematic reviews on the effects of problem-based learning have been limited to knowledge competency either during medical school or postgraduate training. We conducted a systematic review of evidence of the effects that problem-based learning during medical school had on physician competencies after graduation. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Databases, and the tables of contents of 5 major medical education journals from earliest available date through Oct. 31, 2006. We included studies in our review if they met the following criteria: problem-based learning was a teaching method in medical school, physician competencies were assessed after graduation and a control group of graduates of traditional curricula was used. We developed a scoring system to assess the quality of the studies, categorized competencies into 8 thematic dimensions and used a second system to determine the level of evidence for each competency assessed. Our search yielded 102 articles, of which 15 met inclusion criteria after full text review. Only 13 studies entered final systematic analysis because 2 studies reported their findings in 2 articles. According to self-assessments, 8 of 37 competencies had strong evidence in support of problem-based learning. Observed assessments had 7 competencies with strong evidence. In both groups, most of these competencies were in the social and cognitive dimensions. Only 4 competencies had moderate to strong levels of evidence in support of problem-based learning for both self-and observed assessments: coping with uncertainty (strong), appreciation of legal and ethical aspects of health care (strong), communication skills (moderate and strong respectively) and self-directed continuing learning (moderate). Problem-based learning during medical school has positive effects on physician competency after graduation, mainly in social and cognitive dimensions.

  18. 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.

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

    Science.gov (United States)

    Bowen, Robert A; Rogers, Anne; Shaw, Jennifer

    2009-10-20

    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. 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. 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 to be doubly vulnerable because of inconsistencies in substance

  20. 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

  1. Effects of Stimulant Medication under Varied Motivational Operations

    Science.gov (United States)

    Mace, F. Charles; Prager, Kevin L.; Thomas, Karen; Kochy, Jane; Dyer, Tim J.; Perry, Lora; Pritchard, Duncan

    2009-01-01

    We evaluated the evocative effects of four conditions (high- and low-preference activities, low and divided attention) and stimulant medication on the behavior of a 16-year-old boy with attention deficit hyperactivity disorder and moderate mental retardation. All behavior (activity engagement, activity changes, inappropriate touching, rude…

  2. 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.

  3. 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

    2018-01-01

    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…

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

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    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

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

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    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

  6. Attitude and perception of undergraduate medical students toward the problem-based learning in Chitwan Medical College, Nepal

    Directory of Open Access Journals (Sweden)

    Yadav RL

    2018-05-01

    Full Text Available Ram Lochan Yadav,1 Rano Mal Piryani,2 Gopendra Prasad Deo,3 Dev Kumar Shah,1 Laxmi Kumari Yadav,4 Md Nazrul Islam1 1Department of Physiology, Chitwan Medical College, Bharatpur, Nepal; 2Department of Internal Medicine and Health Professional Educational Research Center (HPERC, Chitwan Medical College, Bharatpur, Nepal; 3Department of Anaesthesiology and Critical Care, Chitwan Medical College, Bharatpur, Nepal; 4Department of Microbiology, Chitwan Medical College, Bharatpur, Nepal Background: Problem-based learning (PBL was introduced into Basic Medical Sciences early in the 1980s at Tribhuvan University (TU, Nepal, followed by other universities where didactic lecture method was still followed as the main teaching strategy. Despite gaining its popularity worldwide as integrated teaching learning method, PBL is not given importance in Nepal. This study aimed to assess the attitude and perceptions of undergraduate medical students regarding learning outcomes of PBL and to know their views about role and qualities of effective tutors for its successful implementation.Methods: This descriptive study was based on a self-administered questionnaire. The first part of the questionnaire measured students’ perception and attitude toward benefits of PBL and the second part measured students’ perception about role of PBL tutor. Bachelor of Medicine and Bachelor of Surgery (MBBS first year (2014/2015 academic year students at Chitwan Medical College, TU, were asked to express their opinions about the importance of learning outcomes by rating each statement on a five-point Likert scale and the responses were combined into three categorical variables: “agree” (strongly agree plus agree, “neutral”, and “disagree” (strongly disagree plus disagree. Data were analyzed using SPSS version 21.0.Results: Approximately 85.5% participants agreed that PBL is an interesting method of teaching learning. Most of them (86.7% accepted that PBL is an

  7. 75 FR 82277 - Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements Under the Patient...

    Science.gov (United States)

    2010-12-30

    ...-AA06 Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements Under the Patient... Register (FR Doc 2010-29596 (75 FR 74864)) entitled ``Health Insurance Issuers Implementing Medical Loss... request for comments entitled ``Health Insurance Issuers Implementing Medical Loss Ratio (MLR...

  8. 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

  9. What language is your doctor speaking? Facing the problems of translating medical documents into English

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    Mićović Dragoslava

    2013-01-01

    Full Text Available What is translation - a craft, an art, a profession or a job? Although one of the oldest human activities, translation has not still been fully defined, and it is still young in terms of an academic discipline. The paper defines the difference between translation and interpreting and then attempts to find the answer to the question what characteristics, knowledge and skills a translator must have, particularly the one involved in court translation, and where his/her place in the communication process (both written and oral communication is. When translating medical documentation, a translator is set within a medical language environment as an intermediary between two doctors (in other words, two professionals in the process of communication which would be impossible without him, since it is conducted in two different languages. The paper also gives an insight into types of medical documentation and who they are intended for. It gives practical examples of the problems faced in the course of translation of certain types of medical documentation (hospital discharge papers, diagnoses, case reports,.... Is it possible to make this kind of communication between professionals (doctors standardized, which would subsequently make their translation easier? Although great efforts are made in Serbia regarding medical language and medical terminology, the conclusion is that specific problems encountered by translators can hardly be overcome using only dictionaries and translation manuals.

  10. 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.

  11. 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.

  12. 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.

  13. The dynamics of the emergency medical readmission - The underlying fundamentals.

    Science.gov (United States)

    Byrne, Declan; O'Riordan, Deirdre; Conway, Richard; Cournane, Sean; Silke, Bernard

    2017-11-01

    Hospital readmissions are a perennial problem. We reviewed readmissions to one institution (2002-2015) and investigated their dynamics. 96,474 emergency admissions (in 50,701 patients) to an Irish hospital over a 15-year period were studied, and patterns surrounding early (characteristics; the fundamentals are driven by disease progression over time. Copyright © 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  14. 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

  15. 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.

  16. Undergraduate medical student's perceptions on traditional and problem based curricula: pilot study.

    Science.gov (United States)

    Meo, Sultan Ayoub

    2014-07-01

    To evaluate and compare students' perceptions about teaching and learning, knowledge and skills, outcomes of course materials and their satisfaction in traditional Lecture Based learning versus Problem-Based Learning curricula in two different medical schools. The comparative cross-sectional questionnaire-based study was conducted in the Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia, from July 2009 to January 2011. Two different undergraduate medical schools were selected; one followed the traditional curriculum, while the other followed the problem-based learning curriculum. Two equal groups of first year medical students were selected. They were taught in respiratory physiology and lung function lab according to their curriculum for a period of two weeks. At the completion of the study period, a five-point Likert scale was used to assess students' perceptions on satisfaction, academic environment, teaching and learning, knowledge and skills and outcomes of course materials about effectiveness of problem-based learning compared to traditional methods. SPSS 19 was used for statistical analysis. Students used to problem-based learning curriculum obtained marginally higher scores in their perceptions (24.10 +/- 3.63) compared to ones following the traditional curriculum (22.67 +/- 3.74). However, the difference in perceptions did not achieve a level of statistical significance. Students following problem-based learning curriculum have more positive perceptions on teaching and learning, knowledge and skills, outcomes of their course materials and satisfaction compared to the students belonging to the traditional style of medical school. However, the difference between the two groups was not statistically significant.

  17. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  19. 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 schools.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  4. The documentation of health problems in relation to prescribed medication in people with profound intellectual and multiple disabilities

    NARCIS (Netherlands)

    van der Heide, D. C.; van der Putten, A. A. J.; van den Berg, P. B.; Taxis, K.; Vlaskamp, C.

    Persons with profound intellectual and multiple disabilities (PIMD) suffer from a wide range of health problems and use a wide range of different drugs. This study investigated for frequently used medication whether there was a health problem documented in the medical notes for the drug prescribed.

  5. Teaching medical students to discern ethical problems in human clinical research studies.

    Science.gov (United States)

    Roberts, Laura Weiss; Warner, Teddy D; Green Hammond, Katherine A; Brody, Janet L; Kaminsky, Alexis; Roberts, Brian B

    2005-10-01

    Investigators and institutional review boards are entrusted with ensuring the conduct of ethically sound human studies. Assessing ethical aspects of research protocols is a key skill in fulfilling this duty, yet no empirically validated method exists for preparing professionals to attain this skill. The authors performed a randomized controlled educational intervention, comparing a criteria-based learning method, a clinical-research- and experience-based learning method, and a control group. All 300 medical students enrolled at the University of New Mexico School of Medicine in 2001 were invited to participate. After a single half-hour educational session, a written posttest of ability to detect ethical problems in hypothetical protocol vignettes was administered. The authors analyzed responses to ten protocol vignettes that had been evaluated independently by experts. For each vignette, a global assessment of the perceived significance of ethical problems and the identification of specific ethical problems were evaluated. Eighty-three medical students (27%) volunteered: 50 (60%) were women and 55 (66%) were first- and second-year students. On global assessments, the criteria-focused group perceived ethical problems as more significant than did the other two groups (p evaluation skills. This work supports the potential value of empirically derived methods for preparing professionals to discern ethical aspects of human studies.

  6. A qualitative study of health problems, risk factors, and prevention among Emergency Medical Service workers.

    Science.gov (United States)

    Dropkin, Jonathan; Moline, Jacqueline; Power, Paul M; Kim, Hyun

    2015-01-01

    Risk factors among Emergency Medical Service (EMS) workers are difficult to characterize and inconsistencies remain about their main health problems. To identify main work-related health problems among EMS workers in the United States; identify risk factors at the organizational, task, and exposure level; identify prevention strategies; examine these issues between participants (EMS workers and supervisors). Two types of qualitative research methods based on grounded theory were used: in-depth interviews with emergency medical technicians/paramedics (EMS workers) and focus groups (EMS workers and supervisors). Most participants reported similar health problems (musculoskeletal injuries) and the task related to these injuries, patient handling. Participants also reported similar physical exposures (ascending stairs with patients and patient weight). For organization/psychosocial factors, participants agreed that fitness, wages, breaks, and shift scheduling were linked with injuries, but overall, perceptions about these issues differed more than physical exposures. Lack of trust between EMS workers and supervisors were recurrent concerns among workers. However, not all organizational/psychosocial factors differed. EMS workers and supervisors agreed pre-employment screening could reduce injuries. Participants identified micro- and macro-level prevention opportunities. The grounded theory approach identified workers' main health problems, and the organizational factors and exposures linked with them. Perceptions about work organization/psychosocial exposures appeared more diverse than physical exposures. Prevention among all participants focused on mechanized equipment, but EMS workers also wanted more organizational support.

  7. 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.

  8. Pharmacotherapeutic Problems and Pharmacist Interventions in a Medical Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Tae Yun Park

    2015-05-01

    Full Text Available Background: Interest in pharmacist participation in the multidisciplinary intensive care team is increasing. However, studies examining pharmacist interventions in the medical intensive care unit (MICU are limited in Korea. The aim of this study was to describe the current status of pharmacist interventions and to identify common pharmacologic problems requiring pharmacist intervention in the MICU. Methods: Between September 2013 and August 2014, a retrospective, observational study was conducted in the 22-bed MICU at a university hospital. Data were obtained from two trained pharmacists who participated in MICU rounds three times a week. In addition to patient characteristics, data on the cause, type, related drug, and acceptance rate of interventions were collected. Results: In 340 patients, a total of 1211 pharmacologic interventions were performed. The majority of pharmacologic interventions were suggested by pharmacists at multidisciplinary rounds in the MICU. The most common pharmacologic interventions were adjustment of dosage and administration (n = 328, 26.0%, followed by parenteral/enteral nutritional support (n = 228, 18.1%, the provision of drug information (n = 228, 18.1%, and advice regarding pharmacokinetics (n = 118, 9.3%. Antimicrobial agents (n = 516, 42.6% were the most frequent type of drug associated with pharmacist interventions. The acceptance rate of interventions was 84.1% with most accepted by physicians within 24 hours (n = 602, 92.8%. Conclusions: Medication and nutritional problems are frequently encountered pharmacotherapeutic problems in the MICU. Pharmacist interventions play an important role in the management of these problems.

  9. Color blindness defect and medical laboratory technologists: unnoticed problems and the care for screening.

    Science.gov (United States)

    Dargahi, Hossein; Einollahi, Nahid; Dashti, Nasrin

    2010-01-01

    Color-blindness is the inability to perceive differences between some color that other people can distinguish. Using a literature search, the results indicate the prevalence of color vision deficiency in the medical profession and its on medical skills. Medical laboratory technicians and technologists employees should also screen for color blindness. This research aimed to study color blindness prevalence among Hospitals' Clinical Laboratories' Employees and Students in Tehran University of Medical Sciences (TUMS). A cross-sectional descriptive and analytical study was conducted among 633 TUMS Clinical Laboratory Sciences' Students and Hospitals' Clinical Laboratories' Employees to detect color-blindness problems by Ishihara Test. The tests were first screened with certain pictures, then compared to the Ishihara criteria to be possible color defective were tested further with other plates to determine color - blindness defects. The data was saved using with SPSS software and analyzed by statistical methods. This is the first study to determine the prevalence of color - blindness in Clinical Laboratory Sciences' Students and Employees. 2.4% of TUMS Medical Laboratory Sciences Students and Hospitals' Clinical Laboratories' Employees are color-blind. There is significant correlation between color-blindness and sex and age. But the results showed that there is not significant correlation between color-blindness defect and exposure to chemical agents, type of job, trauma and surgery history, history of familial defect and race. It would be a wide range of difficulties by color blinded students and employees in their practice of laboratory diagnosis and techniques with a potentially of errors. We suggest color blindness as a medical conditions should restrict employment choices for medical laboratory technicians and technologists job in Iran.

  10. Determinants of a successful problem list to support the implementation of the problem-oriented medical record according to recent literature.

    Science.gov (United States)

    Simons, Sereh M J; Cillessen, Felix H J M; Hazelzet, Jan A

    2016-08-02

    A problem-oriented approach is one of the possibilities to organize a medical record. The problem-oriented medical record (POMR) - a structured organization of patient information per presented medical problem- was introduced at the end of the sixties by Dr. Lawrence Weed to aid dealing with the multiplicity of patient problems. The problem list as a precondition is the centerpiece of the problem-oriented medical record (POMR) also called problem-oriented record (POR). Prior to the digital era, paper records presented a flat list of medical problems to the healthcare professional without the features that are possible with current technology. In modern EHRs a POMR based on a structured problem list can be used for clinical decision support, registries, order management, population health, and potentially other innovative functionality in the future, thereby providing a new incentive to the implementation and use of the POMR. On both 12 May 2014 and 1 June 2015 a systematic literature search was conducted. From the retrieved articles statements regarding the POMR and related to successful or non-successful implementation, were categorized. Generic determinants were extracted from these statements. In this research 38 articles were included. The literature analysis led to 12 generic determinants: clinical practice/reasoning, complete and accurate problem list, data structure/content, efficiency, functionality, interoperability, multi-disciplinary, overview of patient information, quality of care, system support, training of staff, and usability. Two main subjects can be distinguished in the determinants: the system that the problem list and POMR is integrated in and the organization using that system. The combination of the two requires a sociotechnical approach and both are equally important for successful implementation of a POMR. All the determinants have to be taken into account, but the weight given to each of the determinants depends on the organizationusing

  11. 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

  12. The algebraic method of the scattering inverse problem solution under untraditional statements

    CERN Document Server

    Popushnoj, M N

    2001-01-01

    The algebraic method of the scattering inverse problem solution under untraditional statements is proposed consistently in this review, in the framework of which some quantum theory od scattering charged particles problem were researched afterwards. The inverse problem of scattering theory of charged particles on the complex plane of the Coulomb coupling constant (CCC) is considered. A procedure of interaction potential restoration is established for the case when the energy, orbital moment quadrate and CCC are linearly dependent. The relation between one-parametric problems of the potential scattering of charged particles is investigated

  13. Strategic and non-strategic problem gamblers differ on decision-making under risk and ambiguity.

    Science.gov (United States)

    Lorains, Felicity K; Dowling, Nicki A; Enticott, Peter G; Bradshaw, John L; Trueblood, Jennifer S; Stout, Julie C

    2014-07-01

    To analyse problem gamblers' decision-making under conditions of risk and ambiguity, investigate underlying psychological factors associated with their choice behaviour and examine whether decision-making differed in strategic (e.g., sports betting) and non-strategic (e.g., electronic gaming machine) problem gamblers. Cross-sectional study. Out-patient treatment centres and university testing facilities in Victoria, Australia. Thirty-nine problem gamblers and 41 age, gender and estimated IQ-matched controls. Decision-making tasks included the Iowa Gambling Task (IGT) and a loss aversion task. The Prospect Valence Learning (PVL) model was used to provide an explanation of cognitive, motivational and response style factors involved in IGT performance. Overall, problem gamblers performed more poorly than controls on both the IGT (P = 0.04) and the loss aversion task (P = 0.01), and their IGT decisions were associated with heightened attention to gains (P = 0.003) and less consistency (P = 0.002). Strategic problem gamblers did not differ from matched controls on either decision-making task, but non-strategic problem gamblers performed worse on both the IGT (P = 0.006) and the loss aversion task (P = 0.02). Furthermore, we found differences in the PVL model parameters underlying strategic and non-strategic problem gamblers' choices on the IGT. Problem gamblers demonstrated poor decision-making under conditions of risk and ambiguity. Strategic (e.g. sports betting, poker) and non-strategic (e.g. electronic gaming machines) problem gamblers differed in decision-making and the underlying psychological processes associated with their decisions. © 2014 Society for the Study of Addiction.

  14. 42 CFR 435.308 - Medically needy coverage of individuals under age 21.

    Science.gov (United States)

    2010-10-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS ELIGIBILITY IN THE STATES, DISTRICT OF.... (3) Individuals in nursing facilities when nursing facility services are provided under the plan to...

  15. [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

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

    Directory of Open Access Journals (Sweden)

    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

  17. 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

  18. EFOMP policy statement 16: The role and competences of medical physicists and medical physics experts under 2013/59/EURATOM.

    Science.gov (United States)

    Caruana, Carmel J; Tsapaki, Virginia; Damilakis, John; Brambilla, Marco; Martín, Guadalupe Martín; Dimov, Asen; Bosmans, Hilde; Egan, Gillian; Bacher, Klaus; McClean, Brendan

    2018-04-01

    On 5 December 2013 the European Council promulgated Directive 2013/59/EURATOM. This Directive is important for Medical Physicists and Medical Physics Experts as it puts the profession on solid foundations and describes it more comprehensively. Much commentary regarding the role and competences has been developed in the context of the European Commission project "European Guidelines on the Medical Physics Expert" published as Radiation Protection Report RP174. The guidelines elaborate on the role and responsibilities under 2013/59/EURATOM in terms of a mission statement and competence profile in the specialty areas of Medical Physics relating to medical radiological services, namely Diagnostic and Interventional Radiology, Radiation Oncology and Nuclear Medicine. The present policy statement summarises the provisions of Directive 2013/59/EURATOM regarding the role and competences, reiterates the results of the European Guidelines on the Medical Physics Expert document relating to role and competences of the profession and provides additional commentary regarding further issues arising following the publication of the RP174 guidelines. Copyright © 2018. Published by Elsevier Ltd.

  19. [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

  20. 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.

  1. 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.

  2. Prioritizing medication safety in care of people with cancer: clinicians’ views on main problems and solutions

    Science.gov (United States)

    Car, Lorainne Tudor; Papachristou, Nikolaos; Urch, Catherine; Majeed, Azeem; Atun, Rifat; Car, Josip; Vincent, Charles

    2017-01-01

    Background Cancer care is liable to medication errors due to the complex nature of cancer treatment, the common presence of comorbidities and the involvement of a number of clinicians in cancer care. While the frequency of medication errors in cancer care has been reported, little is known about their causal factors and effective prevention strategies. With a unique insight into the main safety issues in cancer treatment, frontline staff can help close this gap. In this study, we aimed to identify medication safety priorities in cancer patient care according to clinicians in North West London using PRIORITIZE, a novel priority–setting approach. Methods The project steering group determined the scope, the context and the criteria for prioritization. We then invited North West London cancer care clinicians to identify and prioritize main causes for, and solutions to, medication errors in cancer care. Forty cancer care providers submitted their suggestions which were thematically synthesized into a composite list of 20 distinct problems and 22 solutions. A group of 26 clinicians from the initial cohort ranked the composite list of suggestions using predetermined criteria. Results The top ranked problems focused on patients’ poor understanding of treatments due to language or education difficulties, clinicians’ insufficient attention to patients’ psychological distress, and inadequate information sharing among health care providers. The top ranked solutions were provision of guidance to patients and their carers on what to do when unwell, pre–chemotherapy work–up for all patients and better staff training. Overall, clinicians considered improved communication between health care providers, quality assurance procedures (during prescription and monitoring stages) and patient education as key strategies for improving cancer medication safety. Prescribing stage was identified as the most vulnerable to medication safety threats. The highest ranked suggestions

  3. How doctors learn: the role of clinical problems across the medical school-to-practice continuum.

    Science.gov (United States)

    Slotnick, H B

    1996-01-01

    The author proposes a theory of how physicians learn that uses clinical problem solving as its central feature. His theory, which integrates insights from Maslow, Schön, Norman, and others, claims that physicians-in-training and practicing physicians learn largely by deriving insights from clinical experience. These insights allow the learner to solve future problems and thereby address the learner's basic human needs for security, affiliation, and self-esteem. Ensuring that students gain such insights means that the proper roles of the teacher are (1) to select problems for students to solve and offer guidance on how to solve them, and (2) to serve as a role model of how to reflect on the problem, its solution, and the solution's effectiveness. Three principles guide instruction within its framework for learning: (1) learners, whether physicians-in-training or practicing physicians, seek to solve problems they recognize they have; (2) learners want to be involved in their own learning; and (3) instruction must both be time-efficient and also demonstrate the range of ways in which students can apply what they learn. The author concludes by applying the theory to an aspect of undergraduate education and to the general process of continuing medical education.

  4. Constructivist, Problem-Based Learning Does Work: A Meta-Analysis of Curricular Comparisons Involving a Single Medical School

    Science.gov (United States)

    Schmidt, Henk G.; van der Molen, Henk T.; te Winkel, Wilco W. R.; Wijnen, Wynand H. F. W.

    2009-01-01

    Effects of problem-based learning as reported in curricular comparison studies have been shown to be inconsistent over different medical schools. Therefore, we decided to summarize effects of a single well-established problem-based curriculum rather than to add up sometimes-conflicting findings from different problem-based curricula. Effect sizes…

  5. Students’ understanding and application of the area under the curve concept in physics problems

    Directory of Open Access Journals (Sweden)

    Dong-Hai Nguyen

    2011-06-01

    Full Text Available This study investigates how students understand and apply the area under the curve concept and the integral-area relation in solving introductory physics problems. We interviewed 20 students in the first semester and 15 students from the same cohort in the second semester of a calculus-based physics course sequence on several problems involving the area under the curve concept. We found that only a few students could recognize that the concept of area under the curve was applicable in physics problems. Even when students could invoke the area under the curve concept, they did not necessarily understand the relationship between the process of accumulation and the area under a curve, so they failed to apply it to novel situations. We also found that when presented with several graphs, students had difficulty in selecting the graph such that the area under the graph corresponded to a given integral, although all of them could state that “the integral equaled the area under the curve.” The findings in this study are consistent with those in previous mathematics education research and research in physics education on students’ use of the area under the curve.

  6. Teaching biochemistry to medical students in Singapore--from organic chemistry to problem-based learning.

    Science.gov (United States)

    Khoo, H E

    2005-07-01

    The medical faculty in the National University of Singapore started in 1905 but the Chair in Biochemistry was only established in 1927. For many years the biochemistry course consisted of the teaching of the organic chemistry of substances of physiological importance, nutrition, metabolism and hormones. In 1961, clinical biochemistry was introduced and in the 1980s, genetics and molecular biology were included. By then, most of the organic chemistry content had been removed as greater emphasis was placed on clinical correlation. Laboratory classes consisted of mock glucose tolerance tests and the measurement of various enzymes. By the 1990s, students were no longer interested in such practical classes, so a bold decision was made around 1995 to remove laboratory classes from the curriculum. Unfortunately, this meant that the medical students who might have been interested in laboratory work could no longer do such work. However, the new curriculum in 1999 gave the department an opportunity to offer a laboratory course as an elective for interested students. This new curriculum adopted an integrated approach with Genetics being taught as part of Paediatrics, and a new module (Structural and Cell Biology) comprising aspects of cell biology and biochemistry was introduced. This module is currently taught by staff from Anatomy, Physiology and Biochemistry. Some biochemistry content is now incorporated into the clinical problem scenarios of problem-based learning such as jaundice, diabetes mellitus, anorexia nervosa, etc. So the evolution of teaching biochemistry to medical students in Singapore has paralleled worldwide trends and moved from the didactic teaching of organic chemistry of biomolecules to problem-based learning using clinical cases.

