Consommation des psychotropes en milieu scolaire, au Burkina Faso

African Journals Online (AJOL)

Consommation des psychotropes en milieu scolaire, au Burkina Faso : Prévalences et facteurs de risque. L Nikiéma, S Kouanda, I Seck, S Tiendrebéogo, HG Ouédraogo, M Yaméogo, B Méda, B Doulogou, I Guissou, B Sondo ...

Towards an ‘alternative’ geography of innovation:Alternative milieu, socio-cognitive protection and sustainability experimentation

OpenAIRE

Longhurst, Noel

2015-01-01

This paper highlights the hitherto unrecognised role of ‘alternative’ places in protecting different forms of sustainability innovation. The paper uses the concept of an alternative milieu to illustrate how a geographically localised concentration of countercultural practices, institutions and networks can create socio-cognitive ‘niche’ protection for sustainability experiments. An alternative milieu creates protection for the emergence of novelties by (i) creating ontological and epistemolog...

Can contrast-enhanced multi-detector computed tomography replace transesophageal echocardiography for the detection of thrombogenic milieu and thrombi in the left atrial appendage. A prospective study with 124 patients; Kann die kontrastmittelverstaerkte Mehrzeilen-Computertomografie die transoesophageale Echokardiografie bei der Detektion von thrombogenem Milieu und Vorhofohrthromben ersetzen? Eine prospektive Studie mit 124 Patienten

Energy Technology Data Exchange (ETDEWEB)

Homsi, R.; Luetkens, J.A.; Schild, H.H.; Naehle, C.P. [Bonn Univ. (Germany). Dept. of Radiology; Nath, B. [SHG-KLliniken Voelklingen (Germany). Dept. of Medicine I - Cardiology; Schwab, J.O. [Bonn Univ. (Germany). Dept. of Medicine I - Cardiology

2016-01-15

To assess the diagnostic value of contrast-enhanced multi-detector computed tomography (MD-CT) for identifying patients with left atrial appendage (LAA) thrombus or circulatory stasis. 124 patients with a history of atrial fibrillation and/or cerebral ischemia (83 men, mean age 58.6 ± 12.4 years) and with a clinical indication for MD-CT of the heart and for transesophageal echocardiography (TEE) were included in the study. LAA thrombus or thrombogenic milieu was visually identified in TEE and MD-CT. In addition, MD-CT was analyzed quantitatively measuring the Hounsfield units (HU) of the left atrium (LA), the LAA and the ascending aorta (AA), and calculating the HU ratios LAA/AA (HU [LAA/AA]) und LAA/LA (HU [LAA/LA]). Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were calculated. The prevalence of a thrombus or thrombogenic milieu as assessed by TEE was 21.8 %. The HU ratio was lower in patients with thrombus or thrombogenic milieu (HU [LAA/AA]: 0.590 ± 0.248 vs. 0.909 ± 0.141; p < 0.001 und HU [LAA/LA] 0.689 ± 0.366 vs. 1.082 ± 0.228; p < 0.001). For the diagnosis of thrombus or a thrombogenic milieu, visual analysis yielded a sensitivity of 81.5 %, a specificity of 96.9 %, a PPV of 87.5 % and a NPV of 95.2 %. By combining visual and quantitative analysis with one criterion being positive, the specificity decreased to 91.8 %, the sensitivity to 77.8 %, the PPV to 72.4 %, and the NPV to 94.9 %. Visual analysis of the LAA in the evaluation of thrombus or thrombogenic milieu yields a high NPV of 95.1 % and may especially be useful to rule out LAA thrombi in patients with contraindications for TEE. Additional calculation of HU ratios did not improve the diagnostic performance of MD-CT.

[The nurse within emergency medical-psychological units].

Science.gov (United States)

Darbon, Rémy; Dalphin, Catherine; Prieto, Nathalie; Cheucle, Éric

2017-04-01

The growing recognition of post-traumatic stress disorders and the need to intervene early justifies the creation of emergency medical-psychological units. The nurse has a major role to play within these teams. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Habitat Demonstration Unit Medical Operations Workstation Upgrades

Science.gov (United States)

Trageser, Katherine H.

2011-01-01

This paper provides an overview of the design and fabrication associated with upgrades for the Medical Operations Workstation in the Habitat Demonstration Unit. The work spanned a ten week period. The upgrades will be used during the 2011 Desert Research and Technology Studies (Desert RATS) field campaign. Upgrades include a deployable privacy curtain system, a deployable tray table, an easily accessible biological waste container, reorganization and labeling of the medical supplies, and installation of a retractable camera. All of the items were completed within the ten week period.

Training programs in medical physics in the United States

International Nuclear Information System (INIS)

Lanzl, L.H.

1977-01-01

The history of the field of medical physics in the United States is reviewed; the importance of the development of the nuclear reactor and particle accelerators to medical physics is pointed out. Conclusions and recommendations of an IAEA/WHO seminar on the training of medical physicists (in 1972) are given and compared with existing programs in the US. It is concluded that the recommendations of the IAEA are, for the most part, followed. 1 table

Pharmacist-led medication review in an acute admissions unit

DEFF Research Database (Denmark)

Hansen, Trine Graabæk; Bonnerup, Dorthe Krogsgaard; Kjeldsen, Lene Juel

2015-01-01

of principles and methodologies, and the practical procedure is seldom described in detail, which makes reproducing study findings difficult. The objective of this paper is to provide a detailed description of a procedure developed and used for pharmacist-led medication review in acute admissions units......) collection of information about the patient's medical treatment, (3) patient interview, (4) critical examination of the patient's medications and (5) recommendations for the hospital physician.Conclusions We have provided a detailed description of a procedure for pharmacist-led medication review. We do so...

Donner une voix aux pauvres en milieu urbain : les chiffonniers de ...

International Development Research Centre (IDRC) Digital Library (Canada)

2 mars 2018 ... Pour les pauvres en milieu urbain de Bolivie, il est essentiel d'adopter des « stratégies de survie » pour gagner un revenu supplémentaire qui compense les salaires bas et précaires.

Tetanus in adult males, Bugando Medical Centre, United Republic of Tanzania.

Science.gov (United States)

Aziz, Riaz; Peck, Robert N; Kalluvya, Samuel; Kenemo, Bernard; Chandika, Alphonce; Downs, Jennifer A

2017-11-01

In the United Republic of Tanzania, the incidence of non-neonatal circumcision-related tetanus is probably underreported. We analysed charts and extracted information on outcome and wound location for non-neonatal cases of tetanus admitted to the intensive care unit of Bugando Medical Centre between 2001 and 2016. Bugando Medical Centre, which is one of four teaching referral hospitals in the United Republic of Tanzania, has a 13-bed intensive care unit that manages all admitted patients with tetanus. Within the United Republic of Tanzania, formal programmes of tetanus immunization are targeted at infants or women. From our inpatient logs, we identified six patients with non-neonatal tetanus among male patients with a recent history of circumcision. Only one of these patients had been circumcised within a subnational programme of voluntary medical male circumcision. The other five had been circumcised outside of the programme - e.g. at small rural dispensaries or by a traditional provider with no formal medical training. The six patients were aged 11-55 years and five (83%) of them died in hospital - all of overwhelming sepsis. Within the Tanzanian programme of voluntary medical male circumcision, education on wound hygiene probably helps to reduce the incidence of non-neonatal circumcision-related tetanus. The corresponding incidence among the boys and men who are circumcised beyond this subnational programme is probably higher. The training of all circumcision providers in wound care and a vaccination programme to ensure that male Tanzanians receive tetanus immunization post-infancy are recommended.