  7. 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.

  8. 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.

  9. 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

  10. Major Problems and Countermeasures of Foreign Trade in China under the Background of Expanding Domestic Demand

    OpenAIRE

    Ruan, Wei-tong; Li, Yu-hong

    2010-01-01

    Starting from China's macro-economic policy level and combining with the status of foreign trade in China, major problems in the development of foreign trade are analyzed under the background of expanding domestic demand, which is guided by the macro-economy, international finance, international trade and other related disciplines. Problems are mainly the inflation, the reduction of import, the trade protection, the increase in export costs, the reduction of export, the scale shrinkage of for...

  11. 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.

  12. Facilitating students' application of the integral and the area under the curve concepts in physics problems

    Science.gov (United States)

    Nguyen, Dong-Hai

    This research project investigates the difficulties students encounter when solving physics problems involving the integral and the area under the curve concepts and the strategies to facilitate students learning to solve those types of problems. The research contexts of this project are calculus-based physics courses covering mechanics and electromagnetism. In phase I of the project, individual teaching/learning interviews were conducted with 20 students in mechanics and 15 students from the same cohort in electromagnetism. The students were asked to solve problems on several topics of mechanics and electromagnetism. These problems involved calculating physical quantities (e.g. velocity, acceleration, work, electric field, electric resistance, electric current) by integrating or finding the area under the curve of functions of related quantities (e.g. position, velocity, force, charge density, resistivity, current density). Verbal hints were provided when students made an error or were unable to proceed. A total number of 140 one-hour interviews were conducted in this phase, which provided insights into students' difficulties when solving the problems involving the integral and the area under the curve concepts and the hints to help students overcome those difficulties. In phase II of the project, tutorials were created to facilitate students' learning to solve physics problems involving the integral and the area under the curve concepts. Each tutorial consisted of a set of exercises and a protocol that incorporated the helpful hints to target the difficulties that students expressed in phase I of the project. Focus group learning interviews were conducted to test the effectiveness of the tutorials in comparison with standard learning materials (i.e. textbook problems and solutions). Overall results indicated that students learning with our tutorials outperformed students learning with standard materials in applying the integral and the area under the curve

  13. 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

  14. 75 FR 74863 - Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements Under the Patient...

    Science.gov (United States)

    2010-12-01

    ... Part III Department of Health and Human Services 45 CFR Part 158 Health Insurance Issuers... 0950-AA06 Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements Under the Patient... health insurance issuers under the Public Health Service Act, as added by the Patient Protection and...

  15. 77 FR 28788 - Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Under the Patient Protection and...

    Science.gov (United States)

    2012-05-16

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES 45 CFR Part 158 [CMS-9998-IFC3] Health Insurance Issuers..., entitled ``Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements Under the Patient...) requirements for health insurance issuers under section 2718 of the Public Health Service Act, as added by the...

  16. 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

  17. Predictors of medication adherence and smoking cessation among smokers under community corrections supervision.

    Science.gov (United States)

    Cropsey, Karen L; Clark, C Brendan; Stevens, Erin N; Schiavon, Samantha; Lahti, Adrienne C; Hendricks, Peter S

    2017-02-01

    Individuals in the U.S. criminal justice system now represent over 12% of all current U.S. smokers. With smoking banned in most U.S. jails and prisons, the cessation focus for this population has shifted to individuals who are under community correction supervision (e.g., probation, parole). The aim of this study was to examine predictors of successful smoking cessation among criminal justice individuals supervised in the community. Five hundred participants under community corrections supervision were randomized to receive either four sessions of smoking cessation counseling or no counseling in conjunction with 12weeks of bupropion treatment plus brief physician advice to quit. Logistic regression analyses examined associations of smoking variables with medication adherence and successful abstinence. Mediation analysis evaluated the indirect effects of medication adherence on smoking abstinence. The strongest associate of medication adherence was previous use of bupropion, while the strongest associate of smoking abstinence was medication adherence. Mediation analysis indicated that previous use of bupropion indirectly increased cessation rates through the pathway of increased medication adherence. These results highlight the importance of medication adherence for smoking cessation among community corrections smokers. Providing exposure to medication may be a promising intervention to increase medication adherence and subsequent cessation rates in this population. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. MEDICAL DIAGNOSTICS BY MICROSTRUCTURAL ANALYSIS OF BIOLOGICAL LIQUID DRIED PATTERNS AS A PROBLEM OF BIOINFORMATICS

    Directory of Open Access Journals (Sweden)

    Petr Vladimirovich Lebedev-Stepanov, Dr.

    2018-02-01

    Full Text Available Motivation: It is important to develop the high-precision computerized methods for medical rapid diagnostic which is generalizing the unique clinical experience obtained in the past decade as specialized solutions for diagnostic problems of control of specific diseases and, potentially, for a wide health monitoring of virtually healthy population, identify the reserves of human health and take the actions to prevent of these reserves depletion. In this work we present one of the new directions in bioinformatics, i.e. medical diagnostics by automated expert system on basis of morphology analysis of digital image of biological liquid dried pattern. Results: Proposed method is combination of bioinformatics and biochemistry approaches for obtaining diagnostic information from a morphological analysis of standardized dried patterns of biological liquid sessile drop. We have carried out own research in collaboration with medical diagnostic centers and formed the electronic database for recognition the following types of diseases: candidiasis; neoplasms; diabetes mellitus; diseases of the circulatory system; cerebrovascular disease; diseases of the digestive system; diseases of the genitourinary system; infectious diseases; factors relevant to the work; factors associated with environmental pollution; factors related to lifestyle. The laboratory setup for diagnostics of the human body in pathology states is developed. The diagnostic results are considered. Availability: Access to testing the software can be obtained on request to the contact email below.

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

    Science.gov (United States)

    Kassab, Salah Eldin; Hassan, Nahla; Abu-Hijleh, Marwan F; Sequeira, Reginald P

    2016-01-01

    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. 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. 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. Predicting the tutoring skills based on lecturing skills could have implications for recruiting tutors in PBL medical programs and for tutor training initiatives.

  20. Employing UMLS for generating hints in a tutoring system for medical problem-based learning.

    Science.gov (United States)

    Kazi, Hameedullah; Haddawy, Peter; Suebnukarn, Siriwan

    2012-06-01

    While problem-based learning has become widely popular for imparting clinical reasoning skills, the dynamics of medical PBL require close attention to a small group of students, placing a burden on medical faculty, whose time is over taxed. Intelligent tutoring systems (ITSs) offer an attractive means to increase the amount of facilitated PBL training the students receive. But typical intelligent tutoring system architectures make use of a domain model that provides a limited set of approved solutions to problems presented to students. Student solutions that do not match the approved ones, but are otherwise partially correct, receive little acknowledgement as feedback, stifling broader reasoning. Allowing students to creatively explore the space of possible solutions is exactly one of the attractive features of PBL. This paper provides an alternative to the traditional ITS architecture by using a hint generation strategy that leverages a domain ontology to provide effective feedback. The concept hierarchy and co-occurrence between concepts in the domain ontology are drawn upon to ascertain partial correctness of a solution and guide student reasoning towards a correct solution. We describe the strategy incorporated in METEOR, a tutoring system for medical PBL, wherein the widely available UMLS is deployed and represented as the domain ontology. Evaluation of expert agreement with system generated hints on a 5-point likert scale resulted in an average score of 4.44 (Spearman's ρ=0.80, p<0.01). Hints containing partial correctness feedback scored significantly higher than those without it (Mann Whitney, p<0.001). Hints produced by a human expert received an average score of 4.2 (Spearman's ρ=0.80, p<0.01). Copyright © 2012 Elsevier Inc. All rights reserved.

  1. 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.

  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. 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.

  4. 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 ...

  5. Benefit of Problem-Based Learning for Psychosocial Medicine: first experiences at the medical faculty of berne

    OpenAIRE

    Laederach-Hofmann, Kurt; Stadelmann, Barbara; Isenschmid, Bettina

    2005-01-01

    Aim: Presentation of skills and knowledge of medical students in psychiatry or psychosocial medicine in basic study (year 1 to 3) after the introduction of a problem oriented learning curriculum at the Medical Faculty of Berne.Method: Description of the curriculum with the different teaching units, and the evaluation by means of formative tools used by students and tutors.Results: With reference to qualitative comparison students of the problem based learning track showed a better preparation...

  6. [Problem of sexuality in Polish medical aids. The first half of XX century - to 1939].

    Science.gov (United States)

    Urbanek, Bozena

    2005-01-01

    The article presents an analysis of sexuality-related problems as they are covered in the health guidebooks so well known to her. There are a few topics addressed in Urbanek's text. She describes the evolution of the health guidebooks which was taking place at the end of the 19th and in early 20th centuries and of their users. Women increasingly often were authors and readers of these books. Some of the female authors were medical doctors with an additional passion for writing on public matters. Foreign authors and their works are also mentioned in Urbanek's article. She points to the links between sexology and personal hygiene and even cosmetology. Sexology is present in the guidebooks discussed also as an important ingredient of successful marriage. In this context, Urbanek stresses the changing role of a woman and her strife for acquiring equal rights. Another valuable element in the article is reference to other spheres of culture, such as custom and religion. The 20th century filled these spheres with medical knowledge on childbirth pathologies and their complications. Medical and hygiene-related topics motivate Urbanek to set the question of sexuality in a context of eugenic ideas often debated in the pre-war years. She also points to the multicultural character of the Polish-language health books, identifies various angles of view presented in them, and supports her reflection with well-selected examples. This applies eg. to Soviet books. Although this is not her main subject, Urbanek also writes about health books dealing with sexual matters and destined for men. The author of the article gives a fine description of the variability of sexuality-related contents carried by these books which offered adequate coverage of changes occurring in medical, hygienic, cultural, and even economic fields. The paper is, therefore, not only an analysis of sexuality-related issues but it also presents a broad social context in which these books were conceived and written.

  7. 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…

  8. 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)

  9. Determining Threshold Distance Providing Less Interference for Wireless Medical Implant Communication Systems in Coexisting Environments under Shadow Fading Conditions

    Directory of Open Access Journals (Sweden)

    Selman KULAÇ

    2017-08-01

    Full Text Available Important interference problems will be able to be encountered especially close areas to the hospitals where wireless implantable medical systems' communication traffic occurs heavily in near future. It is possible that these interferences could cause wireless implant devices to malfunction and harmful effects on patients. In this study, it is proposed to determine threshold distance in order to get less interference for wireless implantable medical systems under shadow fading conditions where MICS band and MetAids band users coexist intensely simultaneously. In this method, threshold power according to the \\cite{FCC} is pulled down by adding extra distance margin in order to minimize the interference effects to the MICS systems using confidence interval calculations. Because received signal strength just below the monitoring threshold power according to the \\cite{FCC} brings about much more interferences for the MICS systems even if listen-before-talk technique is applied.

  10. 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....

  11. 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

  12. A Comparison between the Effectiveness of PBL and LBL on Improving Problem-Solving Abilities of Medical Students Using Questioning

    Science.gov (United States)

    He, Yunfeng; Du, Xiangyun; Toft, Egon; Zhang, Xingli; Qu, Bo; Shi, Jiannong; Zhang, Huan; Zhang, Hui

    2018-01-01

    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 of problem-based learning (PBL) and lecture-based…

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

    OpenAIRE

    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. Participant...

  15. Psychosocial problems of clinical students in the University of Ibadan Medical School.

    Science.gov (United States)

    Omokhodion, F O; Gureje, O

    2003-03-01

    A cross sectional study was carried out among medical students in the University of Ibadan to identify their socio economic and psychological problems. Three hundred and sixteen students, 159 males and 157 females participated in the study. The questionnaire, which was self-administered, sought information about sources of financial support, type of accommodation, use of recreational facilities, smoking and drinking habits and sources of stress and insecurity on the campus. The GHQ-12 was used to assess their mental status. Ninety-four percent of students were sponsored by their parents. Average monthly income as pocket money ranged from N800-N15,000. Sixty-three (20%) reported that their pocket money was inadequate and 11 (3.5%) engage in business ventures to supplement their income. Two hundred and fifty-seven (81%) live on the campus, 11 (3.5%) were current smokers and 54 (18%) were current drinkers. Stealing and lack of money were the commonest causes of insecurity on the campus. Lack of money, fear of failure of examinations, family problems and broken relationships were reported as causes of depression among this study population. GHQ scores ranged from 1 to 9 using a cut-off point of 3 scores, 38 students (12.0%) were categorised as having traits of poor mental health. GHQ scores were not associated with age, sex, smoking or drinking status or students' assessment of the adequacy of their pocket money. However, living off campus and poor self-perception were associated with poor mental health (p < 0.01). Counseling services should be provided in the medical school to assist students to handle issues that constitute a source of stress in their psychosocial environment.

  16. View Problems with Driving the YPR-765 Under Armour (Uitzichtproblemen bij onderluiks besturen van de YPR-765).

    Science.gov (United States)

    1996-04-17

    Through interviews with drivers and instructors of the YPR-765, an inventory was made of view problems with driving under armour . Problems with...beginning drivers was worse if executed under armour . Suggestions for improvement are given. The problems signalled appear to conflict with the

  17. Children's Exposure to Violence: The Underlying Effect of Posttraumatic Stress Symptoms on Behavior Problems.

    Science.gov (United States)

    Yoon, Susan; Steigerwald, Stacey; Holmes, Megan R; Perzynski, Adam T

    2016-02-01

    In this study we investigated whether witnessing violence and violence victimization were associated with children's internalizing and externalizing behavior problems and examined the mediating role of posttraumatic stress (PTS) symptoms in these relationships. Secondary data analysis was conducted using 3 waves of data from the National Survey of Child and Adolescent Well-Being. Path analyses were conducted to test direct and indirect effects of violence exposure on behavior problems, using 2,064 children (ages 8-15 years) reported to Child Protective Services for maltreatment. Being a victim of violence in the home was directly associated with more internalizing (β = .06, p = .007) and externalizing behavior problems (β = .07, p = .002), whereas witnessing violence was not directly related to either internalizing (β = .04, p = .056) or externalizing behavior problems (β = .03, p = .130). PTS symptoms mediated the effects of witnessing violence and violence victimization on internalizing behavior problems (β = .02, p = .002). Our findings suggest that PTS symptoms may be a mechanism underlying the association between violence exposure and internalizing behavior problems (R(2) = .23), underscoring the potential importance of assessing PTS symptoms and providing targeted trauma-focused interventions for children exposed to violence at home. Copyright © 2016 International Society for Traumatic Stress Studies.

  18. Learning outcomes and tutoring in problem based-learning: how do undergraduate medical students perceive them?

    Science.gov (United States)

    AlHaqwi, Ali I

    2014-04-01

    To explore opinions of undergraduate medical students regarding learning outcomes of the instructional strategy of Problem Based Learning (PBL). In addition their views were sought about the role of tutors and qualities of effective tutors. This was a cross-sectional, questionnaire based study which was conducted in two colleges of Medicine, Central region, Saudi Arabia during the period of 1st of April to 30(th) June 2012. One hundred seventy four undergraduate medical students participated in this study. Seventy percent of participants have indicated that PBL strategy contributed to the development of their knowledge, presentation skills, team work abilities, and accepting criticism from other colleagues. Regarding the tutors' role in PBL tutorials, majority of the participants (75%) indicated that this role is essential, nevertheless, only 58% of students indicated that this role is clear and well identified. Sixty three percent of participants preferred a member role in the PBL tutorials and 80 percent of participants preferred both content and process expert tutors in the PBL tutorials. Significant statistical difference was noted between the views of students and their schools, gender, and study phase. Majority of the participants believed that PBL had a positive impact on the development of their cognitive, personal and teamwork skills. The view of the students in this study and the available evidence suggest that tutor should have both qualities; content and process expertise, in order to have the best outcomes from the PBL tutorials.

  19. 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.

  20. 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.

  1. Student perceptions of a virtual learning environment for a problem-based learning undergraduate medical curriculum.

    Science.gov (United States)

    de Leng, Bas A; Dolmans, Diana H J M; Muijtjens, Arno M M; van der Vleuten, Cees P M

    2006-06-01

    To investigate the effects of a virtual learning environment (VLE) on group interaction and consultation of information resources during the preliminary phase, self-study phase and reporting phase of the problem-based learning process in an undergraduate medical curriculum. A questionnaire was administered to 355 medical students in Years 1 and 2 to ask them about the perceived usefulness of a virtual learning environment that was created with Blackboard for group interaction and the use of learning resources. The students indicated that the VLE supported face-to-face interaction in the preliminary discussion and in the reporting phase but did not stimulate computer-mediated distance interaction during the self-study phase. They perceived that the use of multimedia in case presentations led to a better quality of group discussion than if case presentations were exclusively text-based. They also indicated that the information resources that were hyperlinked in the VLE stimulated the consultation of these resources during self-study, but not during the reporting phase. Students indicated that the use of a VLE in the tutorial room and the inclusion of multimedia in case presentations supported processes of active learning in the tutorial groups. However, if we want to exploit the full potential of asynchronous computer-mediated communication to initiate in-depth discussion during the self-study phase, its application will have to be selective and deliberate. Students indicated that the links in the VLE to selected information in library repositories supported their learning.

  2. Consumer perspectives of medication-related problems following discharge from hospital in Australia: a quantitative study.

    Science.gov (United States)

    Eassey, Daniela; Smith, Lorraine; Krass, Ines; McLAchlan, Andrew; Brien, Jo-Anne

    2016-06-01

    The aim of this study was to investigate the consumer's perspectives and experiences regarding medication related problems (MRPs) following discharge from hospital. A cross-sectional study was conducted using an online 80-question survey. Survey participants were recruited through an online market research company. Five hundred and six participants completed the survey. Participants were included if they were aged 50 years or older, taking 5 or more prescription medicines, had been admitted to hospital with a minimum stay of 24 h, admitted to hospital within the last 4 months and discharged from hospital within the last 1 month. The survey comprised questions measuring: health literacy, health status, medication safety (measured by reported MRPs), missed dose(s), role of health professionals, health services and cost, and socio-demographic status. Descriptive and univariate statistics and logistic regression analysis was performed to examine the predictors of experiencing MRPs. Four main risk factors of MRPs emerged as significant: health literacy (P < 0.05), health status (P < 0.05), consumer engagement (P < 0.05) and cost of medicines (P = 0.001). Participants reporting a lack of perceived control over their medicines (OR 6.3; 95% CI: 3.4-11.8) or those who played less of a role in follow-up discussions with their healthcare professionals (OR 7.6; 95% CI: 1.3-45.7) were more likely to experience a self-reported MRP. This study provides insight into consumers' experiences and perceptions of self-reported MRPs following hospital discharge. Results highlight novel findings demonstrating the importance of consumer engagement in developing processes to ensure medication safety on patient discharge. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  3. Effect of training problem-solving skill on decision-making and critical thinking of personnel at medical emergencies

    Science.gov (United States)

    Heidari, Mohammad; Shahbazi, Sara

    2016-01-01

    Background: The aim of this study was to determine the effect of problem-solving training on decision-making skill and critical thinking in emergency medical personnel. Materials and Methods: This study is an experimental study that performed in 95 emergency medical personnel in two groups of control (48) and experimental (47). Then, a short problem-solving course based on 8 sessions of 2 h during the term, was performed for the experimental group. Of data gathering was used demographic and researcher made decision-making and California critical thinking skills questionnaires. Data were analyzed using SPSS software. Results: The finding revealed that decision-making and critical thinking score in emergency medical personnel are low and problem-solving course, positively affected the personnel’ decision-making skill and critical thinking after the educational program (P problem-solving in various emergency medicine domains such as education, research, and management, is recommended. PMID:28149823

  4. 78 FR 32991 - Medicaid Program; Increased Federal Medical Assistance Percentage Changes Under the Affordable...

    Science.gov (United States)

    2013-06-03

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 433 [CMS-2327-CN] RIN 0938-AR38 Medicaid Program; Increased Federal Medical Assistance Percentage Changes Under the Affordable Care Act of 2010; Correction AGENCY: Centers for Medicare & Medicaid Services (CMS...

  5. 75 FR 74063 - Supplemental Funding Under the Food and Drug Administration's Convener of Active Medical Product...

    Science.gov (United States)

    2010-11-30

    ... the program expansion including the availability of appropriate staff and sufficient funding. 4. The...] Supplemental Funding Under the Food and Drug Administration's Convener of Active Medical Product Surveillance... expansion of its Conference Cooperative Agreement Program (U13), awarded to the Engelberg Center for Health...

  6. 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.

  7. Homotopy Analysis Method for Boundary-Value Problem of Turbo Warrant Pricing under Stochastic Volatility

    Directory of Open Access Journals (Sweden)

    Hoi Ying Wong

    2013-01-01

    Full Text Available Turbo warrants are liquidly traded financial derivative securities in over-the-counter and exchange markets in Asia and Europe. The structure of turbo warrants is similar to barrier options, but a lookback rebate will be paid if the barrier is crossed by the underlying asset price. Therefore, the turbo warrant price satisfies a partial differential equation (PDE with a boundary condition that depends on another boundary-value problem (BVP of PDE. Due to the highly complicated structure of turbo warrants, their valuation presents a challenging problem in the field of financial mathematics. This paper applies the homotopy analysis method to construct an analytic pricing formula for turbo warrants under stochastic volatility in a PDE framework.

  8. Gene–Environment Correlation Underlying the Association Between Parental Negativity and Adolescent Externalizing Problems

    Science.gov (United States)

    Marceau, Kristine; Horwitz, Briana N.; Ganiban, Jody M.; Reiss, David; Narusyte, Jurgita; Spotts, Erica L.; Neiderhiser, Jenae M.

    2014-01-01

    Studies of adolescent or parent-based twins suggest that gene–environment correlation (rGE) is an important mechanism underlying parent–adolescent relationships. However, information on how parents′ and children’s genes and environments influence correlated parent and child behaviors is needed to distinguish types of rGE. The present study used the novel Extended Children of Twins model to distinguish types of rGE underlying associations between negative parenting and adolescent (age 11–22 years) externalizing problems with a Swedish sample of 909 twin parents and their adolescent offspring and a U.S.-based sample of 405 adolescent siblings and their parents. Results suggest that evocative rGE, not passive rGE or direct environmental effects of parenting on adolescent externalizing, explains associations between maternal and paternal negativity and adolescent externalizing problems. PMID:23573986

  9. Psychosocial problems of pre-clinical students in the University of Ibadan Medical School.

    Science.gov (United States)

    Omokhodion, F O

    2003-06-01

    Recent changes in the psychosocial environment of the university campus such as the steep rise in student numbers, the high cost of living standards and the increase in violence and cult activities has prompted the need to assess the impact of these changes on the students. A cross sectional study was carried out among pre-clinical medical students to identify their psychosocial problems. A self-administered questionnaire was used to collect information about socio-demographic variables including age, sex, sources of financial support, type of accommodation, smoking and drinking habits and use of recreational facilities. Causes of insecurity and depression among students were also recorded. The General Health Questionnaire GHQ-12 was used to assess their mental health status. One hundred and seventy-six students responded to the enquiry, 94 males (53%) and 80 females (45%). One hundred and thirty-seven (79%) live on the campus while 37 (21%) live off campus. Only 9 of the students (5%) were smokers and 28 (16%) were drinkers. Monthly pocket money ranged from Naira 1,000 to Naira 25,000. Forty-one (23%) thought their pocket money was adequate, 92 (52%) thought it was fair and 39 (22%) thought it was inadequate. Causes of insecurity on the campus were cultism 34 (19%), lack of money 27 (15%), lack of textbooks 13 (7%) and stealing 10 (6%). Causes of depression include fear of failure of examinations, 62 (35%), lack of money, 48 (27%) and family problems 17 (10%). Mental health scores ranged from 1 to 10. Using a cut off point of 3 to delineate those with traits of poor mental health, 35 (21%) fell into the category 15 boys and 20 girls. Mean mental health score were higher for females, those living on campus, smokers and drinkers but this was not statistically significant. Fear of failure of examinations, cultism and lack of money are major concerns among medical students on the main university campus. Counselling services should be provided to assist students with

  10. '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

  11. Predictors of prescribed medication use for depression, anxiety, stress, and sleep problems in mid-aged Australian women.

    Science.gov (United States)

    Schofield, Margot J; Khan, Asaduzzaman

    2014-11-01

    The study examined prevalence of self-reported use of medication recommended or prescribed by a doctor for depression, anxiety, stress, and sleep problems; and modelled baseline factors that predicted use over 3 years for each condition. Analyses were undertaken on the 2001 and 2004 surveys of mid-aged women in the Australian Longitudinal Study on Women's Health. Dependent variables were self-reported use in past 4 weeks of medications recommended or prescribed by a doctor for depression, anxiety, stress, or sleep problems in 2001 and 2004. Generalized Estimating Equations (GEE) were used to predict medication use for each condition over 3 years. Prevalence of prescribed medication use (2001, 2004) for each condition was depression (7.2, 8.9 %), anxiety (7.4, 9.0 %), stress (4.8, 5.7 %), and sleep problems (8.7, 9.5 %). Multivariable analyses revealed that odds of medication use across 3 years in all four conditions were higher for women with poorer mental and physical health, using hormone replacement therapy (HRT), or having seen a counsellor; and increased over time for depression, anxiety, and stress models. Medication use for depression was also higher for overweight/obese women, ex-smokers, and unmarried. Medication use for anxiety was higher for unmarried and non-working/low occupational women. Medication use for stress was higher for non-working women. Additional predictors of medication for sleep were surgical menopause, and area of residence. Self-reported use of prescribed medication for four mental health conditions is increased over time after controlling for mental and physical health and other variables. Research needs to explore decision-making processes influencing differential rates of psychoactive medication use and their relationship with health outcomes.