A mobility program for an inpatient acute care medical unit.

Science.gov (United States)

Wood, Winnie; Tschannen, Dana; Trotsky, Alyssa; Grunawalt, Julie; Adams, Danyell; Chang, Robert; Kendziora, Sandra; Diccion-MacDonald, Stephanie

2014-10-01

For many patients, hospitalization brings prolonged periods of bed rest, which are associated with such adverse health outcomes as increased length of stay, increased risk of falls, functional decline, and extended-care facility placement. Most studies of progressive or early mobility protocols designed to minimize these adverse effects have been geared toward specific patient populations and conducted by multidisciplinary teams in either ICUs or surgical units. Very few mobility programs have been developed for and implemented on acute care medical units. This evidence-based quality improvement project describes how a mobility program, devised for and put to use on a general medical unit in a large Midwestern academic health care system, improved patient outcomes.

Do Leadership Style, Unit Climate, and Safety Climate Contribute to Safe Medication Practices?

Science.gov (United States)

Farag, Amany; Tullai-McGuinness, Susan; Anthony, Mary K; Burant, Christopher

2017-01-01

This study aims at: examining if leadership style and unit climate predict safety climate; and testing the direct, indirect, and total effect of leadership style, unit climate, and safety climate on nurses' safe medication practices. The Institute of Medicine and nursing scholars propose that safety climate is a prerequisite to safety practices. However, there is limited empirical evidence about factors contributing to the development of safety climate and about the association with nurses' safe medication practices. This cross-sectional study used survey data from 246 RNs working in a Magnet® hospital. Leadership style and unit climate predicted 20% to 50% of variance on all safety climate dimensions. Model testing revealed the indirect impact of leadership style and unit climate on nurses' safe medication practices. Our hypothesized model explained small amount of the variance on nurses' safe medication practices. This finding suggests that nurses' safe medication practices are influenced by multiple contextual and personal factors that should be further examined.

Iatrogenic medication errors in a paediatric intensive care unit in ...

African Journals Online (AJOL)

This unit has guided the development of various types of adverse event reporting, ... iatrogenic medi cation errors in children at healthcare facilities in industrialised .... A pharmacist dispenses electronically submitted medication orders but ..... Hand-held devices such as smartphones with medication dosage applications.

Less materials, better environment; Minder materialen, beter milieu

Energy Technology Data Exchange (ETDEWEB)

De Bruyn, S.M. [CE, Delft (Netherlands); Van der Voet, E. [Centrum voo Milieukunde, Universiteit van Leiden, Leiden (Netherlands); Idenburg, A.M. [Milieu- en Natuurplanbureau-RIVM, Bilthoven (Netherlands); Van den Bergh, J.C.J.M.; Verbruggen, H. [Faculteit der Economische Wetenschappen en Bedrijfskunde, Vrije Universiteit, Amsterdam (Netherlands)

2004-04-16

The purpose of dematerialization is to reduce the use of materials in order to improve the environment. Several indicators to measure the effects of dematerialization policy are available. In this article the relation between the indicators and policy are discussed. [Dutch] Dematerialisatie heeft tot doel het gebruik van materialen te verminderen waardoor het milieu wordt ontlast. Voor het meten van de effecten van dematerialisatiebeleid zijn diverse indicatoren beschikbaar. In dit artikel wordt de relatie tussen de indicatoren en het beleid besproken.

Kwik en chroom in het milieu. Verschijningsvormen, gedrag en toxiciteit Literatuurstudie

NARCIS (Netherlands)

Kotterman, M.J.J.; Heuvel, van den M.J.

2010-01-01

Kwik is een metaal dat door zijn toxische eigenschappen al jaren in de aandacht staat van milieumonitoring. Het metaal werd en wordt gebruikt voor vele toepassingen, en door zowel de natuurlijke als menselijke emissie komt het overal in het milieu voor. De voornaamste bronnen van kwikverontreiniging

Incontinence urinaire de la femme en milieu urbain au Burkina Faso ...

African Journals Online (AJOL)

Incontinence urinaire de la femme en milieu urbain au Burkina Faso: Enquête épidemiologique auprès de 759 femmes à Bobo Dioulasso. ... showed that the following risk factors were significantly associated with urinary incontinence: dystocia, repeated urinary tract infections, chronic constipation, episiotomy and obesity.

Medication administration errors in an intensive care unit in Ethiopia

Directory of Open Access Journals (Sweden)

Agalu Asrat

2012-05-01

Full Text Available Abstract Background Medication administration errors in patient care have been shown to be frequent and serious. Such errors are particularly prevalent in highly technical specialties such as the intensive care unit (ICU. In Ethiopia, the prevalence of medication administration errors in the ICU is not studied. Objective To assess medication administration errors in the intensive care unit of Jimma University Specialized Hospital (JUSH, Southwest Ethiopia. Methods Prospective observation based cross-sectional study was conducted in the ICU of JUSH from February 7 to March 24, 2011. All medication interventions administered by the nurses to all patients admitted to the ICU during the study period were included in the study. Data were collected by directly observing drug administration by the nurses supplemented with review of medication charts. Data was edited, coded and entered in to SPSS for windows version 16.0. Descriptive statistics was used to measure the magnitude and type of the problem under study. Results Prevalence of medication administration errors in the ICU of JUSH was 621 (51.8%. Common administration errors were attributed to wrong timing (30.3%, omission due to unavailability (29.0% and missed doses (18.3% among others. Errors associated with antibiotics took the lion's share in medication administration errors (36.7%. Conclusion Medication errors at the administration phase were highly prevalent in the ICU of Jimma University Specialized Hospital. Supervision to the nurses administering medications by more experienced ICU nurses or other relevant professionals in regular intervals is helpful in ensuring that medication errors don’t occur as frequently as observed in this study.

[Diagnosis and the technology for optimizing the medical support of a troop unit].

Science.gov (United States)

Korshever, N G; Polkovov, S V; Lavrinenko, O V; Krupnov, P A; Anastasov, K N

2000-05-01

The work is devoted to investigation of the system of military unit medical support with the use of principles and states of organizational diagnosis; development of the method allowing to assess its functional activity; and determination of optimization trends. Basing on the conducted organizational diagnosis and expert inquiry the informative criteria were determined which characterize the stages of functioning of the military unit medical support system. To evaluate the success of military unit medical support the complex multi-criteria pattern was developed and algorithm of this process optimization was substantiated. Using the results obtained, particularly realization of principles and states of decision taking theory in machine program it is possible to solve more complex problem of comparison between any number of military units: to dispose them according to priority decrease; to select the programmed number of the best and worst; to determine the trends of activity optimization in corresponding medical service personnel.

Using evidence to improve satisfaction with medication side-effects education on a neuro-medical surgical unit.