  12. Musculoskeletal injuries description of an under-recognized injury problem among military personnel.

    Science.gov (United States)

    Hauret, Keith G; Jones, Bruce H; Bullock, Steven H; Canham-Chervak, Michelle; Canada, Sara

    2010-01-01

    Although injuries are recognized as a leading health problem in the military, the size of the problem is underestimated when only acute traumatic injuries are considered. Injury-related musculoskeletal conditions are common in this young, active population. Many of these involve physical damage caused by micro-trauma (overuse) in recreation, sports, training, and job performance. The purpose of this analysis was to determine the incidence of injury-related musculoskeletal conditions in the military services (2006) and describe a standardized format in which to categorize and report them. The subset of musculoskeletal diagnoses found to be injury-related in previous military investigations was identified. Musculoskeletal injuries among nondeployed, active duty service members in 2006 were identified from military medical surveillance data. A matrix was used to report and categorize these conditions by injury type and body region. There were 743,547 injury-related musculoskeletal conditions in 2006 (outpatient and inpatient, combined), including primary and nonprimary diagnoses. In the matrix, 82% of injury-related musculoskeletal conditions were classified as inflammation/pain (overuse), followed by joint derangements (15%) and stress fractures (2%). The knee/lower leg (22%), lumbar spine (20%), and ankle/foot (13%) were leading body region categories. When assessing the magnitude of the injury problem in the military services, injury-related musculoskeletal conditions should be included. When these injuries are combined with acute traumatic injuries, there are almost 1.6 million injury-related medical encounters each year. The matrix provides a standardized format to categorize these injuries, make comparisons over time, and focus prevention efforts on leading injury types and/or body regions. Published by Elsevier Inc.

  13. 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

  14. 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.

  15. Implementation of the learning problems of physics-based medical and radiation protection in a medical school

    International Nuclear Information System (INIS)

    Munoz Montplet, C.; Casas Curto, J. D.; Pedraza Gutierrez, S.; Vilanova Busquets, J. C.; Balliu Collgros, E.; Barcelo Obregon, J.; Fuentes Raspall, R.; Guirao Marin, S.; Maroto Genover, A.; Pont Valles, J.; Agramunt Chaler, S.; Jurado Bruggeman, D.

    2013-01-01

    The learning objectives related to medical physics and radiation protection work mostly in the module of Radiology and physical medicine of the second year of the curriculum, complemented by a visit to medical physics and radiation protection and radiation oncology at the Hospital services University of reference during the third course. In this paper we present our experience in the design and implementation during the period 2009-2012 of the module focusing in these disciplines. (Author)

  16. 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...

  17. Statistical evaluation of physical examinations conducted under atomic bomb survivors medical treatment law Nagasaki

    Energy Technology Data Exchange (ETDEWEB)

    Ohri, Shigehisa; Shimada, Daisaburo; Ishida, Morthiro; Onishi, Shigeyuki

    1961-09-19

    An evaluation was made of the reliability and validity of the information obtained by the first examination completed under the ABSMTL. Results of the analysis show clearly that the materials hardly can be utilized for studying the relationship between findings obtained from the medical examination and distance from the hypocenter. From the standpoint of clinical medicine, the lack of exactness in the examinations may be a major difficulty. However, as long as the degree of inexactness of the medical examinations is distributed equally to all sample members, comparison of the findings may be made within the limits of their accuracy. 4 references, 1 figure, 3 tables.

  18. 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

    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...... not adequately support complex clinical work. While the CPOMR can be used for patients with few, simple problems who are admitted for only a short time, the CPOMR is not useful for patients with a complex set of problems or for patients admitted for longer periods of time. This is in accordance with criticism...

  19. 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......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....... 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....

  20. 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.

  1. 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.

  2. 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

  3. 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)

  4. Simultaneous planning of the project scheduling and material procurement problem under the presence of multiple suppliers

    Science.gov (United States)

    Tabrizi, Babak H.; Ghaderi, Seyed Farid

    2016-09-01

    Simultaneous planning of project scheduling and material procurement can improve the project execution costs. Hence, the issue has been addressed here by a mixed-integer programming model. The proposed model facilitates the procurement decisions by accounting for a number of suppliers offering a distinctive discount formula from which to purchase the required materials. It is aimed at developing schedules with the best net present value regarding the obtained benefit and costs of the project execution. A genetic algorithm is applied to deal with the problem, in addition to a modified version equipped with a variable neighbourhood search. The underlying factors of the solution methods are calibrated by the Taguchi method to obtain robust solutions. The performance of the aforementioned methods is compared for different problem sizes, in which the utilized local search proved efficient. Finally, a sensitivity analysis is carried out to check the effect of inflation on the objective function value.

  5. Medical ethics at Guantanamo Bay and Abu Ghraib: the problem of dual loyalty.

    Science.gov (United States)

    Clark, Peter A

    2006-01-01

    Although knowledge of torture and physical and psychological abuse was widespread at both the Guantanamo Bay detention facility and Abu Ghraib prison in Iraq, and known to medical personnel, there was no official report before the January 2004 Army investigation of military health personnel reporting abuse, degradation or signs of torture. Military medical personnel are placed in a position of a "dual loyalty" conflict. They have to balance the medical needs of their patients, who happen to be detainees, with their military duty to their employer. The United States military medical system failed to protect detainee's human rights, violated the basic principles of medical ethics and ignored the basic tenets of medical professionalism.

  6. Identification and Classification of Diseases: Fundamental Problems in Medical Ontology and Epistemology

    Directory of Open Access Journals (Sweden)

    Lennart Nordenfelt

    2013-05-01

    Full Text Available During the last three centuries there has been remarkable development in the area of the identification and classification of diseases. The taxonomic systems adopted in the 18th century by, for instance, Sauvages and Linnaeus bare no resemblance to the modern nomenclatures for pathological phenomena. The aim of this paper is to give a brief historical presentation, but also a critical analysis, of a number of crucial ideas and theories behind the construction of certain major disease classifications. My focus in the second half of the paper is on the most influential modern systems of classification, the International Statistical Classification of Diseases and Related Health Problems (ICD and the International Systematized Nomenclature of Human and Veterinary Medicine (SNOMED. The former is the official classification adopted by the World Health Organization and is used mainly for clinical and administrative purposes. The latter is a highly complex system of classification which has recently been developed for a variety of purposes (including medical research and is meant to be read and handled by computers. ICD, although widely used all over the world, has salient and well-known logical deficiencies. SNOMED has been introduced partly to remedy these deficiencies. I conclude, however, that SNOMED, in spite of its sophisticated resources, cannot completely replace ICD. For many clinical and administrative purposes there is need of a relatively simple system that can be handled by the ordinary doctor and the ordinary health-care administrator.

  7. Problem-based learning in pre-clinical medical education: 22 years of outcome research.

    Science.gov (United States)

    Hartling, Lisa; Spooner, Carol; Tjosvold, Lisa; Oswald, Anna

    2010-01-01

    To conduct a systematic review of problem-based learning (PBL) in undergraduate, pre-clinical medical education. A research librarian developed comprehensive search strategies for MEDLINE, PSYCINFO, and ERIC (1985-2007). Two reviewers independently screened search results and applied inclusion criteria. Studies were included if they had a comparison group and reported primary data for evaluative outcomes. One reviewer extracted data and a second reviewer checked data for accuracy. Two reviewers independently assessed methodological quality. Quantitative synthesis was not performed due to heterogeneity. A qualitative review with detailed evidence tables is provided. Thirty unique studies were included. Knowledge acquisition measured by exam scores was the most frequent outcome reported; 12 of 15 studies found no significant differences. Individual studies demonstrated either improved clerkship (N = 3) or residency (N = 1) performance, or benefits on some clinical competencies during internships for PBL (N = 1). Three of four studies found some benefits for PBL when evaluating diagnostic accuracy. Three studies found few differences of clinical (or practical) importance on the impact of PBL on practicing physicians. Twenty-two years of research shows that PBL does not impact knowledge acquisition; evidence for other outcomes does not provide unequivocal support for enhanced learning. Work is needed to determine the most appropriate outcome measures to capture and quantify the effects of PBL. General conclusions are limited by methodological weaknesses and heterogeneity across studies. The critical appraisal of previous studies, conducted as part of this review, provides direction for future research in this area.

  8. Osteoporosis: A Future Public Health Problem for Israel? Medical and Legal Obligations.

    Science.gov (United States)

    Weisz, George M

    2017-04-01

    Starvation in early life can lead to premature metabolic syndrome and bone demineralization. Osteoporosis in the Jewish population may not yet be a recognized syndrome, but the harsh conditions to which Holocaust survivors were exposed may have increased the incidence of the condition. Immigrants and refugees who came to Israel from East Africa and Yemen - whether decades ago or more recently - may have been at increased risk of under-nutrition during pregnancy, affecting both the mother and consequently the offspring. This malnutrition may be further exacerbated by rapid overfeeding in the adopted developed country. This problem was also recognized at the turn of the 21st century in poor and underdeveloped countries and is becoming a global public health issue. In this review, the risks for premature metabolic syndrome and bone demineralization are enumerated and preventive measures outlined.

  9. Deciding medical problems in radiation protection for thirty years in the Boris Kidric Institute - Experimental and epidemiological experiences

    Energy Technology Data Exchange (ETDEWEB)

    Stojanovic, D; Milivojevic, K; Trajkovic, M [Institute of Nuclear Sciences Boris Kidric, Vinca, Beograd (Serbia and Montenegro)

    1989-07-01

    This paper deals with some research work carried out in the Medical Protection Laboratory of the Boris Kidric Institute of Nuclear Sciences - Vinca. Four research fields have been chosen: the analysis of contribution of collaborators Medical Protection Laboratory on symposium Yugoslav Radiation Protection Association (IRPA); from 1963 to 1989 years; the appearance on the meeting IAEA, International seminars, symposium and Congress, including European and international congress IRPA with presentation the most important obtained results; the activity in the frame research projects and contribution for solving important problems in the field of medical aspects of radiation protection in developing and applicable research; the survey current and practical trends in the future (author)

  10. Deciding medical problems in radiation protection for thirty years in the Boris Kidric Institute - Experimental and epidemiological experiences

    International Nuclear Information System (INIS)

    Stojanovic, D.; Milivojevic, K.; Trajkovic, M.

    1989-01-01

    This paper deals with some research work carried out in the Medical Protection Laboratory of the Boris Kidric Institute of Nuclear Sciences - Vinca. Four research fields have been chosen: the analysis of contribution of collaborators Medical Protection Laboratory on symposium Yugoslav Radiation Protection Association (IRPA); from 1963 to 1989 years; the appearance on the meeting IAEA, International seminars, symposium and Congress, including European and international congress IRPA with presentation the most important obtained results; the activity in the frame research projects and contribution for solving important problems in the field of medical aspects of radiation protection in developing and applicable research; the survey current and practical trends in the future (author)

  11. 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)

  12. Protection problems in the use of radioactive materials in medical diagnosis

    International Nuclear Information System (INIS)

    Williams, E.S.

    1977-01-01

    Diagnostic nuclear medicine is now a routine procedure in United Kingdom hospitals. The associated radiation hazards are classified into direct radiation doses to patients and staff, containment hazards, environmental hazards and hazards to third parties. Hazards to the patient or volunteer under study are excluded from further consideration. The isotopes of iodine represent the greatest contamination problem, although many other radionuclides are used. The facilities normally available for their manipulation in UK hospital departments are described. A closed trolley is usually ready equipped to deal with any accidental spills. The importance of staff training in decontamination techniques is emphasized. Radionuclide generators, permitting on-site preparation of short-lived nuclides from long-lived precursors, are supplied and used within their own radiation shielding, thus minimizing radiation hazards to staff. There are problems in limiting the finger dose associated with intravenous injections of radionuclides. The development of short-lived nuclides such as sup(99m)Tc and sup(113m)In allowed the administration to patients of larger amounts of radioactivity. Any increase in staff exposure has been kept to a minimum by improved designs of imaging equipment. Although diagnostic nuclear medicine is potentially hazardous, the actual radiation dose typically received is but a small fraction of the maximum permissible dose for a radiation worker, and there is no record in the UK of any harm have accrued to any worker in this field as a result of radiation exposure. (U.K.)

  13. 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.

  14. 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....

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. Effort--reward imbalance and medically certified absence for mental health problems: a prospective study of white-collar workers.

    Science.gov (United States)

    Ndjaboué, R; Brisson, C; Vézina, M; Blanchette, C; Bourbonnais, R

    2014-01-01

    Little is known about the effects of psychosocial work factors on objectively assessed mental health problems leading to medically certified absence. Only one study has evaluated the prospective effects of effort-reward imbalance (ERI) at work with regards to this outcome. The present study aimed to evaluate the effects of ERI on the incidence of medically certified absence for mental health problems. The study included 2086 white-collar workers (63.3% women) employed in public organisations in Quebec city. Participants were followed over a 9-year period. Medical absences from work were collected from employers' files and psychosocial factors were measured using the ERI questionnaire. Cox regression models were used to estimate the incidence of certified sickness absence due to mental health problems that lasted 5 workdays or more, while controlling for confounders. Workers exposed to ERI had a higher risk of a first spell of medically certified absence for mental health problems (HR=1.38, 95% CI 1.08 to 1.76) compared with unexposed workers. Low reward was significantly associated with a high risk among men (HR=2.80, 95% CI 1.34 to 5.89) but not in women. (HR=1.24, 95% CI 0.90 to 1.73). Effort at work had no effect on certified absence. All these effects were adjusted for potential confounders. ERI and low reward at work were prospectively associated with medically certified absence for mental health problems. These effects seem to differ by gender. Primary prevention that is aimed at reducing these stressors should be considered to help reduce the incidence of such severe mental health problems.

  1. Stability of multi-objective bi-level linear programming problems under fuzziness

    Directory of Open Access Journals (Sweden)

    Abo-Sinna Mahmoud A.

    2013-01-01

    Full Text Available This paper deals with multi-objective bi-level linear programming problems under fuzzy environment. In the proposed method, tentative solutions are obtained and evaluated by using the partial information on preference of the decision-makers at each level. The existing results concerning the qualitative analysis of some basic notions in parametric linear programming problems are reformulated to study the stability of multi-objective bi-level linear programming problems. An algorithm for obtaining any subset of the parametric space, which has the same corresponding Pareto optimal solution, is presented. Also, this paper established the model for the supply-demand interaction in the age of electronic commerce (EC. First of all, the study uses the individual objectives of both parties as the foundation of the supply-demand interaction. Subsequently, it divides the interaction, in the age of electronic commerce, into the following two classifications: (i Market transactions, with the primary focus on the supply demand relationship in the marketplace; and (ii Information service, with the primary focus on the provider and the user of information service. By applying the bi-level programming technique of interaction process, the study will develop an analytical process to explain how supply-demand interaction achieves a compromise or why the process fails. Finally, a numerical example of information service is provided for the sake of illustration.

  2. An Asymptotic Approach for the Elastodynamic Problem of a Plate under Impact Loading

    Directory of Open Access Journals (Sweden)

    Penelope Michalopoulou

    2010-01-01

    Full Text Available An approach is presented for analyzing the transient elastodynamic problem of a plate under an impact loading. The plate is considered to be in the form of a long strip under plane strain conditions. The loading is taken as a concentrated line force applied normal to the plate surface. It is assumed that this line force is suddenly applied and maintained thereafter (i.e., it is a Heaviside step function of time. Inertia effects are taken into consideration and the problem is treated exactly within the framework of elastodynamic theory. The approach is based on multiple Laplace transforms and on certain asymptotic arguments. In particular, the one-sided Laplace transform is applied to suppress time dependence and the two-sided Laplace transform to suppress the dependence upon a spatial variable (along the extent of the infinite strip. Exact inversions are then followed by invoking the asymptotic Tauber theorem and the Cagniard-deHoop technique. Various extensions of this basic analysis are also discussed.

  3. 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.

  4. Determining risk factors for internalizing problem behavior: the Screening Instrument for Adolescents of Parents with Chronic Medical Condition

    NARCIS (Netherlands)

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

    2013-01-01

    A large body of evidence suggests that the risk for adjustment difficulties in children of parents with a chronic medical condition (CMC) depend on a number of demographic, illness-related, child adaptational, and family characteristics. In particular, internalizing problems are common in children

  5. 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

  6. 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.…

  7. 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.

  8. Automation and adaptation: Nurses’ problem-solving behavior following the implementation of bar coded medication administration technology

    Science.gov (United States)

    Holden, Richard J.; Rivera-Rodriguez, A. Joy; Faye, Héléne; Scanlon, Matthew C.; Karsh, Ben-Tzion

    2012-01-01

    The most common change facing nurses today is new technology, particularly bar coded medication administration technology (BCMA). However, there is a dearth of knowledge on how BCMA alters nursing work. This study investigated how BCMA technology affected nursing work, particularly nurses’ operational problem-solving behavior. Cognitive systems engineering observations and interviews were conducted after the implementation of BCMA in three nursing units of a freestanding pediatric hospital. Problem-solving behavior, associated problems, and goals, were specifically defined and extracted from observed episodes of care. Three broad themes regarding BCMA’s impact on problem solving were identified. First, BCMA allowed nurses to invent new problem-solving behavior to deal with pre-existing problems. Second, BCMA made it difficult or impossible to apply some problem-solving behaviors that were commonly used pre-BCMA, often requiring nurses to use potentially risky workarounds to achieve their goals. Third, BCMA created new problems that nurses were either able to solve using familiar or novel problem-solving behaviors, or unable to solve effectively. Results from this study shed light on hidden hazards and suggest three critical design needs: (1) ecologically valid design; (2) anticipatory control; and (3) basic usability. Principled studies of the actual nature of clinicians’ work, including problem solving, are necessary to uncover hidden hazards and to inform health information technology design and redesign. PMID:24443642

  9. 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.

  10. 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

    2013-10-15

    Financial problems caused by cancer and its treatment can substantially affect survivors and their families and create barriers to seeking health care. 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. 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. Copyright © 2013 American Cancer Society.

  11. 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

  12. 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).

  13. 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...

  14. [Problems of military medical examination of military servicemen suffering from chronic obstructive pulmonary disease].

    Science.gov (United States)

    Chapliuk, A L; Brovkin, S G; Kal'manov, A S; Bulavin, V V

    2015-02-01

    The authors showed that at the present time military much more servicemen, suffering from obstructive pulmonary disease, may receive medical examination in outpatient conditions. Series of researches allow us to perform a medical examination on an outpatient basis. The calculation of the cost-effectiveness of health services to such patients during a military medical examination in the hospital and clinics was made. Savings during the examination in the clinic for 1 patient was 2829 rubbles.

  15. Developing and Evaluating Medical Humanities Problem-Based Learning Classes Facilitated by the Teaching Assistants Majored in the Liberal Arts

    Science.gov (United States)

    Tseng, Fen-Yu; Shieh, Jeng-Yi; Kao, Tze-Wah; Wu, Chau-Chung; Chu, Tzong-Shinn; Chen, Yen-Yuan

    2016-01-01

    Abstract Although medical humanities courses taught by teachers from nonmedical backgrounds are not unusual now, few studies have compared the outcome of medical humanities courses facilitated by physicians to that by teaching assistants majored in the liberal arts. The objectives of this study were to (1) analyze the satisfaction of medical students with medical humanities problem-based learning (PBL) classes facilitated by nonmedical teaching assistants (TAF) majored in the liberal arts, and those facilitated by the attending physicians (APF) and (2) examine the satisfaction of medical students with clinical medicine-related and clinical medicine-unrelated medical humanities PBL classes. A total of 123 medical students, randomly assigned to 16 groups, participated in this study. There were 16 classes in the course: 8 of them were TAF classes; and the others were APF classes. Each week, each group rotated from 1 subject of the 16 subjects of PBL to another subject. All of the 16 groups went through all the 16 subjects in the 2013 spring semester. We examined the medical students’ satisfaction with each class, based on a rating score collected after each class was completed, using a scale from 0 (the lowest satisfaction) to 100 (the highest satisfaction). We also conducted multivariate linear regression analysis to examine the association between the independent variables and the students’ satisfaction. Medical students were more satisfied with the TAF (91.35 ± 7.75) medical humanities PBL classes than APF (90.40 ± 8.42) medical humanities PBL classes (P = 0.01). Moreover, medical students were more satisfied with the clinical medicine-unrelated topics (92.00 ± 7.10) than the clinical medicine-related topics (90.36 ± 7.99) in the medical humanities PBL course (P = 0.01). This medical humanities PBL course, including nonmedical subjects and topics, and nonmedical teaching assistants from the liberal arts as class facilitators, was

  16. 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...

  17. 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.

  18. 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.

  19. 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.

  20. How does race get "under the skin"?: inflammation, weathering, and metabolic problems in late life.

    Science.gov (United States)

    Das, Aniruddha

    2013-01-01

    Using nationally representative data from the 2005-2006 U.S. National Social Life, Health, and Aging Project, this study queries the mechanisms underlying worse metabolic outcomes--blood-sugar control and cardiovascular health--among black than white men ages 57-85. Results indicate that contrary to much of the academic literature as well as media accounts-implicitly rooted in a "culture of irresponsibility" model--older black men's social isolation, poor health behaviors, or obesity may not play a major role in their worse metabolic problems. Instead, these outcomes seem to derive more consistently from a factor almost unexamined in the literature--chronic inflammation, arguably a biological "weathering" mechanism induced by these men's cumulative and multi-dimensional stress. These findings highlight the necessity of focusing attention not simply on proximal behavioral interventions, but on broader stress-inducing social inequalities, to reduce men's race disparities in health. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. Challenges Experienced by Korean Medical Students and Tutors during Problem-Based Learning: A Cultural Perspective

    Science.gov (United States)

    Ju, Hyunjung; Choi, Ikseon; Rhee, Byoung Doo; Tae-Lee, Jong

    2016-01-01

    How people learn is influenced by the cultural contexts in which their learning occurs. This qualitative case study explored challenges Korean medical students and tutors experienced during their PBL sessions from a cultural perspective using Hofstede's cultural dimensions. Twelve preclinical medical students and nine tutors from a large Korean…

  2. 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…

  3. 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.

  4. Modeling and solving a large-scale generation expansion planning problem under uncertainty

    Energy Technology Data Exchange (ETDEWEB)

    Jin, Shan; Ryan, Sarah M. [Iowa State University, Department of Industrial and Manufacturing Systems Engineering, Ames (United States); Watson, Jean-Paul [Sandia National Laboratories, Discrete Math and Complex Systems Department, Albuquerque (United States); Woodruff, David L. [University of California Davis, Graduate School of Management, Davis (United States)

    2011-11-15

    We formulate a generation expansion planning problem to determine the type and quantity of power plants to be constructed over each year of an extended planning horizon, considering uncertainty regarding future demand and fuel prices. Our model is expressed as a two-stage stochastic mixed-integer program, which we use to compute solutions independently minimizing the expected cost and the Conditional Value-at-Risk; i.e., the risk of significantly larger-than-expected operational costs. We introduce stochastic process models to capture demand and fuel price uncertainty, which are in turn used to generate trees that accurately represent the uncertainty space. Using a realistic problem instance based on the Midwest US, we explore two fundamental, unexplored issues that arise when solving any stochastic generation expansion model. First, we introduce and discuss the use of an algorithm for computing confidence intervals on obtained solution costs, to account for the fact that a finite sample of scenarios was used to obtain a particular solution. Second, we analyze the nature of solutions obtained under different parameterizations of this method, to assess whether the recommended solutions themselves are invariant to changes in costs. The issues are critical for decision makers who seek truly robust recommendations for generation expansion planning. (orig.)

  5. 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

  6. Prevalence, associated factors and impact of loneliness and interpersonal problems on internet addiction: A study in Chiang Mai medical students.

    Science.gov (United States)

    Simcharoen, Sutapat; Pinyopornpanish, Manee; Haoprom, Pattaraporn; Kuntawong, Pimolpun; Wongpakaran, Nahathai; Wongpakaran, Tinakon

    2018-01-01

    Internet addiction is common among medical students, and the prevalence is higher than the general population. Identifying and creating solutions for this problem is important. The aim of this study was to examine the prevalence and associated factors, particularly loneliness and interpersonal problems among Chiang Mai medical students. Of 324 first to sixth year medical students, 56.8% comprised females with a mean age of 20.88 (SD 1.8). All completed questionnaires related to the objectives and activities of internet use, the Young Internet Addiction Test, the UCLA loneliness scale, and the Interpersonal Problems Inventory were employed to identify internet addiction. In all, 36.7% of the subjects exhibited internet addiction, mostly at mild level. Amount of time used daily, loneliness and interpersonal problems were strong predictors (beta = 0.441, p < 0.05, beta = 0.219, p < 0.001 and beta = 0.203 p < 0.001, respectively), whereas age and sex were not. All objectives of using internet contributed to the variance of internet addiction score. For internet activities, only non-academic or studying contributed. The final model accounted for 42.8% of total variance of the internet addiction score. Even though most addiction was at a mild level, careful strategies should be applied to better understand the situation. Along with a screening for potential internet addiction among medical students, attention should be paid to identifying those who experience loneliness and interpersonal problems, because both are strong predictors that can be improved by a variety of appropriate intervention. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. A comprehensive model for diagnosing the causes of individual medical performance problems: skills, knowledge, internal, past and external factors (SKIPE).