Science.gov (United States)

Ahrens, Susan L; Wirges, Ashley M

2013-10-01

Patient satisfaction is viewed as a significant indicator of quality of care. More specifically, improving patient satisfaction related to communication about medications and potential side effects can improve healthcare outcomes. Patient satisfaction scores related to medication side effects on a neuro-medical surgical unit were monitored following a quality improvement program. These patients frequently experience cognitive impairment and functional difficulties that can affect the way they understand and handle medications. The purpose of this quality improvement practice change was to (a) develop an educational approach for post acute neurosurgical patients and (b) evaluate whether the use of the approach is successful in improving patient satisfaction scores related to medication education on side effects. The quality improvement program interventions included (a) patient informational handouts inserted into admission folders, (b) nurse education about the importance of providing education on side effects to patient and discussion of their involvement with the program, (c) unit flyers with nurse education, and (d) various communications with bedside nurses through personal work mail and emails. The primary focus was for nurses to employ the "teach back" method to review and reinforce the medication side-effect teaching with patients. Evaluation of the data showed an increase in patient satisfaction after the implementation of the "Always Ask" program.

PHENOMENOLOGICAL INQUIRY AND SELF-FUNCTIONS IN THE TRANSFERENCE-COUNTERTRANSFERENCE MILIEU

Directory of Open Access Journals (Sweden)

Richard G. Erskine

2013-05-01

Full Text Available The article “Balancing on the ‘Borderline’ of Early Affect-Confusion: Part 2 of a Case Study Trilogy” serves as the basis for this rejoinder and collegial discourse. The organizing-functions of reparation, stabilization, regulation, and enhancement are described and placed within the transference-countertransference milieu. Examples of bifurcating client’s questions to resolve transference are provided.

An introduction to medical malpractice in the United States.

Science.gov (United States)

Bal, B Sonny

2009-02-01

Medical malpractice law in the United States is derived from English common law, and was developed by rulings in various state courts. Medical malpractice lawsuits are a relatively common occurrence in the United States. The legal system is designed to encourage extensive discovery and negotiations between adversarial parties with the goal of resolving the dispute without going to jury trial. The injured patient must show that the physician acted negligently in rendering care, and that such negligence resulted in injury. To do so, four legal elements must be proven: (1) a professional duty owed to the patient; (2) breach of such duty; (3) injury caused by the breach; and (4) resulting damages. Money damages, if awarded, typically take into account both actual economic loss and noneconomic loss, such as pain and suffering.

Medical complications and outcomes at an onsite rehabilitation unit for older people.

LENUS (Irish Health Repository)

Mulroy, M

2013-09-01

The rehabilitation of older patients in Ireland after an acute medical event occurs at dedicated onsite hospital units or at offsite centres. Information on medical complications and outcomes is inadequate.

Medical leadership and management in the United Kingdom.

Science.gov (United States)

Kyratsis, Yiannis; Armit, Kirsten; Zyada, Azra; Lees, Peter

2016-06-01

This article aims to outline the historical development of medical leadership in the United Kingdom (UK), present recent advances, and discuss professional development and future prospects. With increasing involvement of medical professionals in top managerial roles in the UK over the last 30 years, leadership development initiatives have been growing steadily and there is increasing recognition of the need for leadership and management skills for doctors. Such skills can help to greatly improve patient care as well as enhance organisational effectiveness and productivity. The central involvement of professional bodies such as the UK Faculty of Medical Leadership and Management, and the establishment of medical fellowship schemes, have provided a solid foundation for a new generation of aspiring medical leaders but there is still a long way to go to achieve a higher degree of professionalism for clinical leadership in the UK. The evidence base is weak such that integrated efforts by clinicians and management academics have much to offer in achieving the vision of socially responsible, clinically relevant and research informed medical leadership training. © The Royal Australian and New Zealand College of Psychiatrists 2016.

Nuclear energy, conflict between the milieu and trade union movements

International Nuclear Information System (INIS)

Krozer, J.; Lugt, B. van der; Oudshoorn, N.; Staal, A.

1980-01-01

The opposition between the Anti Nuclear Energy Movement (AKB) and the trade union (FNV) in the Netherlands over the question of nuclear energy has been analysed. The movements have different social backgrounds which are reflected in their respective strategies. The trade union represents the workers and judges technical developments from their viewpoint. The milieu movement aims to maintain a clean environment and critically considers technical developments. (C.F.)

La communication de recrutement dans le milieu hospitalier

OpenAIRE

Medina, Pablo

2011-01-01

Le développement de la communication institutionnelle et du marketing au sein des institutions hospitalières est très influencé par les changements qui ont lieu dans le milieu sanitaire. La communication de recrutement est l’une des activités les plus stratégiques dans ce cadre, non seulement parce qu’elle répond à des objectifs organisationnels très précis, mais aussi parce qu’elle contribue au développement du champ de la communication institutionnelle dans les hôpitaux. Mais, pour y réussi...

Assessment of Clinical Practices for Crushing Medication in Geriatric Units.

Science.gov (United States)

Fodil, M; Nghiem, D; Colas, M; Bourry, S; Poisson-Salomon, A-S; Rezigue, H; Trivalle, C

2017-01-01

To assess the modification of the form of medication and evaluate staff observance of good clinical practices. One-day assessment of clinical practices. 17 geriatrics units in the 3 Teaching Hospitals of Paris-Sud (APHP), France. Elderly in-patients with difficulties swallowing capsules and tablets. Assessment of target-patient prescriptions and direct observation of nurses' medical rounds. 155/526 in-patients (29.5%) were unable to swallow tablets or capsules: 98 (40.3%) in long-term care, 46 patients (23.8%) in the rehabilitation unit and 11 (12.2%) in the acute care unit (p = .005). In thirty-nine (27.3%) of the 143 prescriptions studied all tablets were safe to crush and all capsules were safe to open. In 104 cases, at least one medication could not be safely modified, including 26 cases (18.2%) in which none of the prescribed drugs were safe to crush or open. In 48.2% of the 110 medications that were crushed, crushing was forbidden, and presented a potential threat in 12.7% of cases or a reduced efficacy in 8.2% of cases. Crushing methods were rarely appropriate: no specific protective equipment was used (81.8%), crushing equipment was shared between patients without cleaning (95.1%), medications were spilled or lost (69.9%). The method of administration was appropriate (water, jellified water) in 25% of the cases, questionable (soup, coffee, compote, juice, cream) in 55% of the cases and unacceptable (laxative) in 21% of the cases. Management of drug prescriptions in patients with swallowing difficulties is not optimal, and may even have iatrogenic effects. In this study, 12.7% of the modifications of the drug form could have been harmful. Doctors, pharmacists and nurses need to reevaluate their practices.

Pay Benefits and Workplace Milieu Effecting Job Satisfaction Level of University Teachers: A Case Study of Punjab University

OpenAIRE

Ali Nisar; Muhammad Iqbal Zafar; Babak Mahmood; Malik Muhammad Sohail; Falak Sher; Muhammad Rizwan Safdar

2012-01-01

The major concern of the study was to examine the influence of pay satisfaction and workplace milieu on job satisfaction levels in the teaching faculty members of University of Punjab. There were three major objectives of this study. First one was to examine the pay satisfaction level of teaching faculty members of University of the Punjab. Second objective was to examine the effect of workplace milieu on job satisfaction level of teaching faculty members of University of the Punjab. And the ...