    Science.gov (United States)

    Norfolk, Tim; Siriwardena, A Niroshan

    2013-01-01

    This discussion paper describes a new and comprehensive model for diagnosing the causes of individual medical performance problems: SKIPE (skills, knowledge, internal, past and external factors). This builds on a previous paper describing a unifying theory of clinical practice, the RDM-p model, which captures the primary skill sets required for effective medical performance (relationship, diagnostics and management), and the professionalism that needs to underpin them. The SKIPE model is currently being used, in conjunction with the RDM-p model, for the in-depth assessment and management of doctors whose performance is a cause for concern.

  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. 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.

  10. 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

    O (n(log μ +log logN)) bits of advice. Among other results, this gives a 3-competitive algorithm for planar graphs, provided with O (n log log N) bits of advice. On the other side, we show that an advice of size Ω (n) is required to obtain a 1-competitive algorithm for sequences of size n even......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...... and treewidth α, there is an online algorithm which receives O (n(log α +log log N))1 bits of advice and optimally serves a sequence of length n. With a different argument, we show that if a graph admits a system of μ collective tree (q, r)- spanners, then there is a (q + r)-competitive algorithm which receives...

  11. Support for medical students with mental health problems: a conceptual model.

    Science.gov (United States)

    Grant, Andrew; Rix, Andrew; Winter, Peter; Mattick, Karen; Jones, Debbie

    2015-02-01

    Medical students experience higher prevalence of mental illness than age-matched controls and are less likely to access appropriate help when this happens. The aim of this study was to determine the range of strategies deployed by medical schools to support medical students with mental health concerns and to use this to identify distinct categories. Websites and documents relating to all 32 UK medical schools were looked at, as were reports for quality assurance visits carried out by the General Medical Council (UK). A structured telephone interview was carried out with medical schools. Support services were examined by tracing the path that might be taken by a hypothetical student with mental health concerns of varying severity, seeing what was required and what was available at each stage. A range of support strategies is available to most medical students both from their medical school and from generic services in the university. Medical students will usually first contact a personal tutor or a senior member of faculty or be contacted by them as a result of concerns raised either via performance issues or by another student. While individual support interventions are mostly based on evidence of effectiveness, there is no unifying theory in terms of what constitutes effective support. To enable analysis of support interventions and comparison across providers, a six-stage conceptual model of prevention was developed. The six stages are the following: prevention, identification, referral, escalation, treatment, and reintegration. The staged model, derived from analysis of existing interventions, provides a framework for evaluation of current provision and comparison of different methods of delivery. Moreover, it provides a framework for future research.

  12. Organization of accident medical service in emergency situations in the system of Federal administration board for medical-biological and emergency problems at the Ministry of public health and medical industry of Russia

    International Nuclear Information System (INIS)

    Parfenova, L.N.

    1995-01-01

    Federal Administration Board for medical-biological problems at the Ministry of Public Health and Medical Industry of Russia, in accordance with the entrusted functions, provides medical-sanitary service for the workers of the branches of industry with especially dangerous labour conditions. For these purpose, there is functioning in its system a network of therapeutic-prophylactic, sanitary, scientific-research, educational and other establishments. A high degree of accident danger of the attended industrial plants determines the state policy of organizations and administrations as well as scientific-practical establishments of the Federal Administration Board in respect of elaboration and introduction of a complex of measures which would enable to guarantee the safe functioning of the plants. All sub-administration establishments have the necessary structures, settle the questions of liquidation of medical-sanitary after-effects of accidents at the attended plants, and are regarded to be the organizations of specialized emergency medical aid of the Federal Administration Board

  13. 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

  14. 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

  15. Practice and problems in radiation protection in medical institutions in Papua New Guinea

    International Nuclear Information System (INIS)

    Patel, I.C.

    1984-01-01

    Sources of ionizing radiations employed in medical centres in Papua New Guinea are outlined and the present practice in radiation protection is discussed. Steps being taken or proposed to improve the standard of radiological protection are also considered

  16. MODERNIZATION OF RUSSIAN HEALT PROTECTION SYSTEM SOLVES THE PROBLEM OF RENDERING QUALITY MEDICAL AID TO POPULATION

    Directory of Open Access Journals (Sweden)

    V. A. Alexeev

    2011-01-01

    Full Text Available Last two dozen years, permanent growth of death rate and decrease birth rate take place in Russia. To great extent, this is owing to inadequate health protection system. The practice of personal payments for medical services in amounts unattainable for overwhelming majority of thepopulation grows. RF President’s Administration sets an example: cardiologist’s advice in their clinics costs 40 times more that according to obligatory medical insurance rates. 84% of the country citizens do not approve this approach and consider it socially unjust. An important national project aimed at modernization of the health protection system started in 2011. Non-private medical establishments are to be equipped with up-to-date equipment, modern information systems and medical service standards based on CRM system adopted in developed countries; salaries of health personnel are to be increased.

  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. 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.

  19. 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.)

  20. Psychological problems of atomic bomb survivors from the medical social worker`s standpoint

    Energy Technology Data Exchange (ETDEWEB)

    Tomoike, Toshio [Japanese Red Cross Nagasaki Atomic Bomb Hospital (Japan)

    1994-12-01

    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.).

  1. General practitioners' perceptions of the effectiveness of medical interventions: an exploration of underlying constructs

    Directory of Open Access Journals (Sweden)

    Marteau Theresa M

    2010-02-01

    Full Text Available Abstract Background Many interventions shown to be effective through clinical trials are not readily implemented in clinical practice. Unfortunately, little is known regarding how clinicians construct their perceptions of the effectiveness of medical interventions. This study aims to explore general practitioners' perceptions of the nature of 'effectiveness'. Methods The design was qualitative in nature using the repertory grid technique to elicit the constructs underlying the perceived effectiveness of a range of medical interventions. Eight medical interventions were used as stimuli (diclophenac to reduce acute pain, cognitive behaviour therapy to treat depression, weight loss surgery to achieve weight loss, diet and exercise to prevent type 2 diabetes, statins to prevent heart disease, stopping smoking to prevent heart disease, nicotine replacement therapy to stop smoking, and stop smoking groups to stop smoking. The setting involved face-to-face interviews followed by questionnaires in London Primary Care Trusts. Participants included a random sample of 13 general practitioners. Results Analysis of the ratings showed that the constructs clustered around two dimensions: low patient effort versus high patient effort (dimension one, and small impact versus large impact (dimension two. Dimension one represented constructs such as 'success requires little motivation', 'not a lifestyle intervention', and 'health-care professional led intervention'. Dimension two represented constructs such as 'weak and/or minimal evidence of effectiveness', 'small treatment effect for users', 'a small proportion of users will benefit' and 'not cost-effective'. Constructs within each dimension were closely related. Conclusions General practitioners judged the effectiveness of medical interventions by considering two broad dimensions: the extent to which interventions involve patient effort, and the size of their impact. The latter is informed by trial evidence, but

  2. Quality of life of glaucoma patients under medical therapy with different prostaglandins

    Directory of Open Access Journals (Sweden)

    Paletta Guedes RA

    2012-10-01

    Full Text Available Ricardo Augusto Paletta Guedes,1–3 Vanessa Maria Paletta Guedes,1–3, Sirley Maria Freitas,2 Alfredo Chaoubah11Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; 2Paletta Guedes Ophthalmological Center, Juiz de Fora, MG, Brazil; 3Santa Casa de Misericórdia Hospital, Juiz de Fora, Minas Gerais, BrazilPurpose: To assess the quality of life of glaucoma patients under medical therapy with different prostaglandin analogs.Methods: A cross-sectional study of consecutive glaucoma patients was designed. We assessed the patients' quality of life through the Brazilian 25-question version of the National Eye Institute Visual Functioning Questionnaire, comprising 12 subscales (general health, general vision, ocular pain, near vision, distance vision, social function, mental health, role limitations, dependency, driving, color vision, and peripheral vision and a total composite score. Clinical features, including current medical treatment, were obtained from each patient's medical record. Three groups of patients were identified according to the prostaglandin in use: bimatoprost, latanoprost, or travoprost. The main outcome measures were: mean score in each subscale and mean total composite score.Results: The mean total composite score for the whole group was 70.60. The bimatoprost, latanoprost, and travoprost groups had the following mean composite scores, respectively: 56.56, 77.36, and 71.08 (P = 0.001, analysis of variance [ANOVA]. Latanoprost and travoprost results were similar, and both were superior to bimatoprost. Most subscales had similar results. The subscale with the lowest score for all groups was general health. Groups were homogenous and comparable.Conclusion: There is a difference in the quality of life between glaucoma patients using prostaglandin analogs. It seems that bimatoprost users have lower QoL when compared to latanoprost and travoprost users.Keywords: glaucoma, medical treatment, prostaglandin analogs

  3. 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.

  4. 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.

  5. 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…

  6. 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…

  7. Depression, financial problems and other reasons for suspending medical studies, and requested support services: findings from a qualitative study.

    Science.gov (United States)

    Soh, Nerissa; Ma, Colleen; Lampe, Lisa; Hunt, Glenn; Malhi, Gin; Walter, Garry

    2012-12-01

    This study aimed to qualitatively explore medical students' reasons for suspending, or thinking of suspending, their studies and the types of support services they request. Data were collected through an anonymous online survey. Medical students' responses to open-ended questions were analyzed thematically. Responses were received from 475 students. Financial problems, doubts as to whether medicine was the right vocation, and depression were the most commonly reported themes. Students endorsed a wide range of other pressures and concerns, barriers to obtaining assistance, and also suggested solutions and services to address their concerns. Medical students' financial concerns and potential depressive symptoms should be addressed by university and faculty support services. Government financial support mechanisms for students should also be reviewed. Students' suggestions of the types of services and their location must be borne in mind when allocating resources.

  8. 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 academic subjects of interest (OR = 0.40, p = 0.02). They were significantly more likely to disagree that: there was a lack of encouragement from teachers (OR = 3.11, p = 0.02); and that the medical course fostered a sense of anonymity and feelings of isolation amongst students (OR = 3.42, p = 0.008). 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.

  9. [Medical surveillance in university: organizational difficulties, legal problems, scientific e technical specificities. Experience of University of Milan Bicocca].

    Science.gov (United States)

    D'Orso, M I; Giuliani, C; Assini, R; Riva, M A; Cesana, G

    2012-01-01

    Our research describes activities of Occupational Health carried out during last year in University of Milan Bicocca by Occupational Doctors. We describe results of medical surveillance in 1153 employees or students exposed to occupational risks for health and safety. We report results obtained, technical difficulties, organizational problems, and preventive actions decided to improve functionality of our activity. Students seem to be less protected and consequently seem to have higher professional safety and health risks.

  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. [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.

  13. Managing sleep problems using non-prescription medications and the role of community pharmacists: older adults' perspectives.

    Science.gov (United States)

    Abraham, Olufunmilola; Schleiden, Loren J; Brothers, Amanda L; Albert, Steven M

    2017-12-01

    To examine older adults' perspectives regarding managing sleep problems through selection and use of non-prescription sleep aids, and the role of pharmacists. Telephone interviews were conducted from May to June 2015 with 116 individuals aged ≥60 years in Pittsburgh, Pennsylvania. Participants reported in a previous survey to have used at least one non-prescription sleep aid in the past 30 days and were willing to participate in a follow-up interview. Interview guides were designed to elicit perspectives of sleep problems, selection and use of non-prescription sleep aids, and consultation with healthcare professionals. Interview transcripts underwent content analysis. Four themes emerged as follows: experiences with sleep problems, selection of non-prescription sleep aids, non-prescription sleep aid use and interactions with healthcare professionals. Over half of participants reported using a non-prescription sleep aid for >1 year, were satisfied with its use and perceived it improved sleep quality. Participants commonly used an antihistamine-only sleep aid; 36% of participants self-recommended their sleep aid; and 16% of participants consulted healthcare professionals. Few participants read medication dosage labels (22%), side effects or warnings (19%), and many reported they disregarded directions. Participants did not typically consult pharmacists about sleep problems (65%) but perceived that they could assist with medication concerns. Although most participants had favourable perceptions of non-prescription sleep aids, older adults may be inappropriately using non-prescription sleep aids to self-manage sleep problems by frequently disregarding medication labels and directions for safe use. Also, few older adults are discussing their sleep aid selection and use with pharmacists. © 2017 The Authors. International Journal of Pharmacy Practice published by John Wiley & Sons Ltd on behalf of Royal Pharmaceutical Society.

  14. 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

    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...... 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....... Cronbach's alpha was used to test for internal consistency and reliability of the collected data and Principal Component Exploratory Factor Analysis was performed. Paired t-test was used to examine differences between pre- and post-analysis data. Results: The internal consistency of the questionnaire...

  15. 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

  16. 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.

  17. 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…

  18. 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…

  19. 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.

  20. 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.

  1. [The attitude of the nursing students of Public Higher Medical Professional School in Opole towards the smoking problems in Poland].

    Science.gov (United States)

    Wojtal, Mariola; Kurpas, Donata; Bielska, Dorota; Steciwko, Andrzej

    2008-01-01

    Cigarette smoking has been main reason of the Polish society health hazard and one of the most widespread unhealthy element of the human life style. Aim of the study is to evaluate the attitude of the nursing students of Public Higher Medical Professional School in Opole towards the smoking problems in Poland. Most of respondents considered the nicotinism problem in Poland as very important--3 of them evaluate importance of problem on the scale of 0 - 10, estimated it from 8, 9 and 10 points. 74.3% of respondents support the opinion to put the total injunction from smoking at public areas into practice. According to respondents, the most effective forms to express a non-smoking lifestyle is to promote the idea of the total injunction from smoking at public areas and the promotion of the nonsmoking people at the mass media.

  2. 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.

  3. [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.

  4. 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

  5. Benefit of Problem-Based Learning for Psychosocial Medicine: first experiences at the medical faculty of berne

    Directory of Open Access Journals (Sweden)

    Laederach-Hofmann, Kurt

    2005-04-01

    Full Text Available Aim: Presentation of skills and knowledge of medical students in psychiatry or psychosocial medicine in basic study (year 1 to 3 after the introduction of a problem oriented learning curriculum at the Medical Faculty of Berne.Method: Description of the curriculum with the different teaching units, and the evaluation by means of formative tools used by students and tutors.Results: With reference to qualitative comparison students of the problem based learning track showed a better preparation of the different teaching units than did traditional students. Moreover, compared to classical teaching, students in problem based learning rated the commitment of the teachers higher. The formative results showed a better adherence to the teaching modules, a higher effort in self learning and a higher interest in psychological or psychiatric learning items.Discussion: The higher commitment of teachers and the explicit structuring of the teaching contents in psychiatry and psychosocial medicine showed positive effects in the learning strategy of students. Beside the fact that exams have been adapted to the new curriculum one can assume that the learning style has changed. This might be a result of the better learning environment in the new curriculum. However, there is not clear how and to what extent these changes will remain active until the final exams of the medical curriculum when psychosocial contents will be reexamined.Conclusions: The intense commitment of the teachers and the better structuring of the subject matter may lead to a better integration of psychosocial and psychiatric issues into the medical curriculum.

  6. Analogy as a strategy for supporting complex problem solving under uncertainty.

    Science.gov (United States)

    Chan, Joel; Paletz, Susannah B F; Schunn, Christian D

    2012-11-01

    Complex problem solving in naturalistic environments is fraught with uncertainty, which has significant impacts on problem-solving behavior. Thus, theories of human problem solving should include accounts of the cognitive strategies people bring to bear to deal with uncertainty during problem solving. In this article, we present evidence that analogy is one such strategy. Using statistical analyses of the temporal dynamics between analogy and expressed uncertainty in the naturalistic problem-solving conversations among scientists on the Mars Rover Mission, we show that spikes in expressed uncertainty reliably predict analogy use (Study 1) and that expressed uncertainty reduces to baseline levels following analogy use (Study 2). In addition, in Study 3, we show with qualitative analyses that this relationship between uncertainty and analogy is not due to miscommunication-related uncertainty but, rather, is primarily concentrated on substantive problem-solving issues. Finally, we discuss a hypothesis about how analogy might serve as an uncertainty reduction strategy in naturalistic complex problem solving.

  7. Why are you draining your brain? Factors underlying decisions of graduating Lebanese medical students to migrate.

    Science.gov (United States)

    Akl, Elie A; Maroun, Nancy; Major, Stella; Afif, Claude; Chahoud, Bechara; Choucair, Jacques; Sakr, Mazen; Schünemann, Holger J

    2007-03-01

    In the context of a worldwide physician brain drain phenomenon, Lebanon has the highest emigration factor in the Middle East and North Africa. In this manuscript we aim to identify and develop a conceptual framework for the factors underlying the decisions of graduating Lebanese medical students to train abroad. We conducted two focus groups and seven semi-structured individual interviews with 23 students. In the deductive analysis (based on the push-pull theory), students reported push factors in Lebanon and pull factors abroad related to five dimensions. They focused predominantly on how training abroad provides them with a competitive advantage in an oversaturated Lebanese job market. An inductive analysis revealed the following emerging concepts: repel factors abroad and retain factors locally; societal expectations that students should train abroad; marketing of abroad training; and an established culture of migration. The marketing of abroad training and the culture of migration are prevalent in the academic institutions.

  8. 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

  9. Stakeholder Perspectives on Changes in Hypertension Care Under the Patient-Centered Medical Home.

    Science.gov (United States)

    O'Donnell, Alison J; Bogner, Hillary R; Cronholm, Peter F; Kellom, Katherine; Miller-Day, Michelle; McClintock, Heather F de Vries; Kaye, Elise M; Gabbay, Robert

    2016-02-25

    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. 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. 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. Practices undergoing PCMH transformation may consider stakeholder perspectives about patient-centered, team-based, and systems-based approaches as they work to optimize hypertension care.

  10. 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.

  11. Field Safety Notes in Product Problems of Medical Devices for Use in Pulmonology.

    Science.gov (United States)

    Hannig, Jürgen; Siekmeier, Rüdiger

    2015-01-01

    The current European system for medical devices is governed by three EC directives: the Medical Device Directive 93/42/EEC, the In-Vitro Diagnostic Directive 98/79/EC and the Active Implantable Medical Device Directive 90/385/EEC and regulates marketing and post-market surveillance of medical devices in the European Economic Area. In cases of incidents and field safety corrective actions (FSCA) manufacturers have to inform the responsible Competent Authority, which is the Federal Institute for Drugs and Medical Devices (BfArM) and the public by field safety notices (FSN). In this study we analyzed FSN of medical devices exclusively serving for diagnostics or treatment in pulmonology (e.g. nebulizers, oxygen concentrators, pulse oximeters, lung function analyzers, and non-active devices for treatment). FSCA and FSN publicized by BfArM in 2005-2013 were analyzed in respect to the MEDDEV 2.12-1 rev 8. In total 41 FSCA were publicized for the included products. German and English FSN were found in 36/35 cases, respectively. FSN were clearly characterized as FSN in 22/20 cases and declaration of the type of action was found in 27/26 cases, respectively. Product names were provided in all cases. Lot numbers or other information for product characterization were available in 7/8 and 26/24 cases, respectively. Detailed information regarding FSCA and product malfunction were found in 27/33 and 36/35 cases, respectively. Information on product related risks with previous use of the affected product was provided in 24/23 cases. In 34/34 cases manufacturers provided information to mitigate product related risks. Requests to pass FSN to persons needing awareness were found in 10/14 cases. Contact data were provided in 30/30 cases. Confirmation that the Competent Authority was informed was found in 12/14 cases and in 19/18 cases a customer confirmation was included. The obtained data suggest that there is an increasing annual number of FSCA and most FSN fulfill the criteria of

  12. 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.

  13. Malaria problem in Afghanistan: malaria scanning results of the Turkish medical aid group after the war.

    Science.gov (United States)

    Oner, Yaşar Ali; Okutan, Salih Erkan; Artinyan, Elizabeth; Kocazeybek, Bekir

    2005-04-01

    Malaria is a parasitic infection caused by Plasmodium species and it is especially seen in tropical and subtropical areas. We aimed to evaluate the effects of the infection in Afghanistan, which is an endemic place for malaria and had severe socio-economical lost after the war. We also compared these data with the ones that were recorded before the war. Blood samples were taken from 376 malaria suspected patients who come to the health center, established by the medical group of Istanbul Medical Faculty in 2002, Afghanistan. Blood samples were screened using the OPTIMAL Rapid Malaria Test and Giemsa staining method. In 95 (25.3%) patients diagnosis was malaria. In 65 patients (17.3%) the agent of the infection was P. falciparum and in 30 patients (8%) agents were other Plasmodium species.

  14. [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.

  15. Management of medical confidentiality in English professional football clubs: some ethical problems and issues.

    Science.gov (United States)

    Waddington, I; Roderick, M

    2002-04-01

    To examine the ways in which confidential matters are dealt with in the context of the relationship between the club doctor (or physiotherapist) and the player as patient in English professional football clubs. Semistructured tape recorded interviews with 12 club doctors, 10 club physiotherapists, and 27 current and former players. A questionnaire was also sent to 90 club doctors; 58 were returned. There is among club doctors and physiotherapists no commonly held code of ethics governing how much and what kind of information about players may properly be passed on to managers; associated with this, there is considerable variation from one club to another in terms of the amount and kind of information passed on to managers. In some clubs, medical staff attempt to operate more or less on the basis of the rules governing confidentiality that apply in general practice, but in other clubs, medical staff are more ready to pass on personal information about players. In some situations, this raises serious ethical questions. Guidelines dealing with confidentiality in practitioner-patient relationships in medical practice have long been available and have recently been restated, specifically in relation to the practice of sports medicine, by the British Olympic Association, the British Medical Association, and the Football Association. This is a welcome first step. However, if the guidelines are to have an impact on practice, detailed consideration needs to be given to ensuring their effective implementation; if this is to be achieved, consideration also needs to be given to identifying those aspects of the culture and organisation of professional football clubs that may hinder the full and effective implementation of those guidelines.

  16. 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

  17. Assessment of collaborative problem solving skills in Undergraduate Medical Students at Ziauddin College of Medicine, Karachi.

    Science.gov (United States)

    Mughal, Arsalan Manzoor; Shaikh, Sirajul Haque

    2018-01-01

    Collaborative Problem Solving Empirical Progressions from the Assessment and Teaching of 21st Century Skills (ATC21S) framework were used to determine the level of collaborative problem solving skills (CPS) in first, second and third year MBBS students at Ziauddin College of Medicine during Problem-Based Learning (PBL) sessions. Variations based on gender and roles were studied. It is an analytical comparative cross-sectional study in which seven PBL groups were selected per year by non-probability convenient sampling. Data was collected using the Collaborative Problem Solving Five Strands Empirical Progressions by the primary investigator through observation of the students during PBL sessions. Duration of study was six months. We found that in our students, development of social dimension skills is facilitated to a greater extent than the development of cognitive dimension skills through the process of PBL. These skills are generally better developed in the leader compared to the scribe and members in a group. They are also more developed in females compared to males. Modification in them is also observed as the year's progress. Although PBLs facilitate development of CPS skills' progression however in our curriculum, PBLs mainly focus on social skills development and have less emphasis on cognitive skill development. Thus, hybrid instructional strategies with components from TBL and mentorship are recommended for better development of CPS skills.

  18. A brief survey on problems and countermeasures of electronic medical record system in basic hospitals

    OpenAIRE

    You-bo JIA; Nan LI

    2014-01-01

    The paper, which took Yanggu People’s hospital’s EPR system in the information construction as a case,analyzed domestic EPR system’s current situation, summarized the problems of the EPR system in its implementation process, and some changes to our hospitals it brought.

  19. Assessment of collaborative problem solving skills in Undergraduate Medical Students at Ziauddin College of Medicine, Karachi

    Science.gov (United States)

    Mughal, Arsalan Manzoor; Shaikh, Sirajul Haque

    2018-01-01

    Objective: Collaborative Problem Solving Empirical Progressions from the Assessment and Teaching of 21st Century Skills (ATC21S) framework were used to determine the level of collaborative problem solving skills (CPS) in first, second and third year MBBS students at Ziauddin College of Medicine during Problem-Based Learning (PBL) sessions. Variations based on gender and roles were studied. Methods: It is an analytical comparative cross-sectional study in which seven PBL groups were selected per year by non-probability convenient sampling. Data was collected using the Collaborative Problem Solving Five Strands Empirical Progressions by the primary investigator through observation of the students during PBL sessions. Duration of study was six months. Results: We found that in our students, development of social dimension skills is facilitated to a greater extent than the development of cognitive dimension skills through the process of PBL. These skills are generally better developed in the leader compared to the scribe and members in a group. They are also more developed in females compared to males. Modification in them is also observed as the year's progress. Conclusion: Although PBLs facilitate development of CPS skills' progression however in our curriculum, PBLs mainly focus on social skills development and have less emphasis on cognitive skill development. Thus, hybrid instructional strategies with components from TBL and mentorship are recommended for better development of CPS skills. PMID:29643904

  20. Validation of the MedUseQ: A Self-Administered Screener for Older Adults to Assess Medication Use Problems.

    Science.gov (United States)

    Berman, Rebecca L; Iris, Madelyn; Conrad, Kendon J; Robinson, Carrie

    2018-01-01

    Older adults taking multiple prescription and nonprescription drugs are at risk for medication use problems, yet there are few brief, self-administered screening tools designed specifically for them. The study objective was to develop and validate a patient-centered screener for community-dwelling older adults. In phase 1, a convenience sample of 57 stakeholders (older adults, pharmacists, nurses, and physicians) participated in concept mapping, using Concept System® Global MAX TM , to identify items for a questionnaire. In phase 2, a 40-item questionnaire was tested with a convenience sample of 377 adults and a 24-item version was tested with 306 older adults, aged 55 and older, using Rasch methodology. In phase 3, stakeholder focus groups provided feedback on the format of questionnaire materials and recommended strategies for addressing problems. The concept map contained 72 statements organized into 6 conceptual clusters or domains. The 24-item screener was unidimensional. Cronbach's alpha was .87, person reliability was acceptable (.74), and item reliability was high (.96). The MedUseQ is a validated, patient-centered tool targeting older adults that can be used to assess a wide range of medication use problems in clinical and community settings and to identify areas for education, intervention, or further assessment.

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

    NARCIS (Netherlands)

    L. Evers (Lanah); K.M. Glorie (Kristiaan); S. van der Ster (Suzanne); A.I. Barros (Ana); H. Monsuur (Herman)

    2012-01-01

    textabstractThe 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

  2. 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.

  3. Financial Stress, Parental Depressive Symptoms, Parenting Practices, and Children's Externalizing Problem Behaviors: Underlying Processes

    Science.gov (United States)

    Lee, Chih-Yuan Steven; Lee, Jaerim; August, Gerald J.

    2011-01-01

    This study examined the relationships among financial stress encountered by families, parents' social support, parental depressive symptoms, parenting practices, and children's externalizing problem behaviors to advance our understanding of the processes by which family financial stress is associated with children's problem behaviors. We also…

  4. Appreciation of learning environment and development of higher-order learning skills in a problem-based learning medical curriculum.

    Science.gov (United States)

    Mala-Maung; Abdullah, Azman; Abas, Zoraini W

    2011-12-01

    This cross-sectional study determined the appreciation of the learning environment and development of higher-order learning skills among students attending the Medical Curriculum at the International Medical University, Malaysia which provides traditional and e-learning resources with an emphasis on problem based learning (PBL) and self-directed learning. Of the 708 participants, the majority preferred traditional to e-resources. Students who highly appreciated PBL demonstrated a higher appreciation of e-resources. Appreciation of PBL is positively and significantly correlated with higher-order learning skills, reflecting the inculcation of self-directed learning traits. Implementers must be sensitive to the progress of learners adapting to the higher education environment and innovations, and to address limitations as relevant.

  5. Premium Collection and the Problem of Voluntary Enrolment in China’s New Rural Cooperative Medical System

    Directory of Open Access Journals (Sweden)

    Armin Müller

    2016-01-01

    Full Text Available In late 2002, the Chinese government launched an initiative to extend the coverage of health insurance in rural China with the New Rural Cooperative Medical System (NRCMS. It covered all of rural China by 2008 and is being continuously adapted and developed. This study explores two conflicting goals in the policy design: universal coverage and voluntary enrolment. Local governments often faced the problem that only insufficient numbers of villagers were enrolling voluntarily. They developed different strategies to cope with it: Complementary outpatient reimbursement via medical savings accounts (MSAs effectively transferred villagers’ premiums back to them, thus making the NRCMS more attractive. Adapting the premium-collection process to the local context or utilising collusive practices allowed them to pay premiums on behalf of the villagers from the insurance funds. These strategies undermine the effectiveness of the NRCMS as a risk-pooling mechanism, facilitate latent coverage gaps and turn it into a tax-funded service.

  6. 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.

  7. 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

  8. Pricing of medical devices under coverage uncertainty--a modelling approach.

    Science.gov (United States)

    Girling, Alan J; Lilford, Richard J; Young, Terry P

    2012-12-01

    Product vendors and manufacturers are increasingly aware that purchasers of health care will fund new clinical treatments only if they are perceived to deliver value-for-money. This influences companies' internal commercial decisions, including the price they set for their products. Other things being equal, there is a price threshold, which is the maximum price at which the device will be funded and which, if its value were known, would play a central role in price determination. This paper examines the problem of pricing a medical device from the vendor's point of view in the presence of uncertainty about what the price threshold will be. A formal solution is obtained by maximising the expected value of the net revenue function, assuming a Bayesian prior distribution for the price threshold. A least admissible price is identified. The model can also be used as a tool for analysing proposed pricing policies when no formal prior specification of uncertainty is available. Copyright © 2011 John Wiley & Sons, Ltd.

  9. 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.

  10. Virtual microscopy system at Chinese medical university: an assisted teaching platform for promoting active learning and problem-solving skills.

    Science.gov (United States)

    Tian, Yanping; Xiao, Wengang; Li, Chengren; Liu, Yunlai; Qin, Maolin; Wu, Yi; Xiao, Lan; Li, Hongli

    2014-04-09

    Chinese medical universities typically have a high number of students, a shortage of teachers and limited equipment, and as such histology courses have been taught using traditional lecture-based formats, with textbooks and conventional microscopy. This method, however, has reduced creativity and problem-solving skills training in the curriculum. The virtual microscope (VM) system has been shown to be an effective and efficient educational strategy. The present study aims to describe a VM system for undergraduates and to evaluate the effects of promoting active learning and problem-solving skills. Two hundred and twenty-nine second-year undergraduate students in the Third Military Medical University were divided into two groups. The VM group contained 115 students and was taught using the VM system. The light microscope (LM) group consisted of 114 students and was taught using the LM system. Post-teaching performances were assessed by multiple-choice questions, short essay questions, case analysis questions and the identification of structure of tissue. Students' teaching preferences and satisfaction were assessed using questionnaires. Test scores in the VM group showed a significant improvement compared with those in the LM group (p 0.05); however, there were notable differences in the mean score rate of case analysis questions and identification of structure of tissue (p effects of the VM system in terms of additional learning resources, critical thinking, ease of communication and confidence. The VM system is an effective tool at Chinese medical university to promote undergraduates' active learning and problem-solving skills as an assisted teaching platform.

  11. General Disinfection in Medical and Dental Hospitals, Selection of Disinfectant Type and Problems Encountered

    OpenAIRE

    Akça, Gülin

    2015-01-01

    Hospitals are the places where, either the patients or other health workers can encounter with dangerous problem of several bacterial, fungal, viral, parasitic infectious agents, especially the emerging and life threatening ones such as, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococcus faecalis (VRE), Stenotrophomonas sp., and multi drug resistant Acinetobacter sp., Pseudomonas sp.. The reasons of these resistant microorganisms that can threaten the life o...

  12. 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.

  13. Comorbidities and medications of patients with chronic hepatitis C under specialist care in the UK

    Science.gov (United States)

    Hudson, Benjamin; Walker, Alex J.

    2017-01-01

    Designing services with the capacity and expertise to meet the needs of the chronic hepatitis C (CHC) population in the era of direct acting antivirals (DAAs), and widening access to such treatments, requires detailed understanding of the characteristics and healthcare needs of the existing patient population. In this retrospective analysis of data from the National HCV Research UK Biobank between March 2012 and October 2014, the characteristics of the CHC population currently under specialist care in the UK were evaluated—with specific focus upon use of medications, adverse lifestyle choices, and comorbidities. Demographic data, risk factors for CHC acquisition, HCV genotype, liver disease status, lifestyle factors, comorbidities, and medication classes were collected. Data were analyzed by history of injecting drug use (IDU), age, and severity of liver disease. A total of 6278 patients (70.5% white; median age, 52 years) from 59 UK specialist centres were included; 59.1% of patients had acquired HCV through IDU. The prevalence of adverse lifestyle factors was significantly lower in non‐IDU compared with previous IDU or recent IDU patients. Depression was common in the previous (50.8%) and recent IDU (68.1%) groups, compared with 27.6% in non‐IDU patients. Cirrhosis was common (23.6%), and prevalence increased with age. We describe a heterogeneous, polymorbid, and aging population of CHC patients in secondary care, and demonstrate underrepresentation of injecting drug users within the current system. The implications of this present significant challenges to physicians and healthcare commissioners in designing services which are fit for purpose inthe DAA era. PMID:28480974

  14. Using Coevolution Genetic Algorithm with Pareto Principles to Solve Project Scheduling Problem under Duration and Cost Constraints

    Directory of Open Access Journals (Sweden)

    Alexandr Victorovich Budylskiy

    2014-06-01

    Full Text Available This article considers the multicriteria optimization approach using the modified genetic algorithm to solve the project-scheduling problem under duration and cost constraints. The work contains the list of choices for solving this problem. The multicriteria optimization approach is justified here. The study describes the Pareto principles, which are used in the modified genetic algorithm. We identify the mathematical model of the project-scheduling problem. We introduced the modified genetic algorithm, the ranking strategies, the elitism approaches. The article includes the example.

  15. 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.

  16. Project selection problem under uncertainty: An application of utility theory and chance constrained programming to a real case

    Directory of Open Access Journals (Sweden)

    Reza Hosnavi Atashgah

    2013-06-01

    Full Text Available Selecting from a pool of interdependent projects under certainty, when faced with resource constraints, has been studied well in the literature of project selection problem. After briefly reviewing and discussing popular modeling approaches for dealing with uncertainty, this paper proposes an approach based on chance constrained programming and utility theory for a certain range of problems and under some practical assumptions. Expected Utility Programming, as the proposed modeling approach, will be compared with other well-known methods and its meaningfulness and usefulness will be illustrated via two numerical examples and one real case.

  17. 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.

  18. Medical negligence liability under the consumer protection act: A review of judicial perspective.

    Science.gov (United States)

    Joga Rao, S V

    2009-07-01

    It is important to know what constitutes medical negligence. A doctor owes certain duties to the patient who consults him for illness. A deficiency in this duty results in negligence. A basic knowledge of how medical negligence is adjudicated in the various judicial courts of India will help a doctor to practice his profession without undue worry about facing litigation for alleged medical negligence.

  19. 20 CFR 255.9 - Individual enrolled under supplementary medical insurance plan.

    Science.gov (United States)

    2010-04-01

    ... supplementary medical insurance premiums will be applied toward payment of such premiums, and the balance of the... medical insurance plan. 255.9 Section 255.9 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS... supplementary medical insurance plan. Where recovery of the overpayment is by setoff as provided for in § 255.6...

  20. 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.

  1. Integration of leadership training into a problem/case-based learning program for first- and second-year medical students.

    Science.gov (United States)

    Ginzburg, Samara B; Deutsch, Susan; Bellissimo, Jaclyn; Elkowitz, David E; Stern, Joel Nh; Lucito, Robert

    2018-01-01

    The evolution of health care systems in response to societal and financial pressures has changed care delivery models, which presents new challenges for physicians. Leadership training is increasingly being recognized as an essential component of medical education training to prepare physicians to meet these needs. Unfortunately, most medical schools do not include leadership training. It has been suggested that a longitudinal and integrated approach to leadership training should be sought. We hypothesized that integration of leadership training into our hybrid problem-based learning (PBL)/case-based learning (CBL) program, Patient-Centered Explorations in Active Reasoning, Learning and Synthesis (PEARLS), would be an effective way for medical students to develop leadership skills without the addition of curricular time. We designed a unique leadership program in PEARLS in which 98 medical students participated during each of their six courses throughout the first 2 years of school. A program director and trained faculty facilitators educated students and coached them on leadership development throughout this time. Students were assessed by their facilitator at the end of every course on development of leadership skills related to teamwork, meaningful self-assessment, process improvement, and thinking outside the box. Students consistently improved their performance from the first to the final course in all four leadership parameters evaluated. The skills that demonstrated the greatest change were those pertaining to thinking outside the box and process improvement. Incorporation of a longitudinal and integrated approach to leadership training into an existing PBL/CBL program is an effective way for medical students to improve their leadership skills without the addition of curricular time. These results offer a new, time-efficient option for leadership development in schools with existing PBL/CBL programs.

  2. Prevalence and severity of dysmenorrhea: a problem related to menstruation, among first and second year female medical students.

    Science.gov (United States)

    Singh, Amita; Kiran, Dukhu; Singh, Harminder; Nel, Bithika; Singh, Prabhakar; Tiwari, Pavan

    2008-01-01

    Dysmenorrhea is the most common of gynecologic complaints. It affects half of all female adolescents today and represents the leading cause of periodic college/school absenteeism among that population. To evaluate the menstrual problem specially dysmenorrhea and its severity in female medical students and its effect on their regular activities. This is a cross-sectional descriptive study; conducted on 107 female medical students, all participants were given a questionnaire to complete; questions were related to menstruation elucidating variations in menstrual patterns, history of dysmenorrhea and its severity, pre-menstrual symptom and absenteeism from college and/or class; to detect the severity of dysmenorrhea we used the verbal multi-dimensional scoring system, participants were given 20 minutes to complete the questionnaire. The mean age of subjects at menarche was 12.5 (+/-1.52) years, with a range of 10-15 years. The prevalence of dysmenorrhea was 73.83%; approximately 4.67% of dysmenorrhic subjects had severe dysmenorrhea. The average duration between two periods and the duration of menstrual flow were 28.34 (+/-7.54) days and 4.5 (+/-2.45) days respectively. Prevalence of other menstrual disorders like irregularity, prolonged menstrual bleeding, heavy menstrual bleeding and PCOD were 7.47%, 10.28%, 23.36% and 3.73% respectively. Among female medical students who reported dysmenorrhea; 31.67% and 8.68% were frequently missing college & classes respectively. Premenstrual symptom was the second most (60.50%) prevalent disorder and 67.08% reported social withdrawal. Dysmenorrhea and PMS is highly prevalent among female medical students, it is related to college/class absenteeism, limitations on social, academic, sports and daily activities. Maximum participants do not seek medical advice and self treat themselves with prostaglandin inhibitors; like Ibuprofen.

  3. CDC Vital Signs: Binge Drinking a Serious, Under-Recognized Problem Among Women and Girls

    Science.gov (United States)

    ... defined as consuming 4 ormore alcohol drinks (beer, wine, or liquor) on an occasion. Problem Drinking too ... more frequently on the basis of potential health benefits. If you do choose to drink, do so ...

  4. [Anophthalmia and microphthalmia requires multidisciplinary care. Many of the children also have other medical problems].

    Science.gov (United States)

    Jugård, Ylva; Odersjö, Marie; Topa, Alexandra; Lindgren, Gun; Andersson Grönlund, Marita

    2015-07-13

    Anophthalmia/microphthalmia (A/M) are rare congenital eye malformations. Early intervention with ocular prosthesis can stimulate orbital growth and prevent facial asymmetry. We reviewed medical records from 18 individuals with A/M (0.8-31 years) treated with ocular prosthesis at Sahlgrenska University Hospital between 2000 and 2012. A majority had other ocular findings. Seven had subnormal visual acuity in the fellow eye, one third were in contact with vision support services and half of the group wore glasses. Eleven individuals had extra-ocular findings such as cardiac defect, hearing impairment and neuropsychiatric disorders, possibly indicating syndromic conditions. We suggest that investigation of A/M children should include ultrasound of the eye, optionally visual evoked potential and magnetic resonance imaging of the CNS. The ophthalmologist should initiate treatment with prosthesis, pediatric assessment, hearing tests and genetic counseling, but should also monitor visual development of the fellow eye.

  5. 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)

  6. Centenarians and supercentenarians: a black swan. Emerging social, medical and surgical problems.

    Science.gov (United States)

    Vacante, Marco; D'Agata, Velia; Motta, Massimo; Malaguarnera, Giulia; Biondi, Antonio; Basile, Francesco; Malaguarnera, Michele; Gagliano, Caterina; Drago, Filippo; Salamone, Salvatore

    2012-01-01

    The Black Swan Theory was described by Nassim Nicholas Taleb in his book "The Black Swan". This theory refers to "high-impact, hard-to-predict, and rare events beyond the realm of normal expectations". According to Taleb's criteria, a Black Swan Event is a surprise, it has a major impact and after the fact, the event is rationalized by hindsight, as if it had been expected. For most of human history centenarians were a rare and unpredictable phenomenon. The improvements of the social-environmental conditions, of medical care, and the quality of life caused a general improvement of the health status of the population and a consequent reduction of the overall morbidity and mortality, resulting in an overall increase of life expectancy. The study of centenarians and supercentenarians had the objective to consider this black swan and to evaluate the health, welfare, social and economic consequences of this phenomenon.

  7. 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)

  8. Knowledge of childhood sleep: a possible variable in under or misdiagnosis of childhood sleep problems.

    Science.gov (United States)

    Schreck, Kimberly A; Richdale, Amanda L

    2011-12-01

    Evidence demonstrates that health professionals have limited knowledge about childhood sleep, frequently do not screen for these problems and often rely on parents to raise sleep issues at clinic visits. However, little is known about parents' sleep knowledge. The goal of this study was to assess parents' knowledge of sleep and specifically: (i) sleep aspects related to the age of children; (ii) developmentally normal sleep; and (iii) sleep problems that may lead to parents' ability to raise sleep issues at clinic visits. This study evaluated the knowledge of 170 parents of children aged 2-17 years about infant, child and adolescent sleep patterns and problems. The majority of parents could not answer correctly questions about developmental sleep patterns or sleep problems, but were more likely to answer correctly questions about normal infant sleep patterns and about sleep problems during waking hours. Parents also were more likely to answer 'don't know' to questions about: (i) older children and adolescents; (ii) sleep apnea; and (iii) dreams and nightmares. The implications of these findings for the identification, intervention and prevention of childhood sleep problems are discussed. 2011 European Sleep Research Society.

  9. 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.

  10. 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

  11. 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.

  12. 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.

  13. 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.

  14. Indian medical students' perspectives on problem-based learning experiences in the undergraduate curriculum: One size does not fit all.

    Science.gov (United States)

    Nanda, Bijli; Manjunatha, Shankarappa

    2013-01-01

    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. 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. 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. 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.

  15. An efficient computational method for a stochastic dynamic lot-sizing problem under service-level constraints

    NARCIS (Netherlands)

    Tarim, S.A.; Ozen, U.; Dogru, M.K.; Rossi, R.

    2011-01-01

    We provide an efficient computational approach to solve the mixed integer programming (MIP) model developed by Tarim and Kingsman [8] for solving a stochastic lot-sizing problem with service level constraints under the static–dynamic uncertainty strategy. The effectiveness of the proposed method

  16. Technical and diagnostic problems of X-ray radiography of children in medical practice

    International Nuclear Information System (INIS)

    Schuster, W.

    An increase in biomedical paediatric radiography of 5-10% per year is expected and therefore it is necessary to look for new possibilities to reduce the dose with the aim to make an increase of radiation exposure impossible, a radiation exposure which would indeed have a very negative effect on the organism of children. Some reasons for the increased radiation sensivity of children are explained. To reduce the radiation exposure the author demands for the sector of children radiobiology that doctors and assistents should be trained in a right way, further a clear diagnosis and the best possible equipment. Concerning the last point various possibilities are presented. The special problem of biomedical radiography is shortly dealt with. At the end of his report the author gives some recommendations concerning the dose, dose capacity, filters which should be used. (MG) [de

  17. 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.

  18. 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.

  19. Practical problems in radiation sterilization of medical devices made from plasticized PVC

    International Nuclear Information System (INIS)

    Beenen, J.H.

    1990-01-01

    The following three methods for sterilizing medical devices made from plasticised PVC are used in the Netherlands. 1. sterilization by steam, steam-air or superheated water. 2. sterilization by electron beam or gamma irradiation. 3. ethylene oxide sterilization. IV-bags, blood bags and other bag types for similar applications made from plasticized PVC are mostly sterilized by steam-air or super heated water, especially when filled or partly filled containers are considered. More complicated products or products with components that cannot resist steam sterilization of 121 0 C are sterilized by ethylene oxide or irradiation. These last two methods also are favoured for sterilizing empty bags where sticking of the surfaces at the sterilization temperature creates a serious handicap. Moreover, steam sterilization may cause a permanent opacity of some plastics. However, we have to add that due to developments in formulations steam sterilization of empty bags is going to be of an increasing importance. proven carcinogenity of the gas ethylene oxide, difficult deaeration and retention of the gas in plasticized PVC has increased the demand for better radiation resistant plastics as an alternative for steam sterilization. (author)

  20. Problem of medical follow-up and assessment of occupational disease in personnel handling radiation sources

    International Nuclear Information System (INIS)

    Klener, V.

    1983-01-01

    The long-term change in the health condition of 120 recorded cases of occupational disease owing to ionizing radiation in the years 1961 to 1981 was evaluated on the basis of the analysis of out-patient records in three regions of the Czech Socialist Republic. In the group the prevalent incidence was of carcinoma of the skin (86), alterations in blood formation (19), cataract (4) leukemia (2) and changes owing to single exposure usually with acute skin manifestations (9). Owing to the inadequate development of radiobiological knowledge and the lack of objective data on exposure, cases of transient leukopenia used to be put in direct relation with occupational exposure to ionizing radiation - this disorder always had a good long-term prognosis. At the present level of protection the determination of peripheral blood count made within preventive medical check-ups of personnel handling radiation sources has only partial significance and should be considered as complementary to the overall complex examination. (author)

  1. 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

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

    Science.gov (United States)

    Zwier, Sandra

    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 gatekeeper arrangements. Exposure led to a stronger intention to seek treatment from the specialist provider and motivation to rely on the providers' claims. Weaker to absent effects were found for intention to question the physician gatekeeper's referral and this was chiefly motivated by the belief that "the doctor knows best." Implications for specialist provider marketing under gatekeeping arrangements are discussed.

  3. A new LP formulation of the admission control problem modelled as an MDP under average reward criterion

    Science.gov (United States)

    Pietrabissa, Antonio

    2011-12-01

    The admission control problem can be modelled as a Markov decision process (MDP) under the average cost criterion and formulated as a linear programming (LP) problem. The LP formulation is attractive in the present and future communication networks, which support an increasing number of classes of service, since it can be used to explicitly control class-level requirements, such as class blocking probabilities. On the other hand, the LP formulation suffers from scalability problems as the number C of classes increases. This article proposes a new LP formulation, which, even if it does not introduce any approximation, is much more scalable: the problem size reduction with respect to the standard LP formulation is O((C + 1)2/2 C ). Theoretical and numerical simulation results prove the effectiveness of the proposed approach.

  4. 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.

  5. 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

  6. 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.

  7. 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

  8. Medical negligence liability under the consumer protection act: A review of judicial perspective

    Directory of Open Access Journals (Sweden)

    S V Joga Rao

    2009-01-01

    Full Text Available It is important to know what constitutes medical negligence. A doctor owes certain duties to the patient who consults him for illness. A deficiency in this duty results in negligence. A basic knowledge of how medical negligence is adjudicated in the various judicial courts of India will help a doctor to practice his profession without undue worry about facing litigation for alleged medical negligence.

  9. [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.

  10. 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.

  11. Fixed vs. random proportions demand models for the assortment planning problem under stockout-based substitution

    NARCIS (Netherlands)

    Honhon, D.B.L.P.; Seshardi, S.

    2013-01-01

    We consider the problem of determining the optimal assortment of products to offer in a given product category when each customer is characterized by a type, which is a list of products he is willing to buy in decreasing order of preference. We assume consumer-driven, dynamic, stockout-based

  12. 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

    problems. We find three applications of our reductions: 1. An exponential-time algorithm: We show how to decide Hamiltonicity in directed n-vertex graphs with running time 1.9999^n provided that the graph has at most 1.0385^n Hamiltonian cycles. We do so by reducing to the algorithm of Björklund...

  13. U.S. academic medical centers under the managed health care environment.

    Science.gov (United States)

    Guo, K

    1999-06-01

    This research investigates the impact of managed health care on academic medical centers in the United States. Academic medical centers hold a unique position in the U.S. health care system through their missions of conducting cutting-edge biomedical research, pursuing clinical and technological innovations, providing state-of-the-art medical care and producing highly qualified health professionals. However, policies to control costs through the use of managed care and limiting resources are detrimental to academic medical centers and impede the advancement of medical science. To survive the threats of managed care in the health care environment, academic medical centers must rely on their upper level managers to derive successful strategies. The methods used in this study include qualitative approaches in the form of key informants and case studies. In addition, a survey questionnaire was sent to 108 CEOs in all the academic medical centers in the U.S. The findings revealed that managers who perform the liaison, monitor, entrepreneur and resource allocator roles are crucial to ensure the survival of academic medical centers, so that academic medical centers can continue their missions to serve the general public and promote their well-being.

  14. 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

  15. 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…

  16. 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.  