Identification of Units and Other Terms in Czech Medical Records

Czech Academy of Sciences Publication Activity Database

Zvára Jr., Karel; Kašpar, Václav

2010-01-01

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

What's New in Treating Inpatients With Personality Disorders?: Dialectical Behavior Therapy and Old-Fashioned, Good Communication.

Science.gov (United States)

Ritter, Sarah; Platt, Lois M

2016-01-01

Psychiatric unit inpatients often have serious mental illnesses with comorbid personality disorders. Mental illnesses usually respond favorably to medication and psychotherapy, but personality disorders do not. Two personality disorders are commonly seen on inpatient units: borderline and antisocial. These personality disorders may destabilize the milieu with disruptive behaviors and present a challenge to nurses. Difficult patient behaviors and therapeutic responses by nurses are examined. Dialectical behavior therapy techniques and good communication skills may be used by nurses to (a) interact therapeutically with patients with personality disorders and (b) protect other patients and the milieu. Copyright 2016, SLACK Incorporated.

Identification of factors which affect the tendency towards and attitudes of emergency unit nurses to make medical errors.

Science.gov (United States)

Kiymaz, Dilek; Koç, Zeliha

2018-03-01

To determine individual and professional factors affecting the tendency of emergency unit nurses to make medical errors and their attitudes towards these errors in Turkey. Compared with other units, the emergency unit is an environment where there is an increased tendency for making medical errors due to its intensive and rapid pace, noise and complex and dynamic structure. A descriptive cross-sectional study. The study was carried out from 25 July 2014-16 September 2015 with the participation of 284 nurses who volunteered to take part in the study. Data were gathered using the data collection survey for nurses, the Medical Error Tendency Scale and the Medical Error Attitude Scale. It was determined that 40.1% of the nurses previously witnessed medical errors, 19.4% made a medical error in the last year, 17.6% of medical errors were caused by medication errors where the wrong medication was administered in the wrong dose, and none of the nurses filled out a case report form about the medical errors they made. Regarding the factors that caused medical errors in the emergency unit, 91.2% of the nurses stated excessive workload as a cause; 85.1% stated an insufficient number of nurses; and 75.4% stated fatigue, exhaustion and burnout. The study showed that nurses who loved their job were satisfied with their unit and who always worked during day shifts had a lower medical error tendency. It is suggested to consider the following actions: increase awareness about medical errors, organise training to reduce errors in medication administration, develop procedures and protocols specific to the emergency unit health care and create an environment which is not punitive wherein nurses can safely report medical errors. © 2017 John Wiley & Sons Ltd.

Cardiomyopathie du péri-partum prise en charge en milieu ...

African Journals Online (AJOL)

Cardiomyopathie du péri-partum prise en charge en milieu Hospitalier Universitaire de Bobo-Dioulasso : aspects thérapeutiques et évolutifs. S. J-B. Tougouma, A.A. Yaméogo, A. Dembélé, G. Kinda, N.V. Yaméogo, G.R.C. Millogo, J.K. Kologo, A. Héma, Y. Kambiré, L. Savadogo, M.S. Ouédraogo, P. Zabsonré ...

Diversity of United States medical students by region compared to US census data

Directory of Open Access Journals (Sweden)

Smith MM

2015-05-01

Full Text Available Mark M Smith,1 Steven H Rose,1 Darrell R Schroeder,2 Timothy R Long1 1Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, USA; 2Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, MN, USA Purpose: Increasing the diversity of the United States (US physician workforce to better represent the general population has received considerable attention. The purpose of this study was to compare medical student race data to that of the US general population. We hypothesized that race demographics of medical school matriculants would reflect that of the general population. Patients and methods: Published race data from the United States Census Bureau (USCB 2010 census and the 2011 Association of American Medical Colleges (AAMC allopathic medical school application and enrollment by race and ethnicity survey were analyzed and compared. Race data of enrolled medical students was compared to race data of the general population within geographic regions and subregions. Additionally, race data of medical school applicants and matriculants were compared to race data of the overall general population. Results: Race distribution within US medical schools was significantly different than race distribution for the overall, regional, and subregional populations of the US (P<0.001. Additionally, the overall race distribution of medical school applicants differed significantly to the race distribution of the general population (P<0.001. Conclusion: This study demonstrated that race demographics of US medical school applicants and matriculants are significantly different from that of the general population, and may be resultant of societal quandaries present early in formal education. Initiatives targeting underrepresented minorities at an early stage to enhance health care career interest and provide academic support and mentorship will be required to address the racial disparity that exists in US

Medical staffing in Ontario neonatal intensive care units.

Science.gov (United States)

Paes, B; Mitchell, A; Hunsberger, M; Blatz, S; Watts, J; Dent, P; Sinclair, J; Southwell, D

1989-06-01

Advances in technology have improved the survival rates of infants of low birth weight. Increasing service commitments together with cutbacks in Canadian training positions have caused concerns about medical staffing in neonatal intensive care units (NICUs) in Ontario. To determine whether an imbalance exists between the supply of medical personnel and the demand for health care services, in July 1985 we surveyed the medical directors, head nurses and staff physicians of nine tertiary level NICUs and the directors of five postgraduate pediatric residency programs. On the basis of current guidelines recommending an ideal neonatologist:patient ratio of 1:6 (assuming an adequate number of support personnel) most of the NICUs were understaffed. Concern about the heavy work pattern and resulting lifestyle implications has made Canadian graduates reluctant to enter this subspecialty. We propose strategies to correct staffing shortages in the context of rapidly increasing workloads resulting from a continuing cutback of pediatric residency positions and restrictions on immigration of foreign trainees.

A "Neurological Emergency Trolley" reduces turnaround time for high-risk medications in a general intensive care unit.

Science.gov (United States)

Ajzenberg, Henry; Newman, Paula; Harris, Gail-Anne; Cranston, Marnie; Boyd, J Gordon

2018-02-01

To reduce medication turnaround times during neurological emergencies, a multidisciplinary team developed a neurological emergency crash trolley in our intensive care unit. This trolley includes phenytoin, hypertonic saline and mannitol, as well as other equipment. The aim of this study was to assess whether the cart reduced turnaround times for these medications. In this retrospective cohort study, medication delivery times for two year epochs before and after its implementation were compared. Eligible patients were identified from our intensive care unit screening log. Adults who required emergent use of phenytoin, hypertonic saline or mannitol while in the intensive care unit were included. Groups were compared with nonparametric analyses. 33-bed general medical-surgical intensive care unit in an academic teaching hospital. Time to medication administration. In the pre-intervention group, there were 43 patients with 66 events. In the post-intervention group, there were 45 patients with 80 events. The median medication turnaround time was significantly reduced after implementation of the neurological emergency trolley (25 vs. 10minutes, p=0.003). There was no statistically significant difference in intensive care or 30-day survival between the two cohorts. The implementation of a novel neurological emergency crash trolley in our intensive care unit reduced medication turnaround times. Copyright © 2017 Elsevier Ltd. All rights reserved.