  17. 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.

  18. ["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.

  19. What can we learn from problem-based learning tutors at a graduate entry medical school? A mixed method approach.

    Science.gov (United States)

    O Doherty, Diane; Mc Keague, Helena; Harney, Sarah; Browne, Gerard; McGrath, Deirdre

    2018-05-04

    Problem-based learning (PBL) has been adopted by many medical schools as an innovative method to deliver an integrated medical curriculum since its inception at McMaster University (Dornan et al., Med Educ 39(2):163-170, 2005; Finucane et al., Med Educ 35(1):56-61, 2001; Barrows, Tutorials in problem-based learning: A new direction in teaching the health professions, 1984). The student experience in PBL has been explored in detail (Merriam, New Directions for Adult and Continuing Education 89: 3-13, 2001; Azer, Kaohsiung J Med Sci 25(5): 240-249, 2009; Boelens et al., BMC Med Ed 15(1): 84, 2015; Dolmans et al., Med Teach 24(2):173-180, 2002; Lee et al., Med Teach 35(2): e935-e942, 2013) but the tutors who facilitate PBL have valuable insight into how PBL functions and this aspect has not been extensively researched. The integrated curriculum for years 1 and 2 at the Graduate Entry Medical School at the University of Limerick is delivered though problem-based learning (PBL). This programme requires collaborative teamwork between students and the tutors who facilitate small-group tutorial sessions. All PBL tutors at GEMS are medically qualified, with the majority (68%) currently working in clinical practice. A mixed-methods approach was adopted, utilising two surveys and follow-up focus groups to fully understand the tutor experience. Thirty-three tutors took part in two online surveys with a response rate of 89%. Thirteen tutors participated in two focus groups. Descriptive analysis was completed on survey data and thematic analysis on focus group discussions which highlighted five main themes. Tutors reported challenges with managing group dynamics, development of confidence in tutoring with experience and a willingness to learn from peers to improve practice. Findings are in keeping with previously published work. Results also identified several less commonly discussed issues impacting student engagement in PBL including the use of mobile device technology

  20. 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.

  1. Problem-solving versus cognitive restructuring of medically ill seniors with depression (PROMISE-D trial: study protocol and design

    Directory of Open Access Journals (Sweden)

    Sharpe Louise

    2012-11-01

    more chronic health problems, is becoming an increasing problem internationally, particularly amongst the elderly. Evidence-based psychological treatments exist for late-life depression and these have been shown to be effective for participants with individual health problems and depression. However, there are no studies that have compared the two leading psychotherapies shown to be effective in the treatment of late-life depression. In addition, many trials of psychotherapy with older adults exclude those with multi-morbidity. Hence, this trial will confirm whether CBT and PST are efficacious in the treatment of depression in the context of complex medical needs and determine which of these two interventions is most efficacious. Trial registration ACTRN12612000854831

  2. 29 CFR 1904.9 - Recording criteria for cases involving medical removal under OSHA standards.

    Science.gov (United States)

    2010-07-01

    ... surveillance requirements of an OSHA standard, you must record the case on the OSHA 300 Log. (b) Implementation—(1) How do I classify medical removal cases on the OSHA 300 Log? You must enter each medical removal case on the OSHA 300 Log as either a case involving days away from work or a case involving restricted...

  3. 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 ...

  4. 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...

  5. Neural pathway in the right hemisphere underlies verbal insight problem solving.

    Science.gov (United States)

    Zhao, Q; Zhou, Z; Xu, H; Fan, W; Han, L

    2014-01-03

    Verbal insight problem solving means to break mental sets, to select the novel semantic information and to form novel, task-related associations. Although previous studies have identified the brain regions associated with these key processes, the interaction among these regions during insight is still unclear. In the present study, we explored the functional connectivity between the key regions during solving Chinese 'chengyu' riddles by using event-related functional magnetic resonance imaging. Results showed that both insight and noninsight solutions activated the bilateral inferior frontal gyri, middle temporal gyri and hippocampi, and these regions constituted a frontal to temporal to hippocampal neural pathway. Compared with noninsight solution, insight solution had a stronger functional connectivity between the inferior frontal gyrus and middle temporal gyrus in the right hemisphere. Our study reveals the neural pathway of information processing during verbal insight problem solving, and supports the right-hemisphere advantage theory of insight. Copyright © 2013 IBRO. Published by Elsevier Ltd. All rights reserved.

  6. [Girls detained under civil and criminal law in juvenile detention centres; psychiatric disorders, trauma and psychosocial problems].

    Science.gov (United States)

    Hamerlynck, S M J J; Doreleijers, Th A H; Vermeiren, R R J M; Cohen-Kettenis, P T

    2009-01-01

    As from 2008, juveniles sentenced under civil law and juveniles sentenced under criminal law can no longer be assigned to the same juvenile detention centres. The reasoning runs as follows: the centres are unlikely to provide adequate treatment for the 'civil' group, and the 'criminal' group may exert a negative influence on the 'civil' group. Hitherto, there has been no research into the question of whether the problems and treatment requirements of girls in the two categories call for detention in the same detention centres or in different ones. The aim of this study is to investigate differences between the two groups of girls with regard to offence history, sociodemographic characteristics, contact with the social services, psychiatric disorders and trauma. Investigation of a representative sample of 211 female minors in three juvenile detention centres using standard instruments. results 82% of the girls were detained under civil law, 18% under criminal law. There were strong similarities between the groups. However, the 'criminal' group more often had a violent history of delinquency and a non-Dutch background, whereas the 'civil' group more often had a background of residential placements, oppositional-defiant disorder, suicidality and self-harm. Girls detained under civil and under criminal law differed in characteristics such as criminal record, but there were striking similarities in the girls' behavioural problems and psychiatric disorders. It is argued that assignment to a particular type of detention centre should depend on treatment requirements rather than on measures imposed by civil or criminal law.

  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

    2013-01-01

    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. PMID:24212504

  8. Agency problems in hospitals participating in self-management project under global budget system in Taiwan.

    Science.gov (United States)

    Yan, Yu-Hua; Hsu, Shuofen; Yang, Chen-Wei; Fang, Shih-Chieh

    2010-02-01

    The main purposes of this study are to clarify the agency problems in the hospitals participating in self-management project within the context of Global Budgeting Payment System regulated by Taiwan government, and also to provide some suggestions for hospital administrator and health policy maker in reducing the waste of healthcare resources resulting from agency problems. For the purposes above, this study examines the relationships between two agency problems (ex ante moral hazard and ex post moral hazard) aroused among the hospitals and Bureau of National Health Insurance in Taiwan's health care sector. This study empirically tested the theoretical model at organization level. The findings suggest that the hospital's ex ante moral hazards before participating the self-management project do have some influence on its ex post moral hazards after participating the self-management project. This study concludes that the goal conflict between the agents and the principal certainly exist. The principal tries hard to control the expenditure escalation and keep the financial balance, but the agents have to subsist within limited healthcare resources. Therefore, the agency cost would definitely occur due to the conflicts between both parties. According to the results of the research, some suggestions and related management concepts were proposed at the end of the paper.

  9. 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.

  10. 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.

  11. Giving Voice to the Medically Under-Served: A Qualitative Co-Production Approach to Explore Patient Medicine Experiences and Improve Services to Marginalized Communities.

    Science.gov (United States)

    Latif, Asam; Tariq, Sana; Abbasi, Nasa; Mandane, Baguiasri

    2018-01-27

    With an aging population, the appropriate, effective and safe use of medicines is a global health priority. However, "'medically under-served" patients continue to experience significant inequalities around access to healthcare services. This study forms part of a wider project to co-develop and evaluate a digital educational intervention for community pharmacy. The aim of this paper is to explore the medicine needs of patients from marginalized communities and suggest practical way on how services could be better tailored to their requirements. Following ethical approval, qualitative data was gathered from: (1) workshops with patients and professionals ( n = 57 attendees); and (2) qualitative semi-structured interviews (10 patients and 10 pharmacists). Our findings revealed that patients from marginalized communities reported poor management of their medical conditions and significant problems with adherence to prescribed medicines. Their experience of pharmacy services was found to be variable with many experiencing discrimination or disadvantage as a result of their status. This study highlights the plight of medically under-served communities and the need for policy makers to tailor services to an individual's needs and circumstances. Furthermore, patients and professionals can work in collaboration using a co-production approach to develop educational interventions for pharmacy service improvements.

  12. [Recommendations for problem solving in integrative postgraduate medical training of physicians at anthroposophic hospitals in Germany and Switzerland].

    Science.gov (United States)

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

    2014-01-01

    In the context of the first-time evaluation of the quality and problems of integrative postgraduate medical training (PGMT) at German and Swiss anthroposophic hospitals, all 240 trainees and all 214 trainers were asked to propose options for problem solutions. The study included a cross-sectional questionnaire survey with sections for further comments. The data were evaluated with qualitative content analysis (Mayring). 56 (51.8%) out of 108 responding trainees and 54 (54%) out of 100 responding trainers had given potential solutions. Both groups were analyzed together. On internal level, recommendations comprised re-orientation on a leadership basis, i.e. elevation of PGMT to a core element of hospital policy in anthroposophic medicine (AM), as well as better personnel policy; trainers with more professional and teaching competency in AM; structured and extended continual education program; coordination of PGMT with ward and hospital organization; and work load reduction for physicians through process optimization and resource planning. Externally, the recommendations embraced financial support; external training programs; networking of anthroposophic hospitals in PGMT; implementation of a common competence center for anthroposophic PGMT; conventional and anthroposophic PGMT curriculums; and improvement of science base and public discourse of AM. The proposed options for problem solving in PGMT at anthroposophic hospitals emerge from concrete problem perceptions of the trainers and trainees. They can serve as a basis for concrete improvements of PGMT in AM that could be implemented professionally and in an international context. The preconditions for this are given through the already existing establishment of AM at universities and through the good international connections of anthroposophic hospitals and anthroposophic physicians' associations.

  13. 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

  14. When death is not a problem: Regulating implicit negative affect under mortality salience.

    Science.gov (United States)

    Lüdecke, Christina; Baumann, Nicola

    2015-12-01

    Terror management theory assumes that death arouses existential anxiety in humans which is suppressed in focal attention. Whereas most studies provide indirect evidence for negative affect under mortality salience by showing cultural worldview defenses and self-esteem strivings, there is only little direct evidence for implicit negative affect under mortality salience. In the present study, we assume that this implicit affective reaction towards death depends on people's ability to self-regulate negative affect as assessed by the personality dimension of action versus state orientation. Consistent with our expectations, action-oriented participants judged artificial words to express less negative affect under mortality salience compared to control conditions whereas state-oriented participants showed the reversed pattern. © 2015 Scandinavian Psychological Associations and John Wiley & Sons Ltd.

  15. Feeding Problems and Their Underlying Mechanisms in the Esophageal Atresia–Tracheoesophageal Fistula Patient

    Science.gov (United States)

    Mahoney, Lisa; Rosen, Rachel

    2017-01-01

    Feeding difficulties such as dysphagia, coughing, choking, or vomiting during meals, slow eating, oral aversion, food refusal, and stressful mealtimes are common in children with repaired esophageal atresia (EA) and the reasons for this are often multifactorial. The aim of this review is to describe the possible underlying mechanisms contributing to feeding difficulties in patients with EA and approaches to management. Underlying mechanisms for these feeding difficulties include esophageal dysphagia, oropharyngeal dysphagia and aspiration, and aversions related to prolonged gastrostomy tube feeding. The initial diagnostic evaluation for feeding difficulties in a patient with EA may involve an esophagram, videofluoroscopic imaging or fiberoptic endoscopic evaluation during swallowing, upper endoscopy with biopsies, pH-impedance testing, and/or esophageal motility studies. The main goal of management is to reduce the factors contributing to feeding difficulties and may include reducing esophageal stasis, maximizing reflux therapies, treating underlying lung disease, dilating strictures, and altering feeding methods, routes, or schedules. PMID:28620597

  16. 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.

  17. The fall of charged particles under gravity: a study of experimental problems

    International Nuclear Information System (INIS)

    Darling, T.W.; Rossi, F.; Moorhead, G.F.

    1990-01-01

    There are currently several proposals to study the motion of antiprotons, negative hydrogen ions, positrons and electrons under gravity. The motions of such charged particles are affected by residual gas, radiation, electric and magnetic fields, as well as gravity. The electric fields are particularly sensitive to the state of the 'shielding' container. In this paper the physics of these extraneous influences on the motion of charged particles under gravity is reviewed. The effects considered include: residual gas scattering, wall potentials due to patches, stress, thermal gradients, contamination states, and image-charge induced dissipation. 51 refs., 6 figs

  18. 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.

  19. Problem-based learning at the receiving end: a 'mixed methods' study of junior medical students' perspectives.

    Science.gov (United States)

    Maudsley, Gillian; Williams, Evelyn M I; Taylor, David C M

    2008-11-01

    Qualitative insights about students' personal experience of inconsistencies in implementation of problem-based learning (PBL) might help refocus expert discourse about good practice. This study explored how junior medical students conceptualize: PBL; good tutoring; and less effective sessions. Participants comprised junior medical students in Liverpool 5-year problem-based, community-orientated curriculum. Data collection and analysis were mostly cross-sectional, using inductive analysis of qualitative data from four brief questionnaires and a 'mixed' qualitative/quantitative approach to data handling. The 1999 cohort (end-Year 1) explored PBL, generated 'good tutor' themes, and identified PBL (dis)advantages (end-Year 1 then mid-Year 3). The 2001 cohort (start-Year 1) described critical incidents, and subsequently (end-Year 1) factors in less effective sessions. These factors were coded using coding-frames generated from the answers about critical incidents and 'good tutoring'. Overall, 61.2% (137), 77.9% (159), 71.0% (201), and 71.0% (198) responded to the four surveys, respectively. Responders perceived PBL as essentially process-orientated, focused on small-groupwork/dynamics and testing understanding through discussion. They described 'good tutors' as knowing when and how to intervene without dominating (51.1%). In longitudinal data (end-Year 1 to mid-Year 3), the main perceived disadvantage remained lack of 'syllabus' (and related uncertainty). For less effective sessions (end-Year 1), tutor transgressions reflected unfulfilled expectations of good tutors, mostly intervening poorly (42.6% of responders). Student transgressions reflected the critical incident themes, mostly students' own lack of work/preparation (54.8%) and other students participating poorly (33.7%) or dominating/being self-centred (31.6%). Compelling individual accounts of uncomfortable PBL experiences should inform improvements in implementation.

  20. Gene-Environment Correlation Underlying the Association between Parental Negativity and Adolescent Externalizing Problems

    Science.gov (United States)

    Marceau, Kristine; Horwitz, Briana N.; Narusyte, Jurgita; Ganiban, Jody M.; Spotts, Erica L.; Reiss, David; Neiderhiser, Jenae M.

    2013-01-01

    Studies of adolescent or parent-based twins suggest that gene-environment correlation (rGE) is an important mechanism underlying parent-adolescent relationships. However, information on how parents' and children's genes and environments influence correlated parent "and" child behaviors is needed to distinguish types of rGE. The present…

  1. 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…

  2. 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.

  3. 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

  4. Teaching pharmacology to medical students in an integrated problem-based learning curriculum:an Australian perspective

    Institute of Scientific and Technical Information of China (English)

    Owen L WOODMAN; Agnes E DODDS; Albert G FRAUMAN; Mosepele MOSEPELE

    2004-01-01

    The world-wide move away from the didactic teaching of single disciples to integrated Problem-based Learning (PBL) curricula in medical education has posed challenges for the basic sciences. In this paper we identify two major challenges. The first challenge is the need to describe a core disciplinary curriculum that can be articulated and mapped onto the new structure. We illustrate how the British Pharmacological Society (BPS) Guidelines are used to evaluate the curriculum coverage in the medical course at The University of Melbourne. The second challenge is to ensure that foundational concepts are given adequate emphasis within the new structure, and in particular, that students have the opportunity to pursue these concepts in their self-directed learning. We illustrate one approach to teaching important pharmacological concepts in an integrated curriculum with a case study from the first year curriculum at The University of Melbourne. Finally, we propose the features of an integrated curriculum that facilitates the learning of basic pharmacology in a situation where PBL and integration sets the curriculum framework.

  5. Medical students preference of problem-based learning or traditional lectures in King Abdulaziz University, Jeddah, Saudi Arabia.

    Science.gov (United States)

    Ibrahim, Nahla Khamis; Banjar, Shorooq; Al-Ghamdi, Amal; Al-Darmasi, Moroj; Khoja, Abeer; Turkistani, Jamela; Arif, Rwan; Al-Sebyani, Awatif; Musawa, Al-Anoud; Basfar, Wijdan

    2014-01-01

    Problem-based learning (PBL) is the most important educational innovations in the past 4 decades. The objective of the study was to compare between the preference of medical students for PBL and the preference for traditional lectures regarding learning outcomes (e.g., knowledge, attitude, and skills) gained from both methods. A cross-sectional study was conducted among medical students who studied the hybrid curriculum (PBL and traditional lectures) in King Abdulaziz University, Jeddah, in 2011. Data was collected through a pre-constructed, validated, confidentially anonymous, and self-administered questionnaire. Students' perceptions toward PBL and traditional lectures were assessed through their response to 20 statements inquired about both methods of learning using a five-point Likert scale. Descriptive and analytic statistics were performed using SPSS, version 21 (SPSS Inc, Chicago, Ill., USA). Learners preferred PBL more to traditional lectures for better linking the knowledge of basic and clinical sciences (t test=10.15, P .05) was observed regarding the amount of basic knowledge recalled from both methods. Students preferred PBL more to lectures for better learning attitudes, skills, future outcomes, and learning satisfaction (P learn better than lecturing (P traditional lectures for improving most of learning outcome domains, especially, learning attitudes and skills. Introducing hybrid-PBL curriculum in all Saudi universities is highly recommended.

  6. 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

    The problem of peak load arises when demand fluctuates over time while the pro- duction technology is not flexible (or making it flexible is economically inefficient) and/or when a product is non-storable (or storage cost is huge). Peak load is a com- mon problem in consumption of public utilities......, on the one hand, observed cost saving benefit of postponing the time of charging to off-peak lower fee of charging and, on the other hand, the cost of delay in departure time for planned trips and uncertain cost of late charging associated with likelihood occur- rence of unanticipated trip before the car...... of electricity. The electric vehicle (EV) users choice of time of charging problem under PLP is different from that of general households using energy for house appliances since there is uncertain cost to the former as- sociated with likelihood occurrence of unanticipated trips such as visiting hospital...

  7. 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.

  8. 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...

  9. Generalized Euler-Lagrange Equations for Fuzzy Fractional Variational Problems under gH-Atangana-Baleanu Differentiability

    Directory of Open Access Journals (Sweden)

    Jianke Zhang

    2018-01-01

    Full Text Available We study in this paper the Atangana-Baleanu fractional derivative of fuzzy functions based on the generalized Hukuhara difference. Under the condition of gH-Atangana-Baleanu fractional differentiability, we prove the generalized necessary and sufficient optimality conditions for problems of the fuzzy fractional calculus of variations with a Lagrange function. The new kernel of gH-Atangana-Baleanu fractional derivative has no singularity and no locality, which was not precisely illustrated in the previous definitions.

  10. 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

  11. 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

  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. A discrepancy in objective and subjective measures of knowledge: do some medical students with learning problems delude themselves?

    Science.gov (United States)

    Anthoney, T R

    1986-01-01

    In general, the rankings of first-year medical students on a written test of long-term neuroscience retention (RET) correlated strongly with how many of three neuroscience research presentations given within the following 2 days the students reported understanding. The lowest-ranking sixth of the class on RET, however, reported understanding almost every lecture, even more than the highest-ranking RET students did. Some of these low-ranking students were aware that they had areas of weakness, but simply tolerated more of them without reporting overall lack of understanding. Other low-ranking students, however, seemed genuinely unaware that they had any areas of weakness. This interpretation was further supported by data on small-group problem-solving performance during the first-year neuroscience course, on use of human resources during the final first-year neuroscience take-home examination, and on performance during the third-year clinical clerkships. Persistence of the problem, even after 5 months of instruction specifically designed to improve such information-processing skills, suggests that correction may be difficult to achieve. The need for specific valid evaluative instruments and effective correctional techniques is noted.

  14. 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

  15. 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

  16. PROBLEM OF OPTIMIZATION OF ENTERPRISE FINANCIAL STREAMS: URGENCY UNDER ECONOMIC CRISIS CONDITIONS

    Directory of Open Access Journals (Sweden)

    J. E. Gorbach

    2011-01-01

    Full Text Available The paper considers a problem of structural optimization of financial streams in the economic activities of the enterprises. The authors describe a general process of enterprise capital structure optimization while breaking it in stages and consider the most interesting financial stream theories. The paper presents for the first time «Combined optimization model». In order to develop the model the most commonly applied methods have been used, namely: an optimization  method on the basis of an average capital price, an optimization method on the basis of financial leverage effect and an optimization method on the basis of the average managing subject price. Alternative calculations of optimum structure of financial stream sources on the basis of the proposed «combined model» have been presented in corresponding tables. The authors also use for the first time such concepts as «a break-even point» and «a safety zone» in respect of enterprise financial streams while using a graphic method.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. Underlying mechanisms of mistreatment in the surgical learning environment: A thematic analysis of medical student perceptions.

    Science.gov (United States)

    Brandford, Elena; Hasty, Brittany; Bruce, Janine S; Bereknyei Merrell, Sylvia; Shipper, Edward S; Lin, Dana T; Lau, James N

    2018-02-01

    Medical students experience more psychological distress than the general population. One contributing factor is mistreatment. This study aims to understand the mechanisms of mistreatment as perceived by medical students. Students completed anonymous surveys during the first and last didactic session of their surgery clerkship in which they defined and gave examples of mistreatment. Team-based thematic analysis was performed on responses. Between January 2014 and June 2016, 240 students participated in the surgery clerkship. Eighty-nine percent of students completed a survey. Themes observed included (1) Obstruction of Students' Learning, (2) Exploitation of Student Vulnerability, (3) Exclusion from the Medical Team, and (4) Contextual Amplifiers of Mistreatment Severity. The themes observed in this study improve our understanding of the students' perspective on mistreatment as it relates to their role in the clinical learning context, which can serve as a starting point for interventions that ultimately improve students' experiences in the clinical setting. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. The robust min-max newsvendor problem with balking under a service level constraint

    Directory of Open Access Journals (Sweden)

    Taesu Cheong

    2013-11-01

    Full Text Available In this paper we study an extension of a classic newsvendor model with balking under a service-level constraint. We also relax the assumption that the demand distribution is fully available to a decision-maker; we assume that only the mean and variance of the demand distribution are known, and discuss the procedure for determining the optimal order quantity for the concomitant model. We further extend our base model to two different cases: (i when the fixed ordering cost is included, and (ii when yield is uncertain. We illustrate the solution procedures for each case with numerical examples. Moreover, we discuss the performance and robustness of the approach through randomly generated test instances, and perform a numerical sensitivity analysis to evaluate the impact of the changes of a targeted fill-rate and variances of a demand distribution.

  3. Implementation of modified team-based learning within a problem based learning medical curriculum: a focus group study.

    Science.gov (United States)

    Burgess, Annette; Roberts, Chris; Ayton, Tom; Mellis, Craig

    2018-04-10

    While Problem Based Learning (PBL) has long been established internationally, Team-based learning (TBL) is a relatively new pedagogy in medical curricula. Both PBL and TBL are designed to facilitate a learner-centred approach, where students, in interactive small groups, use peer-assisted learning to solve authentic, professionally relevant problems. Differences, however, exist between PBL and TBL in terms of preparation requirements, group numbers, learning strategies, and class structure. Although there are many similarities and some differences between PBL and TBL, both rely on constructivist learning theory to engage and motivate students in their learning. The aim of our study was to qualitatively explore students' perceptions of having their usual PBL classes run in TBL format. In 2014, two iterations in a hybrid PBL curriculum were converted to TBL format, with two PBL groups of 10 students each, being combined to form one TBL class of 20, split into four groups of five students. At the completion of two TBL sessions, all students were invited to attend one of two focus groups, with 14 attending. Thematic analysis was used to code and categorise the data into themes, with constructivist theory used as a conceptual framework to identify recurrent themes. Four key themes emerged; guided learning, problem solving, collaborative learning, and critical reflection. Although structured, students were attracted to the active and collaborative approach of TBL. They perceived the key advantages of TBL to include the smaller group size, the preparatory Readiness Assurance Testing process, facilitation by a clinician, an emphasis on basic science concepts, and immediate feedback. The competitiveness of TBL was seen as a spur to learning. These elements motivated students to prepare, promoted peer assisted teaching and learning, and focussed team discussion. An important advantage of PBL over TBL, was the opportunity for adequate clinical reasoning within the problem

  4. 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.

  5. [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.

  6. 78 FR 50136 - Notice of Information Collection Under Emergency Review: Medical History and Examination for...

    Science.gov (United States)

    2013-08-16

    ...: Medical History and Examination for Foreign Service DS-1843 and DS-1622 ACTION: Notice of request for... methods: Web: Persons with access to the Internet may use the Federal Docket Management System (FDMS) to... History and Examination for Foreign Service. OMB Control Number: 1405-0068. Type of Request: Emergency...