Medication prescribing errors in the medical intensive care unit of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

Science.gov (United States)

Sada, Oumer; Melkie, Addisu; Shibeshi, Workineh

2015-09-16

Medication errors (MEs) are important problems in all hospitalized populations, especially in intensive care unit (ICU). Little is known about the prevalence of medication prescribing errors in the ICU of hospitals in Ethiopia. The aim of this study was to assess medication prescribing errors in the ICU of Tikur Anbessa Specialized Hospital using retrospective cross-sectional analysis of patient cards and medication charts. About 220 patient charts were reviewed with a total of 1311 patient-days, and 882 prescription episodes. 359 MEs were detected; with prevalence of 40 per 100 orders. Common prescribing errors were omission errors 154 (42.89%), 101 (28.13%) wrong combination, 48 (13.37%) wrong abbreviation, 30 (8.36%) wrong dose, wrong frequency 18 (5.01%) and wrong indications 8 (2.23%). The present study shows that medication errors are common in medical ICU of Tikur Anbessa Specialized Hospital. These results suggest future targets of prevention strategies to reduce the rate of medication error.

International students in United States’ medical schools: does the medical community know they exist?

Directory of Open Access Journals (Sweden)

Jashodeep Datta

2012-06-01

Full Text Available Background: Matriculation of international students to United States’ (US medical schools has not mirrored the remarkable influx of these students to other US institutions of higher education. Methods: While these students’ numbers are on the rise, the visibility for their unique issues remains largely ignored in the medical literature. Results: These students are disadvantaged in the medical school admissions process due to financial and immigration-related concerns, and academic standards for admittance also continue to be significantly higher compared with their US-citizen peers. Furthermore, it is simply beyond the mission of many medical schools – both public and private – to support international students’ education, especially since federal, state-allocated or institutional funds are limited and these institutions have a commitment to fulfill the healthcare education needs of qualified domestic candidates. In spite of these obstacles, a select group of international students do gain admission to US medical schools and, upon graduation, are credentialed equally as their US-citizen counterparts by the Accreditation Council for Graduate Medical Education (ACGME. However, owing to their foreign citizenship, these students have visa requirements for post-graduate training that may adversely impact their candidacy for residency placement. Conclusion: By raising such issues, this article aims to increase the awareness of considerations pertinent to this unique population of medical students. The argument is also made to support continued recruitment of international students to US medical schools in spite of these impediments. In our experience, these students are not only qualified to tackle the rigors of a US medical education, but also enrich the cultural diversity of the medical student body. Moreover, these graduates could effectively complement the efforts to augment US physician workforce diversity while contributing to

United States academic medical centers: priorities and challenges amid market transformation.

Science.gov (United States)

Thompson, Irene M; Anason, Barbara

2012-01-01

United States academic medical centers (AMCs) have upheld their long-standing reputation for excellence by teaching and training the next generation of physicians, supporting medical research, providing world-class medical care, and offering breakthrough treatments for highly complex medical cases. In recent years, the pace and direction of change reshaping the American health care industry has created a set of new and profound challenges that AMC leaders must address in order to sustain their institutions. University HealthSystem Consortium (UHC) is an alliance of 116 leading nonprofit academic medical centers and 276 of their affiliated hospitals, all of which are focused on delivering world-class patient care. Formed in 1984, UHC fosters collaboration with and among its members through its renowned programs and services in the areas of comparative data and analytics, performance improvement, supply chain management, strategic research, and public policy. Each year, UHC surveys the executives of its member institutions to understand the issues they view as most critical to sustaining the viability and success of their organizations. The results of UHC's most recent 2011 member survey, coupled with a 2012 Strategic Health Perspectives Harris Interactive presentation, based in parton surveys of major health care industry stakeholders reveal the most important and relevant issues and opportunities that hospital leaders face today, as the United States health care delivery system undergoes a period of unprecedented transformation.

Home iv antibiotic therapy through a medical day care unit

OpenAIRE

Gourdeau, Marie; Deschênes, Louise; Caron, Martine; Desmarais, Marc

1993-01-01

An out-patient parenteral antibiotic therapy program provided through a medical day care unit was evaluated in a tertiary care hospital. From July 11, 1988 to December 31, 1990, 122 patients were treated either on site at the unit or at home with self-administered intravenous antibiotics. In all, 142 courses of parenteral antibiotics (mostly cephalosporins and clindamycin) were given for a total of 124 infections, mostly bone and soft tissue infections (67 of 124, 54%). The duration of out-pa...

Key considerations for the success of Medical Education Research and Innovation units in Canada: unit director perceptions.

Science.gov (United States)

Varpio, Lara; Bidlake, Erin; Humphrey-Murto, Sue; Sutherland, Stephanie; Hamstra, Stanley J

2014-08-01

Growth in the field of medical education is evidenced by the proliferation of units dedicated to advancing Medical Education Research and Innovation (MERI). While a review of the literature discovered narrative accounts of MERI unit development, we found no systematic examinations of the dimensions of and structures that facilitate the success of these units. We conducted qualitative interviews with the directors of 12 MERI units across Canada. Data were analyzed using qualitative description (Sandelowski in Res Nurs Health 23:334-340, 2000). Final analysis drew on Bourdieu's (Outline of a theory of practice. Cambridge University Press, Cambridge, 1977; Media, culture and society: a critical reader. Sage, London, 1986; Language and symbolic power. Harvard University Press, Cambridge, 1991) concepts of field, habitus, and capital, and more recent research investigating the field of MERI (Albert in Acad Med 79:948-954, 2004; Albert et al. in Adv Health Sci Educ 12:103-115, 2007). When asked about the metrics by which they define their success, directors cited: teaching, faculty mentoring, building collaborations, delivering conference presentations, winning grant funding, and disseminating publications. Analyzed using Bourdieu's concepts, these metrics are discussed as forms of capital that have been legitimized in the MERI field. All directors, with the exception of one, described success as being comprised of elements (capital) at both ends of the service-research spectrum (i.e., Albert's PP-PU structure). Our analysis highlights the forms of habitus (i.e., behaviors, attitudes, demeanors) directors use to negotiate, strategize and position the unit within their local context. These findings may assist institutions in developing a new-or reorganizing an existing-MERI unit. We posit that a better understanding of these complex social structures can help units become savvy participants in the MERI field. With such insight, units can improve their academic output and

A Comparative Analysis of Patient Access Modes at Wilford Hall United States Air Force Medical Center and Selected Civilian Medical Centers

Science.gov (United States)

1983-12-01

In A COMPARATIVE ANALYSIS OF PATIENT ACCESS MODES AT WILFORD HALL UNITED STATES AIR FORCE MEDICAL CENTER N AND SELECTED CIVILIAN MEDICAL CENTERS0 N...current patient access modes at WHMC and several civilian medical centers of comparable size. This project has pursued the subject of patient access in...selected civilian medical centers which are comparable to WHMC in size, specialty mix, workload, and mission, providing responsive and efficient patient

Increasing the reactivity of an artificial dithiol-disulfide pair through modification of the electrostatic milieu

DEFF Research Database (Denmark)

Hansen, Rosa E; Østergaard, Henrik; Winther, Jakob R

2005-01-01

K(a) value of Cys149, as well as favorable electrostatic interactions with the negatively charged reagents. The results presented here show that the electrostatic milieu of cysteine thiols in proteins can have substantial effects on the rates of the thiol-disulfide exchange reactions.......The thiol-disulfide exchange reaction plays a central role in the formation of disulfide bonds in newly synthesized proteins and is involved in many aspects of cellular metabolism. Because the thiolate form of the cysteine residue is the key reactive species, its electrostatic milieu is thought...... surface. We have studied properties of vicinal cysteine residues in proteins using a model system based on redox-sensitive yellow fluorescent protein (rxYFP). In this system, the formation of a disulfide bond between two cysteines Cys149 and Cys202 is accompanied by a 2.2-fold decrease in fluorescence...

Hospital-acquired acute kidney injury in medical, surgical, and intensive care unit: A comparative study

Directory of Open Access Journals (Sweden)

T B Singh

2013-01-01

Full Text Available Acute kidney injury (AKI is a common complication in hospitalized patients. There are few comparative studies on hospital-acquired AKI (HAAKI in medical, surgical, and ICU patients. This study was conducted to compare the epidemiological characteristics, clinical profiles, and outcomes of HAAKI among these three units. All adult patients (>18 years of either gender who developed AKI based on RIFLE criteria (using serum creatinine, 48 h after hospitalization were included in the study. Patients of acute on chronic renal failure and AKI in pregnancy were excluded. Incidence of HAAKI in medical, surgical, and ICU wards were 0.54%, 0.72%, and 2.2% respectively ( P < 0.0001. There was no difference in age distribution among the groups, but onset of HAAKI was earliest in the medical ward ( P = 0.001. RIFLE-R was the most common AKI in medical (39.2% and ICU (50% wards but in the surgical ward, it was RIFLE-F that was most common (52.6%. Acute tubular necrosis was more common in ICU ( P = 0.043. Most common etiology of HAAKI in medical unit was drug induced (39.2%, whereas in surgical and ICU, it was sepsis (34% and 35.2% respectively. Mortality in ICU, surgical and medical units were 73.5%, 43.42%, and 37.2%, respectively ( P = 0.003. Length of hospital stay in surgical, ICU and medical units were different ( P = 0.007. This study highlights that the characters of HAAKI are different in some aspects among different hospital settings.

3D web based learning of medical equipment employed in intensive care units.

Science.gov (United States)

Cetin, Aydın

2012-02-01

In this paper, both synchronous and asynchronous web based learning of 3D medical equipment models used in hospital intensive care unit have been described over the moodle course management system. 3D medical equipment models were designed with 3ds Max 2008, then converted to ASE format and added interactivity displayed with Viewpoint-Enliven. 3D models embedded in a web page in html format with dynamic interactivity-rotating, panning and zooming by dragging a mouse over images-and descriptive information is embedded to 3D model by using xml format. A pilot test course having 15 h was applied to technicians who is responsible for intensive care unit at Medical Devices Repairing and Maintenance Center (TABOM) of Turkish High Specialized Hospital.

The 'valuation milieu': Toward a territorial approach to sustainability transitions

International Nuclear Information System (INIS)

Huguenin, Ariane

2017-01-01

During the last decade research in Transition Studies has highlighted the complex and multidimensional dynamics involved in the transformation towards new socio-technical regimes of sustainable development. However, existing analysis have often neglected the territorial dimension of such transformations. To deal more explicitly with this dimension, this article proposes the concept of 'milieu valuateur'. Through a case analysis in the field of energy in the Swiss municipality of Neuchatel, this article illustrates how the reterritorialization of productive capacities at a city scale enables to reconstruct a higher value through demonstration

Das unsichtbare neue Zeitalter : "New Age", privatisierte Religion und kultisches Milieu

OpenAIRE

Knoblauch, Hubert

1989-01-01

As modernity is usually called disenchanted, new religious movements, New Age and occultism are taken to mark a u-turn in the social development of religion. They are regarded as indicators of a "postmodern" religion. It is suggested that these movements follow the pattern of the invisible religion observed by Thomas Luckmann in the 1960s. They are syncretistic and individualistic as an "esoteric culture"; their structure, the "cultic milieu", can be characterized by a low degree of...

[Medical short stay unit for geriatric patients in the emergency department: clinical and healthcare benefits].

Science.gov (United States)

Pareja, Teresa; Hornillos, Mercedes; Rodríguez, Miriam; Martínez, Javier; Madrigal, María; Mauleón, Coro; Alvarez, Bárbara

2009-01-01

To evaluate the impact of comprehensive geriatric assessment and management of high-risk elders in a medical short stay unit located in the emergency department of a general hospital. We performed a descriptive, prospective study of patients admitted to the medical short stay unit for geriatric patients of the emergency department in 2006. A total of 749 patients were evaluated, with a mean (standard deviation) stay in the unit of 37 (16) h. The mean age was 86 (7) years; 57% were women, and 50% had moderate-severe physical impairment and dementia. Thirty-five percent lived in a nursing home. The most frequent reason for admission was exacerbation of chronic cardiopulmonary disease. Multiple geriatric syndromes were identified. The most frequent were immobility, pressure sores and behavioral disorders related to dementia. Seventy percent of the patients were discharged to home after being stabilized and were followed-up by the geriatric clinic and day hospital (39%), the home care medical team (11%), or the nursing home or primary care physician (20%). During the month after discharge, 17% were readmitted and 7.7% died, especially patients with more advanced age or functional impairment. After the unit was opened, admissions to the acute geriatric unit fell by 18.2%. Medical short stay units for geriatric patients in emergency departments may be useful for geriatric assessment and treatment of exacerbations of chronic diseases. These units can help to reduce the number of admissions and optimize the care provided in other ambulatory and domiciliary geriatric settings.

Impact of Milieu Teaching on Communication Skills of Young Children with Autism Spectrum Disorder

Science.gov (United States)

Christensen-Sandfort, Robyn J.; Whinnery, Stacie B.

2013-01-01

This 5-month study examined the impact of a behaviorally based naturalistic teaching strategy, milieu teaching, on the communication skills of preschool-aged children with Autism Spectrum Disorder (ASD) in an early childhood special education (ECSE) classroom. A multiple baseline across participants design was used. Communication targets were…

Dragons and Dinosaurs: Directing Inquiry in Biology Using the Notions of "Milieu" and "Validation"

Science.gov (United States)

Achiam, Marianne; Solberg, Jan; Evans, Robert

2013-01-01

This article describes how inquiry teaching can be directed towards specific content learning goals while allowing for student exploration and validation of hypotheses. Drawing from the Theory of Didactical Situations, the concepts of "milieu" and "validation" are illustrated through two sample biology lessons designed to engage and challenge…

Radiological emergency response in a medical waste treatment unit

Energy Technology Data Exchange (ETDEWEB)

Suzuki, Fabio F.; Boni-Mitake, Malvina; Vianna, Estanislau B.; Nicolau, Jose R.A.; Rodrigues, Demerval L. [Instituto de Pesquisas Energeticas e Nucleares (IPEN), Sao Paulo, SP (Brazil)

2000-07-01

Radioactive materials are largely used in medicine, research and industry. The amount of radioactive material employed in each application varies from negligible to large and it can be in sealed or non-sealed form. A medical waste treatment unit that deals only with A-type medical waste (ABNT-NBR 12808), which does not include radioactive waste, detected abnormal radiation levels in a collecting truck and the IPEN-CNEN/SP Nuclear and Radiological Emergency Response Team was called. The presence of radioactive material inside the truck was confirmed; however, its origin and nature were not possible to be determined because the truck had collected medical waste in several facilities. So, an operation in order to segregate and identify that material was carried out. During the operation, a second collecting truck presenting abnormal radiation levels arrived to the unit and the same procedure was carried out on that truck. In both situations, the contaminated objects found were infantile diapers. The radioactive waste was transported to IPEN-CNEN/SP to be managed. Samples of the radioactive materials were submitted to gamma spectrometry and the radionuclide was identified as Iodine-131. Since that attendance, similar occurrences have been frequent. These events suggest that it is necessary a better control of the radioactive waste at the generating facilities and there should be basic radioprotection orientations to the discharging patients that were submitted to nuclear medicine procedures. (author)

Radiological emergency response in a medical waste treatment unit

International Nuclear Information System (INIS)

Suzuki, Fabio F.; Boni-Mitake, Malvina; Vianna, Estanislau B.; Nicolau, Jose R.A.; Rodrigues, Demerval L.