  7. Surgery or general medicine: a study of the reasons underlying the choice of medical specialty

    Directory of Open Access Journals (Sweden)

    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

  8. Analytical solution for the problem of maximum exit velocity under Coulomb friction in gravity flow discharge chutes

    Energy Technology Data Exchange (ETDEWEB)

    Salinic, Slavisa [University of Kragujevac, Faculty of Mechanical Engineering, Kraljevo (RS)

    2010-10-15

    In this paper, an analytical solution for the problem of finding profiles of gravity flow discharge chutes required to achieve maximum exit velocity under Coulomb friction is obtained by application of variational calculus. The model of a particle which moves down a rough curve in a uniform gravitational field is used to obtain a solution of the problem for various boundary conditions. The projection sign of the normal reaction force of the rough curve onto the normal to the curve and the restriction requiring that the tangential acceleration be non-negative are introduced as the additional constraints in the form of inequalities. These inequalities are transformed into equalities by introducing new state variables. Although this is fundamentally a constrained variational problem, by further introducing a new functional with an expanded set of unknown functions, it is transformed into an unconstrained problem where broken extremals appear. The obtained equations of the chute profiles contain a certain number of unknown constants which are determined from a corresponding system of nonlinear algebraic equations. The obtained results are compared with the known results from the literature. (orig.)

  9. 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

  10. Problems of differential diagnosis in evaluation of pathological effects of ionizing radiation in medical supervision of occupationally exposed persons

    International Nuclear Information System (INIS)

    Stojanovic, D.; Veljkovic, D.; Aleksic, B.; Djukic, Z.

    1977-01-01

    The results of medical supervision of persons occupationally exposed to ionizing radiation and controlled in period to ten years, have been presented. Observations were selected according to occupation (radiologists, phtisiologists, surgeons, physicians, stomatologists, veterinaries, technicians), to the sex, age, character of exposition, film badges data of the received doses. The problems of differential diagnosis of some states and diseases according to the systems (skin, eyes, cardiovascular system, endocrine system, nervous system, haematopoietic tissue), have been discussed with special attention to focus of a disease, which can change numerical values in the peripheral blood or as far as their look is concerned that could be very similar to changes affected by action of ionizing radiation. On the basis of the existed criteria for evaluation of haematological parameters, pathological states of the skin, lenticular injury, changes in cardiovascular system and changes in other systems too, indications and contraindications for work with ionizing radiation have been observed. The incidence and persistance of morphological changes of lymphocytes and granulocytes in peripheral blood and anaemic states in correlation with other changes in the frame of the estimation of risk of malignancy have also been observed. The results obtained showed that the majority of data falls into the normal limits, but nevertheless there were some clinical and laboratory changes caused by the action of radiation, on the basis of which is possible to make the evaluation of the state of the health of radiation workers. An early discovery of changes in some radiosensitive systems, observation of the evolution of changes and influence of factors which favourised the progression of some changes and the problems of specifity and characteristics of some states and diseases, including the importance of differential diagnosis for expertize have been discussed

  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. 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.

  13. 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.

  14. Medical and economic impact of extraintestinal infections due to Escherichia coli: focus on an increasingly important endemic problem.

    Science.gov (United States)

    Russo, Thomas A; Johnson, James R

    2003-04-01

    Escherichia coli is probably the best-known bacterial species and one of the most frequently isolated organisms from clinical specimens. Despite this, underappreciation and misunderstandings exist among medical professionals and the lay public alike regarding E. coli as an extraintestinal pathogen. Underappreciated features include (i) the wide variety of extraintestinal infections E. coli can cause, (ii) the high incidence and associated morbidity, mortality, and costs of these diverse clinical syndromes, (iii) the pathogenic potential of different groups of E. coli strains for causing intestinal versus extraintestinal disease, and (iv) increasing antimicrobial resistance. In this era in which health news often sensationalizes uncommon infection syndromes or pathogens, the strains of E. coli that cause extraintestinal infection are an increasingly important endemic problem and underappreciated "killers". Billions of health care dollars, millions of work days, and hundreds of thousands of lives are lost each year to extraintestinal infections due to E. coli. New treatments and prevention measures will be needed for improved outcomes and a diminished disease burden.

  15. The Effects of a Problem Solving-Based Intervention on Depressive Symptoms and HIV Medication Adherence Are Independent

    NARCIS (Netherlands)

    Gross, Robert; Bellamy, Scarlett L.; Chapman, Jennifer; Han, Xiaoyan; O'Duor, Jacqueline; Strom, Brian L.; Houts, Peter S.; Palmer, Steven C.; Coyne, James C.

    2014-01-01

    Depression and depressive symptoms predict poor adherence to medical therapy, but the association is complex, nonspecific, and difficult to interpret. Understanding this association may help to identify the mechanism explaining the results of interventions that improve both medical therapy adherence

  16. 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.

  17. How inflammation underlies physical and organ function in acutely admitted older medical patients

    DEFF Research Database (Denmark)

    Klausen, Henrik Hedegaard; Bodilsen, Ann Christine; Petersen, Janne

    2017-01-01

    OBJECTIVES: To investigate whether systemic inflammation in acutely admitted older medical patients (age >65 years) is associated with physical performance and organ dysfunction. Organ dysfunction´s association with physical performance, and whether these associations are mediated by systemic...... inflammation was assessed by suPAR, TNFα, and IL-6. Associations were investigated by regression analyses adjusted for age, sex, cognitive impairment, CRP, and VitalPAC Modified Early Warning Score. RESULTS: A total of 369 patients were evaluated. In adjusted analyses, suPAR and TNFα was associated with both...

  18. Effect of Rotation for Two-Temperature Generalized Thermoelasticity of Two-Dimensional under Thermal Shock Problem

    Directory of Open Access Journals (Sweden)

    Kh. Lotfy

    2013-01-01

    Full Text Available The theory of two-temperature generalized thermoelasticity based on the theory of Youssef is used to solve boundary value problems of two-dimensional half-space. The governing equations are solved using normal mode method under the purview of the Lord-Şhulman (LS and the classical dynamical coupled theory (CD. The general solution obtained is applied to a specific problem of a half-space subjected to one type of heating, the thermal shock type. We study the influence of rotation on the total deformation of thermoelastic half-space and the interaction with each other under the influence of two temperature theory. The material is homogeneous isotropic elastic half-space. The methodology applied here is use of the normal mode analysis techniques that are used to solve the resulting nondimensional coupled field equations for the two theories. Numerical results for the displacement components, force stresses, and temperature distribution are presented graphically and discussed. The conductive temperature, the dynamical temperature, the stress, and the strain distributions are shown graphically with some comparisons.

  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. Changes in the 'medical research' licensing procedure under the German Radiation Protection Ordinance

    International Nuclear Information System (INIS)

    Habeck, M.; Minkov, V.; Griebel, J.; Brix, G.; Epsch, R.; Langer, M.

    2012-01-01

    This publication outlines the 'medical research' licensing procedure as specified in the amendment of the German Radiation Protection Ordinance of November 1, 2011. The general licensing requirements for the use of radiation have not been changed by the amendment. Three so-called use restrictions (i.e., dose limits of 10 mSv and 20 mSv, age limit of 50 years) have been modified. They will only apply to healthy volunteers in the future. In addition, there are considerable simplifications with respect to applications and licensing procedures of the Federal Office for Radiation Protection (Bundesamt fuer Strahlenschutz, BfS) regarding the use of radiation in the newly introduced 'accompanying diagnostics' ('Begleitdiagnostik') case group. The newly established, independent panel of experts at the German Radiological Society (Deutsche Roentgengesellschaft, DRG) may provide essential support to principal investigators, qualified physicians and sponsors for differentiating between 'medical research' and 'health care', the latter not being subject to licensing. An expert statement will be issued by the DRG within four weeks of an inquiry. This consulting service is subject to confidentiality, and is free of charge for inquirers and without any commitment. (orig.)

  1. Acute lung affection in an endurance-trained man under amiodarone medication

    Directory of Open Access Journals (Sweden)

    Saurbier, Bernward

    2005-06-01

    Full Text Available Patients undergoing treatment with amiodarone can develop severe pulmonary side effects. This effect, which is often highly underestimated, can lead to dyspnea, pneumonitis, and further fibrosis. A recent change in the labeling of amdiodarone by the American Food and Drug Administration (FDA supports this suspicion. Tracing the symptoms back to the causing agent can be difficult, as shown in our report. The subject of this case report is an endurance-trained 65 year old male marathon runner who appeared with atrial fibrillation during a routine check up in autumn 2003. After medical cardioversion with flecainide a complaint free interval of 8 months was followed by a relapse, which resulted in a change of medication to amiodarone. Due to misunderstandings the patient kept on taking the amiodarone loading dose for six weeks and returned with severe dyspnea on exertion. Losses in CO diffusing capacity, a lowered macrophages count and a positive lymphocyte transformation test were the only first hand clinical evidence of amiodarone intoxication, despite the sensation of dyspnea. This case shows that special care has to be taken in treatment with amiodarone. Side effects can be hard to trace and do not evidently show a clear connection to amiodarone.

  2. Quantitative assessment of postoperative blood collection in brain tumor surgery under valproate medication.

    Science.gov (United States)

    Psaras, T; Will, B E; Schoeber, W; Rona, S; Mittelbronn, M; Honegger, J B

    2008-11-01

    The aim of the study was to evaluate whether valproate (VPA) increases the risk of bleeding complications in patients undergoing brain tumor surgery. A retrospective chart review of 85 patients operated on between January and December 2005 was performed. 19 patients received VPA, 22 patients were given other anti-epileptic drugs (AEDs), 44 patients received no AEDs. Data analyzed included intraoperative blood loss, transfusion, important comorbidity factors and concomitant diseases. Preoperative and postoperative laboratory data included hemoglobin, hematocrit, fibrinogen, platelet count, INR, prothrombin time, partial thromboplastin time and RBC count. The tumor volume was evaluated by preoperative MRI and CT scans of the brain. All 85 patients underwent a native CT scan of the brain on the first day after the operation. The volume of the resection cavity and the volume of blood were documented. We could show that the volume of the tumor had a significant effect on the amount of blood in the tumor cavity, whereas VPA medication had no effect. In our dataset, we found that tumor size had a significant effect on postoperative blood volume. In contrast, no serious bleeding complications occurred in the patients receiving VPA. Therefore, the present study does not provide any evidence for the need to discontinue VPA medication prior to and during surgery.

  3. 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.

  4. From primary care to public health: using Problem-based Learning and the ecological model to teach public health to first year medical students.

    Science.gov (United States)

    Hoover, Cora R; Wong, Candice C; Azzam, Amin

    2012-06-01

    We investigated whether a public health-oriented Problem-Based Learning case presented to first-year medical students conveyed 12 "Population Health Competencies for Medical Students," as recommended by the Association of American Medical Colleges and the Regional Medicine-Public Health Education Centers. A public health-oriented Problem-Based Learning case guided by the ecological model paradigm was developed and implemented among two groups of 8 students at the University of California, Berkeley-UCSF Joint Medical Program, in the Fall of 2010. Using directed content analysis, student-generated written reports were coded for the presence of the 12 population health content areas. Students generated a total of 29 reports, of which 20 (69%) contained information relevant to at least one of the 12 population health competencies. Each of the 12 content areas was addressed by at least one report. As physicians-in-training prepare to confront the challenges of integrating prevention and population health with clinical practice, Problem-Based Learning is a promising tool to enhance medical students' engagement with public health.

  5. 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

  6. Interprofessional, simulation-based technology-enhanced learning to improve physical health care in psychiatry: The recognition and assessment of medical problems in psychiatric settings course.

    Science.gov (United States)

    Akroyd, Mike; Jordan, Gary; Rowlands, Paul

    2016-06-01

    People with serious mental illness have reduced life expectancy compared with a control population, much of which is accounted for by significant physical comorbidity. Frontline clinical staff in mental health often lack confidence in recognition, assessment and management of such 'medical' problems. Simulation provides one way for staff to practise these skills in a safe setting. We produced a multidisciplinary simulation course around recognition and assessment of medical problems in psychiatric settings. We describe an audit of strategic and design aspects of the recognition and assessment of medical problems in psychiatric settings course, using the Department of Health's 'Framework for Technology Enhanced Learning' as our audit standards. At the same time as highlighting areas where recognition and assessment of medical problems in psychiatric settings adheres to these identified principles, such as the strategic underpinning of the approach, and the means by which information is collected, reviewed and shared, it also helps us to identify areas where we can improve. © The Author(s) 2014.

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

    Science.gov (United States)

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

    2013-01-01

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

  8. Medical and Non-Medical Predictors of Disability Discharge Disposition for Navy Personnel with a Back Problem: A Focus on Entitlement

    Science.gov (United States)

    1988-03-28

    Washington D.C. 20350-1000. Stryker, S., & Gottlieb, A. (1981). Attribution theory and symbolic interactionism : A comparison. In J.H. Howes, W...ERFORMIING ORGANIZATION 6b OFFiCE SYMBOL 7a NAME OF MONITORING ORGANIZATION (If applicable) Naval Health Research Center 40 Commander, Naval Medical Command...Washington, DC 20372 ea NAME OF FUNDING/SPONSORING Bb OFFICE SYMBOL 9. PROCUREMENT INSTRUMENT IDENTIFICATION NUMBER ORGANIZATION Naval Medical (If applicable

  9. [Hygienic aspects of the lifestyle of medical students under the present conditions].

    Science.gov (United States)

    Kozhevnikova, N G; Kataeva, V A

    2011-01-01

    The paper gives the results of a study of the lifestyle of medical students. The students' motor activity has been found to be lower and to continue to drop in the undergraduates. Examination of the daily routine has shown that 92% of the students break the study-and-rest routine; the reported reasons for this are a high academic load, a prolonged academic day, a study-work combination, mental stress during examinations, and computer-aided learning. The students' nutrition is inadequate in major nutrients, poor-quality, irregular, and uncontrolled. The college crowd shows a preponderance of bad habits; 85% of cases had these or those combinations of risk factors: smoking, low motor activity, overweight, alcohol consumption, etc.

  10. Developing and Evaluating Medical Humanities Problem-Based Learning Classes Facilitated by the Teaching Assistants Majored in the Liberal Arts: A Longitudinal Crossover Study.

    Science.gov (United States)

    Tseng, Fen-Yu; Shieh, Jeng-Yi; Kao, Tze-Wah; Wu, Chau-Chung; Chu, Tzong-Shinn; Chen, Yen-Yuan

    2016-02-01

    Although medical humanities courses taught by teachers from nonmedical backgrounds are not unusual now, few studies have compared the outcome of medical humanities courses facilitated by physicians to that by teaching assistants majored in the liberal arts. The objectives of this study were to (1) analyze the satisfaction of medical students with medical humanities problem-based learning (PBL) classes facilitated by nonmedical teaching assistants (TAF) majored in the liberal arts, and those facilitated by the attending physicians (APF) and (2) examine the satisfaction of medical students with clinical medicine-related and clinical medicine-unrelated medical humanities PBL classes.A total of 123 medical students, randomly assigned to 16 groups, participated in this study. There were 16 classes in the course: 8 of them were TAF classes; and the others were APF classes. Each week, each group rotated from 1 subject of the 16 subjects of PBL to another subject. All of the 16 groups went through all the 16 subjects in the 2013 spring semester. We examined the medical students' satisfaction with each class, based on a rating score collected after each class was completed, using a scale from 0 (the lowest satisfaction) to 100 (the highest satisfaction). We also conducted multivariate linear regression analysis to examine the association between the independent variables and the students' satisfaction.Medical students were more satisfied with the TAF (91.35 ± 7.75) medical humanities PBL classes than APF (90.40 ± 8.42) medical humanities PBL classes (P = 0.01). Moreover, medical students were more satisfied with the clinical medicine-unrelated topics (92.00 ± 7.10) than the clinical medicine-related topics (90.36 ± 7.99) in the medical humanities PBL course (P = 0.01).This medical humanities PBL course, including nonmedical subjects and topics, and nonmedical teaching assistants from the liberal arts as class facilitators, was satisfactory. This

  11. Medical Procedure Problems from the Viewpoint of Elderly Referrals to Healthcare Centers of Hamadan: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Parisa Parsa

    2017-09-01

    Conclusion The results showed that there are problems of treatment in elderly. So after reviewing the problems with appropriate interventions, training can guide and help the elderly in this area. The authorities can also use findings from research in planning.

  12. Study on the prevalence and underlying factors of myopia among the students of a medical college in Kerala

    Directory of Open Access Journals (Sweden)

    Shiny George, Biju Baby Joseph

    2014-04-01

    Full Text Available Background: Few decades earlier, wearing spectacles was a province of adults over 40 years of age. Now we see more children and adolescents with spectacles/contact lenses. Various studies in Asian population show a dramatic increase in refractive error, especially myopia among school and college students. More advanced levels of education like medical education that involves extensive near work such as reading and writing have been repeatedly associated with greater myopia prevalence Objective: To study the prevalence and the underlying factors of myopia in MBBS students of a Medical college in Kerala. Research methodology: One hundred and sixty two MBBS students (2009 – 2012 batches were examined. 40 students were selected from each class by systematic random sampling technique, their visual acuity was checked using Snellen’s Chart and Diopters were obtained. Details of factors were obtained using a questionnaire. Results: Prevalence of myopia was observed as 39.5%. First and second year students had a greater percentage of myopia with 40% & 52.5% respectively. 40.6% of myopics had positive family history of myopia (p = 0.003. Duration of TV watching and computer use showed a significant relation with myopia. (p = 0. 033, 0.009. Reading hours, type of light used, playing or texting with cell phone and sleeping habits of students were not significant. Conclusion: Prevalence of myopia was high among medical students (39.5%. Significance of genetic predisposition was well appreciated in our study.

  13. Contemporary concepts of the medical therapy of portal hypertension under liver cirrhosis.

    Science.gov (United States)

    Garbuzenko, Dmitry Victorovich

    2015-05-28

    Severe complications of liver cirrhosis are mostly related to portal hypertension. At the base of the pathogenesis of portal hypertension is the increase in hepatic vascular resistance to portal blood flow with subsequent development of hyperdynamic circulation, which, despite of the formation of collateral circulation, promotes progression of portal hypertension. An important role in its pathogenesis is played by the rearrangement of vascular bed and angiogenesis. As a result, strategic directions of the therapy of portal hypertension under liver cirrhosis include selectively decreasing hepatic vascular resistance with preserving or increasing portal blood flow, and correcting hyperdynamic circulation and pathological angiogenesis, while striving to reduce the hepatic venous pressure gradient to less than 12 mmHg or 20% of the baseline. Over the last years, substantial progress in understanding the pathophysiological mechanisms of hemodynamic disorders under liver cirrhosis has resulted in the development of new drugs for their correction. Although the majority of them have so far been investigated only in animal experiments, as well as at the molecular and cellular level, it might be expected that the introduction of the new methods in clinical practice will increase the efficacy of the conservative approach to the prophylaxis and treatment of portal hypertension complications. The purpose of the review is to describe the known methods of portal hypertension pharmacotherapy and discuss the drugs that may affect the basic pathogenetic mechanisms of its development.

  14. Medical documentation: part of the solution, or part of the problem? A narrative review of the literature on the time spent on and value of medical documentation.

    Science.gov (United States)

    Clynch, Neil; Kellett, John

    2015-04-01

    Even though it takes up such a large part of all clinicians' working day the medical literature on documentation and its value is sparse. Medline searches combining the terms medical records, documentation, time, and value or efficacy or benefit yielded only 147 articles. This review is based on the relevant articles selected from this search and additional studies gathered from the personal experience of the authors and their colleagues. Documentation now occupies a quarter to half of doctors' time yet much of the information collected is of dubious or unproven value. Most medical records departments still use the traditional paper chart, and there is considerable debate on the benefits of electronic medical records (EMRs). Although EMRs contains a lot more information than a paper record clinicians do not find it easy to getting useful information out of them. Unlike the paper chart narrative is difficult to enter into most EMRs so that they do not adequately communicate the patient's "story" to clinicians. Recent innovations have the potential to address these issues. Although documentation is widespread throughout the health care industry there has been almost no formal research into its value, on how to enhance its value, or on whether the time spent on it has negative effects on patient care. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  15. Suitable configurations for triangular formation flying about collinear libration points under the circular and elliptic restricted three-body problems

    Science.gov (United States)

    Ferrari, Fabio; Lavagna, Michèle

    2018-06-01

    The design of formations of spacecraft in a three-body environment represents one of the most promising challenges for future space missions. Two or more cooperating spacecraft can greatly answer some very complex mission goals, not achievable by a single spacecraft. The dynamical properties of a low acceleration environment such as the vicinity of libration points associated to a three-body system, can be effectively exploited to design spacecraft configurations able of satisfying tight relative position and velocity requirements. This work studies the evolution of an uncontrolled formation orbiting in the proximity of periodic orbits about collinear libration points under the Circular and Elliptic Restricted Three-Body Problems. A three spacecraft triangularly-shaped formation is assumed as a representative geometry to be investigated. The study identifies initial configurations that provide good performance in terms of formation keeping, and investigates key parameters that control the relative dynamics between the spacecraft within the three-body system. Formation keeping performance is quantified by monitoring shape and size changes of the triangular formation. The analysis has been performed under five degrees of freedom to define the geometry, the orientation and the location of the triangle in the synodic rotating frame.

  16. Economic analysis of a Japanese air pollution regulation : an optimal retirement problem under vehicle type regulation in the NOx-particulate matter law

    Science.gov (United States)

    2008-06-01

    This paper empirically examines the vehicle type regulation that was introduced under the : Automobile Nitrogen OxidesParticulate Matter Law to mitigate air pollution problems in Japanese metropolitan areas. The vehicle type regulation effectively...

  17. Situation of the medical physics in the Republic of Argentina. Regulatory problem linked to the requirement of physic specialists

    International Nuclear Information System (INIS)

    Arbor Gonzalez, A.; Larcher, A.; Blanco, S.

    2001-01-01

    This paper provides up-to-date data on the participation of medical physicists in current staffs for radiotherapy, nuclear medicine and diagnostic radiology in Argentina, and it presents projections on the academic education of specialists in the next five years. At the same time, the regulatory framework including the requirements for physicists staffing levels in medical practices is presented. This panorama permits to stick out the important role of the professional associations and the academic institutions in the development of Medical Physics in the country. (author)

  18. [Forensic medical implications of histomorphological changes in the bone and cartilage tissues under effect of radiation].

    Science.gov (United States)

    Osipenkova-Vichtomova, T K

    2013-01-01

    The objective of the present work was to study roentgenological, microscopic, and histomorphological changes in the bone and cartilage tissues under effect of different doses of gamma-ray radiation from Gammatron-2 (GUT Co 400) and betatron bremsstrahlung radiation (25 MeV). The total radiation dose varied from 9.6 Gy to 120 Gy per unit area during 5-8 weeks. The study included 210 patients at the age from 7 to 82 years (97 men and 113 women). Histomorphological studies were carried out using samples of bone and cartilage tissues taken from different body regions immediately after irradiation and throughout the follow-up period of up to 4 years 6 months. Control samples were the unexposed bone and cartilage tissues from the same subjects (n = 14). The tissues were stained either with eosin and hematoxylin or by Van Gieson's and Mallory's methods. Gomori's nonspecific staining was used to detect acid and alkaline phosphatase activities. Moreover, argyrophilic substance was identified in the cartilaginous tissue. Best's carmine was used for glycogen staining and Weigert's stain for elastic fibers. Metachromasia was revealed by toluidine blue staining and fat by the sudan III staining technique. In addition, the ultrastructure of cartilaginous tissue was investigated. Taken together, these methods made it possible to identify the signs of radiation-induced damage to the bone and cartilage tissues in conjunction with complications that are likely to develop at different periods after irradiation including such ones as spontaneous fractures, deforming arthrosis and radiation-induced tumours.

  19. Effectiveness of problem based learning as an instructional tool for acquisition of content knowledge and promotion of critical thinking among medical students.

    Science.gov (United States)

    Tayyeb, Rakhshanda

    2013-01-01

    To assess effectiveness of PBL as an instructional tool in clinical years to improve learning of undergraduate students in terms of acquisition of content knowledge, critical thinking and problem solving skills through problem based learning and traditional way of teaching. Quasi-experimental study. Fatima Jinnah Medical College for Women, Lahore, from October 2009 to April 2010. Final year medical students attending Obstetrics and Gynaecology and Surgery rotations were inducted as participants in this study. Two batches of 50 students each attended Gynaecology rotation and two batches attended Surgery rotation, i.e. 100 students in each. Each batch was divided into two groups i.e. A and B of 25 students each. Group-A learnt through traditional teaching, involving bedside teaching and lectures in wards and Group-B learnt relevant clinical knowledge through a modified PBL process. Content knowledge was tested by MCQs testing recall while clinical reasoning and problem were assessed by MCQs testing analysis and critical thinking. Intra-group comparison of mean scores of pre and post-test scores was done using paired sample t-tests while for intergroup comparison of mean scores was done through independent sample t-test. Teaching through traditional method significantly improved content knowledge, (p = 0.001) but did not considerably improve clinical reasoning and problem solving skills (p = 0.093) whereas, content knowledge of students who studied through PBL remained the same (p = 0.202) but there was marked improvement in their clinical reasoning and problem solving skills (p = critical thinking and problem solving skills among medical students.