2000-01-01

Radioactive materials are largely used in medicine, research and industry. The amount of radioactive material employed in each application varies from negligible to large and it can be in sealed or non-sealed form. A medical waste treatment unit that deals only with A-type medical waste (ABNT-NBR 12808), which does not include radioactive waste, detected abnormal radiation levels in a collecting truck and the IPEN-CNEN/SP Nuclear and Radiological Emergency Response Team was called. The presence of radioactive material inside the truck was confirmed; however, its origin and nature were not possible to be determined because the truck had collected medical waste in several facilities. So, an operation in order to segregate and identify that material was carried out. During the operation, a second collecting truck presenting abnormal radiation levels arrived to the unit and the same procedure was carried out on that truck. In both situations, the contaminated objects found were infantile diapers. The radioactive waste was transported to IPEN-CNEN/SP to be managed. Samples of the radioactive materials were submitted to gamma spectrometry and the radionuclide was identified as Iodine-131. Since that attendance, similar occurrences have been frequent. These events suggest that it is necessary a better control of the radioactive waste at the generating facilities and there should be basic radioprotection orientations to the discharging patients that were submitted to nuclear medicine procedures. (author)

Organizational effects on patient satisfaction in hospital medical-surgical units.

Science.gov (United States)

Bacon, Cynthia Thornton; Mark, Barbara

2009-05-01

The purpose of this study was to examine the relationships between hospital context, nursing unit structure, and patient characteristics and patients' satisfaction with nursing care in hospitals. Although patient satisfaction has been widely researched, our understanding of the relationship between hospital context and nursing unit structure and their impact on patient satisfaction is limited. The data source for this study was the Outcomes Research in Nursing Administration Project, a multisite organizational study conducted to investigate relationships among nurse staffing, organizational context and structure, and patient outcomes. The sample for this study was 2,720 patients and 3,718 RNs in 286 medical-surgical units in 146 hospitals. Greater availability of nursing unit support services and higher levels of work engagement were associated with higher levels of patient satisfaction. Older age, better health status, and better symptom management were also associated with higher levels of patient satisfaction. Organizational factors in hospitals and nursing units, particularly support services on the nursing unit and mechanisms that foster nurses' work engagement and effective symptom management, are important influences on patient satisfaction.

Philippos Monotropos' Dioptra and its Social Milieu: Niketas Stethatos, Nikolaos III Grammatikos and the Persecution of Bogomilism

Directory of Open Access Journals (Sweden)

Eirini Afentoulidou-Leitgeb

2012-11-01

Full Text Available This article aims to investigate the social milieu of Philippos Monotropos, author of the Dioptra. Explicit evidence on Philippos is scarce, but the comparison with contemporary texts allows some conclusions. Indeed, the way that Philippos treats Bogomilism indicates connections with imperial and patriarchal circles. Moreover, numerous parallels between the Dioptra and the Poem on Fast Days written by Nikolaos III Grammatikos shows that the Patriarch knew and ap­preciated the Dioptra very soon after its composition. The hypothesis that Philip­pos belonged to an educated, urbane ecclesiastical milieu is in accordance with the assessment of the Dioptra as a simplistic epitome of Christian humanistic theology – contrary to previous views that overemphasised its ascetic element.

Characteristics of HIV-Positive Transgender Men Receiving Medical Care: United States, 2009-2014.

Science.gov (United States)

Lemons, Ansley; Beer, Linda; Finlayson, Teresa; McCree, Donna Hubbard; Lentine, Daniel; Shouse, R Luke

2018-01-01

To present the first national estimate of the sociodemographic, clinical, and behavioral characteristics of HIV-positive transgender men receiving medical care in the United States. This analysis included pooled interview and medical record data from the 2009 to 2014 cycles of the Medical Monitoring Project, which used a 3-stage, probability-proportional-to-size sampling methodology. Transgender men accounted for 0.16% of all adults and 11% of all transgender adults receiving HIV medical care in the United States from 2009 to 2014. Of these HIV-positive transgender men receiving medical care, approximately 47% lived in poverty, 69% had at least 1 unmet ancillary service need, 23% met criteria for depression, 69% were virally suppressed at their last test, and 60% had sustained viral suppression over the previous 12 months. Although they constitute a small proportion of all HIV-positive patients, more than 1 in 10 transgender HIV-positive patients were transgender men. Many experienced socioeconomic challenges, unmet needs for ancillary services, and suboptimal health outcomes. Attention to the challenges facing HIV-positive transgender men may be necessary to achieve the National HIV/AIDS Strategy goals of decreasing disparities and improving health outcomes among transgender persons.

Medical abortion practices : a survey of National Abortion Federation members in the United States

NARCIS (Netherlands)

Wiegerinck, Melanie M. J.; Jones, Heidi E.; O'Connell, Katharine; Lichtenberg, E. Steve; Paul, Maureen; Westhoff, Carolyn L.

2008-01-01

Background: Little is known about clinical implementation of medical abortion in the United States following approval of mifepristone as an abortifacient by the Food and Drug Administration (FDA) in 2000. We collected information regarding medical abortion practices of National Abortion Federation

The United States facing their petroleum dependence

International Nuclear Information System (INIS)

Noel, P.

2002-06-01

In the framework of ''the energy crisis of 2000-2001'', the Cheney report and the petroleum dependence, this study presents a critical examination of the United States petroleum situation, its perception in the american political milieu and the public policies implementing during the last ten years. The first section is devoted to the petroleum supply. In the second section, the american petroleum policy and the energy safety are studied. (A.L.B.)

[Cases of acute poisoning admitted to a medical intensive care unit].

Science.gov (United States)

Viertel, A; Weidmann, E; Brodt, H R

2001-10-19

Because of the paucity of information on the epidemiology of acute poisoning requiring intensive medical care, all such patients treated on the medical intensive care unit of the university hospital in Frankfurt am Main, Germany, between January 1993 and December 1999, were retrospectively evaluated. Of the total of 6211 patients, 147 (80 women, 67 men, mean age 41 years, 2,3 %) were treated for acute intoxication in the intensive care unit. Reasons for admission to the intensive care unit were the need for ventilator treatment or intensive monitoring of vital functions. 52 % of the patients (n = 76) had attempted suicide, most of them using anti-depressive drugs (n = 19), paracetamol (n = 16), or benzodiazepines (n = 9). Two patients (2,6 %) died. 48 % of the patients (n = 71) were admitted because of accidental poisoning. Leading toxic agents in this group were heroin (n = 19), alcohol (n = 18) and digitalis (n = 12). 11 patients had taken herbicides, animal poisons or chemicals used at work or for house cleaning. In this cohort, three i. v. drug abusers (4,2 %) had died. Depending on the agents used, a variety of treatments (charcoal, antidots, extracorporal therapy) were undertaken. Due to excellent care in the prehospital phase and in the emergency room the number of patients requiring treatment on the intensive care unit was rather low. The mortality was in the range of other reports.