  20. [Towards the problem of necessity to reduce the medical evacuation stages in conditions of local wars and armed conflicts].

    Science.gov (United States)

    Gaĭdar, B V; Ivantsov, V A; Sidel'nikov, V O; Rusev, I T; Madaĭ, D Iu; Kokoev, V G; Zinov'ev, E V; Mutalibov, M M

    2004-06-01

    The article is devoted to the review of modern opinions concerning the experience of military operation medical support in conditions of local wars and military conflicts. On the base of analysis of medical assistance rendered to the wounded and casualties in Republic of Chechnya the advantages and defects of different approaches are discussed. The experience in rendering assistance to the casualties in the Armed Forces of NATO countries during the local wars for the last decades is discussed. It is shown that the optimal variant of organization of treatment-and-evacuation measures during the local armed conflicts and wars is the two-stage scheme of evacuation: the first medical aid--the qualified (specialized) medical aid.

  1. Utilization and perceived problems of online medical resources and search tools among different groups of European physicians.

    Science.gov (United States)

    Kritz, Marlene; Gschwandtner, Manfred; Stefanov, Veronika; Hanbury, Allan; Samwald, Matthias

    2013-06-26

    There is a large body of research suggesting that medical professionals have unmet information needs during their daily routines. To investigate which online resources and tools different groups of European physicians use to gather medical information and to identify barriers that prevent the successful retrieval of medical information from the Internet. A detailed Web-based questionnaire was sent out to approximately 15,000 physicians across Europe and disseminated through partner websites. 500 European physicians of different levels of academic qualification and medical specialization were included in the analysis. Self-reported frequency of use of different types of online resources, perceived importance of search tools, and perceived search barriers were measured. Comparisons were made across different levels of qualification (qualified physicians vs physicians in training, medical specialists without professorships vs medical professors) and specialization (general practitioners vs specialists). Most participants were Internet-savvy, came from Austria (43%, 190/440) and Switzerland (31%, 137/440), were above 50 years old (56%, 239/430), stated high levels of medical work experience, had regular patient contact and were employed in nonacademic health care settings (41%, 177/432). All groups reported frequent use of general search engines and cited "restricted accessibility to good quality information" as a dominant barrier to finding medical information on the Internet. Physicians in training reported the most frequent use of Wikipedia (56%, 31/55). Specialists were more likely than general practitioners to use medical research databases (68%, 185/274 vs 27%, 24/88; χ²₂=44.905, Presources on the Internet and frequent reliance on general search engines and social media among physicians require further attention. Possible solutions may be increased governmental support for the development and popularization of user-tailored medical search tools and open

  2. Scientometric analysis of the means of scientific communication of the problem of medical consequences of Chernobyl Nuclear accident

    International Nuclear Information System (INIS)

    Artamonova, N.O.; Kulyinyich, G.V.; Pavlyichenko, Yu.V.; Gorvan', A.Je.; Zakrut'ko, L.Yi.; Novgorods'ka, L.M.; Byilan, L.G.

    2014-01-01

    In this paper evaluation of the structure and trends in the development of the Ukrainian scientific communication tools on the medical consequences of the Chernobyl nuclear accident using bibliometric methods has been given. The main developers of methodical documents are allocated, the dynamics of the distribution of methodical references, information letters and innovations is estimated. The importance of scientific communications tools in dissemination and use of new medical knowledge is demonstrated

  3. Should performance-enhancing drugs in sport be legalized under medical supervision?

    Science.gov (United States)

    Wiesing, Urban

    2011-02-01

    This review examines the question of whether performance-enhancing drugs should be permitted in sport under the control of physicians, and evaluates the expected outcomes of such a scenario. Such a change in regulation would need to be tightly controlled because of the risks involved. The results of legalizing performance-enhancing drugs in competitive sport would be either unhelpful or negative, and the unwanted aspects of doping control would not disappear. Athletes, including children and adolescents who wanted to pursue competitive sports, would be forced to take additional, avoidable health risks. The 'natural lottery' of athletic talents would be compensated for only partially by use of performance-enhancing agents. It would also be complemented by another 'natural lottery' of variable responses to doping measures, combined with the inventiveness of doping doctors. There would be no gain in 'justice' (i.e. fairer results that reflected efforts made) for athletes as a result of legalizing doping. Legalization would not reduce restrictions on athletes' freedom; the control effort would remain the same, if not increased. Extremely complicated international regulations would have to be adopted. The game of the 'tortoise and the hare' between doping athletes and inspectors would remain because prohibited but not identifiable practices could still provide additional benefits from use of permissible drugs. Audience mistrust, particularly toward athletes who achieved outstanding feats, would remain because it would still be possible that these athletes were reliant on illegal doping practices. Doping entails exposing the athletes to avoidable risks that do not need to be taken to increase the appeal of a sport. Most importantly, the function of sport as a role model would definitely be damaged. It is not necessary to clarify the question of what constitutes the 'spirit of sport' and whether this may be changed. From a practical point of view, a legalization of

  4. Evaluation of a medication intensity screening tool used in malignant hematology and bone marrow transplant services to identify patients at risk for medication-related problems.

    Science.gov (United States)

    Lucena, Mariana; Bondarenka, Carolyn; Luehrs-Hayes, Genevieve; Perez, Andy

    2018-06-01

    Background In 2014, a screening tool was implemented at Medical University of South Carolina (MUSC) Health to identify patients who are at risk for medication-related events. Patients are classified as high-risk if they meet one of the following criteria: receiving anticoagulation therapy, taking more than 10 scheduled medications upon admission, or readmission within the past 30 days. The goal of this study was to determine risk criteria specific to the malignant hematology (MH) and bone marrow transplant (BMT) patients. Methods A retrospective chart review of 114 patients admitted and discharged from the MH/BMT services between 1 September 2015 and 31 October 2015 was performed. A pharmacist-conducted medication history was completed and documented, and all interventions at admission and throughout hospitalization were categorized by severity and by value of service. The primary objective was to evaluate if patients in the MH/BMT services have more medication-related interventions documented upon admission compared with patients who are not screened as high risk. The secondary objectives were to evaluate the different types and severities of interventions made by pharmacists during the entire hospital stay, and to determine if there are certain characteristics that can help identify hematology/oncology high-risk patients. Results More interventions documented upon admission in the high-risk group as a whole when compared with the not high-risk group (73 vs. 31), but when normalized per patients in each group, there was an equal number of interventions (1.0). The most common interventions were to modify regimen (36%) and discontinue therapy (16%). The patient characteristics associated with high-risk included neutropenia, lower average platelet counts on admission, and longer length of stay. Conclusion The screening tool does not further differentiate an already complex MH/BMT patient population. Pharmacists may be more useful at capturing errors or changes during

  5. External dose estimation of the human associated with companion animals under veterinary nuclear medical diagnosis

    International Nuclear Information System (INIS)

    Ito, Nobuhiko; Hanawa, Asumi; Suzuki, Kanan

    2004-01-01

    This study was performed in order to make a safety guideline for veterinary nuclear medicine in Japan. Well often used radionuclides ( 18 F and 99 mTc) were employed for evaluating the external radiation exposures of veterinarians, animal owners, and the public. The human external radiation exposure from radiation sources in phantom likened to animal was considered by comparing the results of computer simulation and the actually measured exposure. The computer simulation was performed by using macro program of Microsoft Visual Basic for Applications (VBA). In this simulation calculation process, radiation absorption and buildup were taken into consideration with the gamma ray emitted from radioactive materials in the body of the animal. Both corresponded well though the simulation result tended to be overvalued from the actual measurement value. Therefore, it is thought that this system can be applied to the estimation of human's external exposure. When the calculation was done on the condition that the radioactive substance exists only in internal organs (heart, liver, kidneys, and bladder), the unequal distribution of the dose rate was found near the animal body. External radiation exposure estimation to the veterinarian, the animal owner and the public was performed under consideration of the actual working condition, the distance from the source, and the time of exposure. In the calculation, the radiation dose of the animal owner and the public did not exceed the dose limit (5 mSv/yr for the animal owner, and 1 mSv/yr for the general public: International Commission of Radiological Protection (ICRP) 1990) in the release after 24 hours of the radiopharmaceutical administering. The calculation condition used in this study was actually more excessive. So the authors consider these exposures would cause no significant issue by starting the veterinary nuclear medicine in Japan. Moreover, since injected radiopharmaceutical is excreted out of the body actually, the

  6. Merging Problem-Based Learning with Simulation-Based Learning in the Medical Undergraduate Curriculum: The PAIRED Framework for Enhancing Lifelong Learning

    Science.gov (United States)

    Koh, Jansen

    2016-01-01

    Lifelong learning is an essential trait that is expected of every physician. The CanMeds 2005 Physician Competency Framework emphasizes lifelong learning as a key competency that physicians must achieve in becoming better physicians. However, many physicians are not competent at engaging in lifelong learning. The current medical education system is deficient in preparing medical students to develop and carry out their own lifelong learning curriculum upon graduation. Despite understanding how physicians learn at work, medical students are not trained to learn while working. Similarly, although barriers to lifelong learning are known, medical students are not adequately skilled in overcoming these barriers. Learning to learn is just as important, if not more, as acquiring the skills and knowledge required of a physician. The medical undergraduate curriculum lacks a specific learning strategy to prepare medical students in becoming an adept lifelong learner. In this article, we propose a learning strategy for lifelong learning at the undergraduate level. In developing this novel strategy, we paid particular attention to two parameters. First, this strategy should be grounded on literature describing a physician’s lifelong learning process. Second, the framework for implementing this strategy must be based on existing undergraduate learning strategies to obviate the need for additional resources, learner burden, and faculty time. In this paper, we propose a Problem, Analysis, Independent Research Reporting, Experimentation Debriefing (PAIRED) framework that follows the learning process of a physician and serves to synergize the components of problem-based learning and simulation-based learning in specifically targeting the barriers to lifelong learning. PMID:27446767

  7. A case series of patients using medicinal marihuana for management of chronic pain under the Canadian Marihuana Medical Access Regulations.

    Science.gov (United States)

    Lynch, Mary E; Young, Judee; Clark, Alexander J

    2006-11-01

    The Canadian Marihuana Medical Access Regulations (MMAR) program allows Health Canada to grant access to marihuana for medical use to those who are suffering from grave and debilitating illnesses. This is a report on a case series of 30 patients followed at a tertiary care pain management center in Nova Scotia who have used medicinal marihuana for 1-5 years under the MMAR program. Patients completed a follow-up questionnaire containing demographic and dosing information, a series of 11-point numerical symptom relief rating scales, a side effect checklist, and a subjective measure of improvement in function. Doses of marihuana ranged from less than 1 to 5g per day via the smoked or oral route of administration. Ninety-three percent of patients reported moderate or greater pain relief. Side effects were reported by 76% of patients, the most common of which were increased appetite and a sense of well-being, weight gain, and slowed thoughts. Limitations of the study include self-selection bias, small size, and lack of a control group. The need for further study using controlled trials is discussed along with an overview of the MMAR program.

  8. Patient Safety Activity Under the Social Insurance Medical Fee Schedule in Japan: An Overview of the 2010 Nationwide Survey.

    Science.gov (United States)

    Hirose, Masahiro; Kawamura, Toshihiko; Igawa, Mikio; Imanaka, Yuichi

    2017-11-16

    Little is known about patient safety performance under the social insurance medical fee schedule in Japan. The Health Ministry in Japan introduced the preferential patient safety countermeasure fee (PPSCF) to promote patient safety in 2006 and revised the PPSCF system in 2010. This study aims to address the patient safety performance status at hospitals implementing the PPSCF. A nationwide questionnaire survey targeting 2674 hospitals with the PPSCF was performed in 2010 to 2011. The 627 participant hospitals were divided into the following three groups: 178 hospitals implementing PPSCF 1 with 400 beds or more (group A), 286 hospitals implementing PPSCF 1 with 399 beds or fewer (group B), and 163 hospitals implementing PPSCF 2 (group C). The mean numbers (standard errors) of patient safety managers were 1.45 (0.07) in group A, 1.12 (0.04) in group B, and 0.37 (0.12) in group C (P fee schedule in Japan.

  9. Medical and physical problems of mammography. 2. Studies on optimum quality of radiation and on radiation exposure

    Energy Technology Data Exchange (ETDEWEB)

    Barke, R; Geissler, S; Rosenkranz, G [Medizinische Akademie, Dresden (German Democratic Republic). Radiologische Klinik

    1980-02-01

    Problems concerning the implications of the radiation energy in relation to the image contrast and the radiation exposure are discussed, and measurements of the energy distribution are described. The effects of the voltage and of the filter on the energy distribution were determined, with and without a molybdenum filter, in the voltage range of 25 - 50 kV. The form of the spectral energy distribution depends but slightly on the output voltage. On the other side, the radiation exposure can be expressed as a function of the radiographic kilovoltage. The effects of the quantum energy and of the scattered radiation on the contrast and the optimal energy were studied on a model. With regard to the importance of the detection of microcalcifications, the effects of the scattered radiation on the contrast behaviour of details of varying size were investigated. The direct proportionality of the contrast to the detail size is lost under the influence of the scattered radiation. For this reason, minimal kV values are required for imaging very small details. Studies on the imaging geometry of the DG 40 mammographical device permit to conclude that the necessary resolving power (..gamma.. = 5 mm/sup -1/) is reached with the TF 13 and XR 10 films. On the basis of the relevant literature, the present views on radiation exposure and especially on cancer induction by mammography are discussed. To estimate the risk, the radiation exposure must be determined in the own system. By means of thermoluminescent dosimetry in patients, using LiF and CaSO/sub 4/, the surface dose, the exit dose and the sternal exposure, adding the XR 10 and the TF 13 to the DG 40 (the mean values at 30 kV were 49 and 34 ..mu..Gy, respectively) were determined. An increase in voltage leads to a reduction of the dose, but impairs the quality of the image. The values obtained are compared with data from the literature. Conclusions are drawn as to the use of mammography in practice.

  10. Distribution of hydrogen within the HDR-containment under severe accident conditions. OECD standard problem. Final comparison report

    International Nuclear Information System (INIS)

    Karwat, H.

    1992-08-01

    The present report summarizes the results of the International Standard Problem Exercise ISP-29, based on the HDR Hydrogen Distribution Experiment E11.2. Post-test analyses are compared to experimentally measured parameters, well-known to the analysis. This report has been prepared by the Institute for Reactor Dynamics and Reactor Safety of the Technical University Munich under contract with the Gesellschaft fuer Anlagen- und Reaktorsicherheit (GRS) which received funding for this activity from the German Ministry for Research and Technology (BMFT) under the research contract RS 792. The HDR experiment E11.2 has been performed by the Kernforschungszentrum Karlsruhe (KfK) in the frame of the project 'Projekt HDR-Sicherheitsprogramm' sponsored by the BMFT. Ten institutions from eight countries participated in the post-test analysis exercise which was focussing on the long-lasting gas distribution processes expected inside a PWR containment under severe accident conditions. The gas release experiment was coupled to a long-lasting steam release into the containment typical for an unmitigated small break loss-of-coolant accident. In lieu of pure hydrogen a gas mixture consisting of 15% hydrogen and 85% helium has been applied in order to avoid reaching flammability during the experiment. Of central importance are common overlay plots comparing calculated transients with measurements of the global pressure, the local temperature-, steam- and gas concentration distributions throughout the entire HDR containment. The comparisons indicate relatively large margins between most calculations and the experiment. Having in mind that this exercise was specified as an 'open post-test' analysis of well-known measured data the reasons for discrepancies between measurements and simulations were extensively discussed during a final workshop. It was concluded that analytical shortcomings as well as some uncertainties of experimental boundary conditions may be responsible for deviations

  11. Distribution of hydrogen within the HDR-containment under severe accident conditions. OECD standard problem. Final comparison report

    Energy Technology Data Exchange (ETDEWEB)

    Karwat, H

    1992-08-15

    The present report summarizes the results of the International Standard Problem Exercise ISP-29, based on the HDR Hydrogen Distribution Experiment E11.2. Post-test analyses are compared to experimentally measured parameters, well-known to the analysis. This report has been prepared by the Institute for Reactor Dynamics and Reactor Safety of the Technical University Munich under contract with the Gesellschaft fuer Anlagen- und Reaktorsicherheit (GRS) which received funding for this activity from the German Ministry for Research and Technology (BMFT) under the research contract RS 792. The HDR experiment E11.2 has been performed by the Kernforschungszentrum Karlsruhe (KfK) in the frame of the project 'Projekt HDR-Sicherheitsprogramm' sponsored by the BMFT. Ten institutions from eight countries participated in the post-test analysis exercise which was focussing on the long-lasting gas distribution processes expected inside a PWR containment under severe accident conditions. The gas release experiment was coupled to a long-lasting steam release into the containment typical for an unmitigated small break loss-of-coolant accident. In lieu of pure hydrogen a gas mixture consisting of 15% hydrogen and 85% helium has been applied in order to avoid reaching flammability during the experiment. Of central importance are common overlay plots comparing calculated transients with measurements of the global pressure, the local temperature-, steam- and gas concentration distributions throughout the entire HDR containment. The comparisons indicate relatively large margins between most calculations and the experiment. Having in mind that this exercise was specified as an 'open post-test' analysis of well-known measured data the reasons for discrepancies between measurements and simulations were extensively discussed during a final workshop. It was concluded that analytical shortcomings as well as some uncertainties of experimental boundary conditions may be responsible for deviations

  12. 38 CFR 17.90 - Medical care for veterans receiving vocational training under 38 U.S.C. chapter 15.

    Science.gov (United States)

    2010-07-01

    ....S.C. chapter 15. Hospital care, nursing home care and medical services may be provided to any... and medical services means class V dental care, priority III medical services, nursing home care and... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Medical care for veterans...

  13. The article critique as a problem-based teaching method for medical students early in their training: a French example using anatomy.

    Science.gov (United States)

    Havet, Eric; Duparc, Fabrice; Peltier, Johan; Tobenas-Dujardin, Anne-Claire; Fréger, Pierre

    2012-01-01

    In France, "article critique" became a particular teaching method in the second part of the medical curriculum. It approaches a reading exercise of scientific medical papers similar to that of journal club. It could be compared to reviewing a paper as performed by reviewers of a scientific journal. We studied the relevancy of that teaching method for the youngest medical students. Our questions were about the understanding and the analyzing ability of a scientific paper while students have just learned basic medical sciences as anatomy. We have included 54 "article critique" written by voluntary students in second and third years of medical cursus. All of the IMRaD structure items (introduction, materials and methods, results and discussion) were analyzed using a qualitative scale for understanding as for analyzing ability. For understanding, 89-96% was good or fair and for the analyzing ability, 93-100% was good or fair. The anatomical papers were better understood than therapeutic or paraclinical studies, but without statistical difference, except for the introduction chapter. Results for analyzing ability were various according to the subject of the papers. This teaching method could be compared to a self-learning method, but also to a problem-based learning method. For the youngest students, the lack of medical knowledge aroused the curiosity. Their enthusiasm to learn new medical subjects remained full. The authors would insist on the requirement of rigorous lessons about evidence-based medicine and IMRaD structure and on a necessary companionship of the students by the teachers.

  14. Impact of problem-based, active learning on graduation rates for 10 generations of Dutch medical students

    NARCIS (Netherlands)

    Schmidt, Henk G.; Cohen-Schotanus, Janke; Arends, Lidia R.

    We aimed to study the effects of active-learning curricula on graduation rates of students and on the length of time needed to graduate. Graduation rates for 10 generations of students enrolling in the eight Dutch medical schools between 1989 and 1998 were analysed. In addition, time needed to

  15. Large scale implementation of clinical medication reviews in Dutch community pharmacies: Drug-related problems and interventions

    NARCIS (Netherlands)

    Kempen, Thomas G. H.; Van De Steeg-Van Gompel, Caroline H. P. A.; Hoogland, Petra; Liu, Yuqian; Bouvy, Marcel L.

    2014-01-01

    Background: Research on the benefits of clinical medication reviews (CMRs) performed by pharmacists has been conducted mostly in controlled settings and has been widely published. Less is known of the effects after large scale implementation in community pharmacies. An online CMR tool enabled the

  16. The Relationship of Social Problem-Solving Skills and Dysfunctional Attitudes with Risk of Drug Abuse among Dormitory Students at Isfahan University of Medical Sciences.

    Science.gov (United States)

    Nasrazadani, Ehteram; Maghsoudi, Jahangir; Mahrabi, Tayebeh

    2017-01-01

    Dormitory students encounter multiple social factors which cause pressure, such as new social relationships, fear of the future, and separation from family, which could cause serious problems such as tendency toward drug abuse. This research was conducted with the goal to determine social problem-solving skills, dysfunctional attitudes, and risk of drug abuse among dormitory students of Isfahan University of Medical Sciences, Iran. This was a descriptive-analytical, correlational, and cross-sectional research. The research sample consisted of 211 students living in dormitories. The participants were selected using randomized quota sampling method. The data collection tools included the Social Problem-Solving Inventory (SPSI), Dysfunctional Attitude Scale (DAS), and Identifying People at Risk of Addiction Questionnaire. The results indicated an inverse relationship between social problem-solving skills and risk of drug abuse ( P = 0.0002), a direct relationship between dysfunctional attitude and risk of drug abuse ( P = 0.030), and an inverse relationship between social problem-solving skills and dysfunctional attitude among students ( P = 0.0004). Social problem-solving skills have a correlation with dysfunctional attitudes. As a result, teaching these skills and the way to create efficient attitudes should be considered in dormitory students.

  17. Medication Errors - A Review

    OpenAIRE

    Vinay BC; Nikhitha MK; Patel Sunil B

    2015-01-01

    In this present review article, regarding medication errors its definition, medication error problem, types of medication errors, common causes of medication errors, monitoring medication errors, consequences of medication errors, prevention of medication error and managing medication errors have been explained neatly and legibly with proper tables which is easy to understand.

  18. Incidence of Decompression Illness and Other Diving Related Medical Problems Amongst Royal Navy Divers 1995-1999

    Science.gov (United States)

    1999-01-01

    conditions hypobares ou hyperbares ] To order the complete compilation report, use: ADA395680 The component part is provided here to allow users access to...following report: TITLE: Operational Medical Issues in Hypo-and Hyperbaric Conditions [les Questions medicales a caractere oprationel liees aux...Navy diving accidents, and with the assistance of the British Hyperbaric Association (BHA) all civilian cases of decompression illness treated by member

  19. Effects of differences in problem-based learning course length on academic motivation and self-directed learning readiness in medical school students.

    Science.gov (United States)

    Yune, So Jung; Im, Sun Ju; Lee, Sun Hee; Baek, Sun Yong; Lee, Sang Yeoup

    2010-03-01

    Problem-based learning (PBL) is an educational approach in which complex authentic problems serve as the context and stimulus for learning. PBL is designed to encourage active participation during learning. The goal of this study was to study the effects of PBL on academic motivation and self-directed learning readiness in medical school students. The subjects of this study were 190 students in the 1st and 2nd grade of medical school. The period of the PBL course was two weeks for Year 1 and five weeks for Year 2 students. Students completed one module over one week. Academic motivation tests and self-directed learning readiness tests were performed before and after the PBL course. The differences between the two groups were analyzed using paired t-test and repeated measures MANCOVA. PBL had positive effects on academic self-efficacy (self-control efficacy, task-level preference) and academic failure tolerance (behavior, task-difficulty preference) as academic motivation. PBL had a mildly positive effect on self-directed learning readiness. In addition, the five-week PBL course had greater positive effects on academic motivation than the two-week course but not with regard to self-directed learning readiness. Medical students engage in academic motivation and self-directed learning readiness during PBL, suggesting that the five-week PBL course has greater positive effects than the two-week course. Future studies are needed to confirm the most effective periods of PBL.

  20. Safety in numbers 7: Veni, vidi, duci: a grounded theory evaluation of nursing students' medication dosage calculation problem-solving schemata construction.

    Science.gov (United States)

    Weeks, Keith W; Higginson, Ray; Clochesy, John M; Coben, Diana

    2013-03-01

    This paper evaluates nursing students' transition through schemata construction and competence development in medication dosage calculation problem-solving (MDC-PS). We advance a grounded theory from interview data that reflects the experiences and perceptions of two groups of undergraduate pre-registration nursing students: eight students exposed to a prototype authentic MDC-PS environment and didactic transmission methods of education and 15 final year students exposed to the safeMedicate authentic MDC-PS environment. We advance a theory of how classroom-based 'chalk and talk' didactic transmission environments offered multiple barriers to accurate MDC-PS schemata construction among novice students. While conversely it was universally perceived by all students that authentic learning and assessment environments enabled MDC-PS schemata construction through facilitating: 'seeing' the authentic features of medication dosage problems; context-based and situational learning; learning within a scaffolded environment that supported construction of cognitive links between the concrete world of clinical MDC-PS and the abstract world of mathematics; and confidence-building in their cognitive and functional competence ability. Drawing on the principle of veni, vidi, duci (I came, I saw, I calculated), we combined the two sets of evaluations to offer a grounded theoretical basis for schemata construction and competence development within this critical domain of professional practice. Copyright © 2012 Elsevier Ltd. All rights reserved.