Medical abortion practices: a survey of National Abortion Federation members in the United States

NARCIS (Netherlands)

Wiegerinck, Melanie M. J.; Jones, Heidi E.; O'Connell, Katharine; Lichtenberg, E. Steve; Paul, Maureen; Westhoff, Carolyn L.

2008-01-01

Little is known about clinical implementation of medical abortion in the United States following approval of mifepristone as an abortifacient by the Food and Drug Administration (FDA) in 2000. We collected information regarding medical abortion practices of National Abortion Federation (NAF) members

Evaluation of medication errors with implementation of electronic health record technology in the medical intensive care unit

Directory of Open Access Journals (Sweden)

Liao TV

2017-05-01

Full Text Available T Vivian Liao,1 Marina Rabinovich,2 Prasad Abraham,2 Sebastian Perez,3 Christiana DiPlotti,4 Jenny E Han,5 Greg S Martin,5 Eric Honig5 1Department of Pharmacy Practice, College of Pharmacy, Mercer Health Sciences Center, 2Department of Pharmacy and Clinical Nutrition, Grady Health System, 3Department of Surgery, Emory University, 4Pharmacy, Ingles Markets, 5Department of Medicine, Emory University, Atlanta, GA, USA Purpose: Patients in the intensive care unit (ICU are at an increased risk for medication errors (MEs and adverse drug events from multifactorial causes. ME rate ranges from 1.2 to 947 per 1,000 patient days in the medical ICU (MICU. Studies with the implementation of electronic health records (EHR have concluded that it significantly reduced overall prescribing errors and the number of errors that caused patient harm decreased. However, other types of errors, such as wrong dose and omission of required medications increased after EHR implementation. We sought to compare the number of MEs before and after EHR implementation in the MICU, with additional evaluation of error severity.Patients and methods: Prospective, observational, quality improvement study of all patients admitted to a single MICU service at an academic medical center. Patients were evaluated during four periods over 2 years: August–September 2010 (preimplementation; period I, January–February 2011 (2 months postimplementation; period II, August–September 2012 (21 months postimplementation; period III, and January–February 2013 (25 months postimplementation; period IV. All medication orders and administration records were reviewed by an ICU clinical pharmacist and ME was defined as a deviation from established standards for prescribing, dispensing, administering, or documenting medication. The frequency and classification of MEs were compared between groups by chi square; p<0.05 was considered significant.Results: There was a statistically significant increase

A description of medication errors reported by pharmacists in a neonatal intensive care unit.

Science.gov (United States)

Pawluk, Shane; Jaam, Myriam; Hazi, Fatima; Al Hail, Moza Sulaiman; El Kassem, Wessam; Khalifa, Hanan; Thomas, Binny; Abdul Rouf, Pallivalappila

2017-02-01

Background Patients in the Neonatal Intensive Care Unit (NICU) are at an increased risk for medication errors. Objective The objective of this study is to describe the nature and setting of medication errors occurring in patients admitted to an NICU in Qatar based on a standard electronic system reported by pharmacists. Setting Neonatal intensive care unit, Doha, Qatar. Method This was a retrospective cross-sectional study on medication errors reported electronically by pharmacists in the NICU between January 1, 2014 and April 30, 2015. Main outcome measure Data collected included patient information, and incident details including error category, medications involved, and follow-up completed. Results A total of 201 NICU pharmacists-reported medication errors were submitted during the study period. All reported errors did not reach the patient and did not cause harm. Of the errors reported, 98.5% occurred in the prescribing phase of the medication process with 58.7% being due to calculation errors. Overall, 53 different medications were documented in error reports with the anti-infective agents being the most frequently cited. The majority of incidents indicated that the primary prescriber was contacted and the error was resolved before reaching the next phase of the medication process. Conclusion Medication errors reported by pharmacists occur most frequently in the prescribing phase of the medication process. Our data suggest that error reporting systems need to be specific to the population involved. Special attention should be paid to frequently used medications in the NICU as these were responsible for the greatest numbers of medication errors.

Culture and medical decision making: Healthcare consumer perspectives in Japan and the United States.

Science.gov (United States)

Alden, Dana L; Friend, John M; Lee, Angela Y; de Vries, Marieke; Osawa, Ryosuke; Chen, Qimei

2015-12-01

Two studies identified core value influences on medical decision-making processes across and within cultures. In Study 1, Japanese and American adults reported desired levels of medical decision-making influence across conditions that varied in seriousness. Cultural antecedents (interdependence, independence, and power distance) were also measured. In Study 2, American adults reviewed a colorectal cancer screening decision aid. Decision preparedness was measured along with interdependence, independence, and desire for medical information. In Study 1, higher interdependence predicted stronger desire for decision-making information in both countries, but was significantly stronger in Japan. The path from information desire to decision-making influence desire was significant only in Japan. The independence path to desire for decision-making influence was significant only in the United States. Power distance effects negatively predicted desire for decision-making influence only in the United States. For Study 2, high (low) interdependents and women (men) in the United States felt that a colorectal cancer screening decision aid helped prepare them more (less) for a medical consultation. Low interdependent men were at significantly higher risk for low decision preparedness. Study 1 suggests that Japanese participants may tend to view medical decision-making influence as an interdependent, information sharing exchange, whereas American respondents may be more interested in power sharing that emphasizes greater independence. Study 2 demonstrates the need to assess value influences on medical decision-making processes within and across cultures and suggests that individually tailored versions of decision aids may optimize decision preparedness. (c) 2015 APA, all rights reserved).

Individual and work-unit measures of psychological demands and decision latitude and the use of antihypertensive medication

DEFF Research Database (Denmark)

Daugaard, S; Andersen, J H; Grynderup, Matias Brødsgaard

2015-01-01

were associated with the purchase of prescribed antihypertensive medication among women. This effect was present on both the work-unit and the individual level. Among men there were no associations. The lack of interaction between psychological demands and decision latitude did not support the job......PURPOSE: To analyse whether psychological demands and decision latitude measured on individual and work-unit level were related to prescription of antihypertensive medication. METHODS: A total of 3,421 women and 897 men within 388 small work units completed a questionnaire concerning psychological...... working conditions according to the job strain model. Mean levels of psychological demands and decision latitude were computed for each work unit to obtain exposure measures that were less influenced by reporting bias. Dispensed antihypertensive medication prescriptions were identified in The Danish...

Educational gradients in psychotropic medication use among older adults in Costa Rica and the United States.

Science.gov (United States)

Domino, Marisa Elena; Dow, William H; Coto-Yglesias, Fernando

2014-10-01

The relationship of education, psychiatric diagnoses, and use of psychotropic medication has been explored in the United States, but little is known about this relationship in poorer countries, despite the high burden of mental illness in these countries. This study estimated educational gradients in diagnosis and psychotropic drug use in the United States and Costa Rica, a middle-income country with universal health insurance. Analyses were conducted by using data of older adults (≥60) from the 2005 U.S. Medical Expenditure Panel Survey (N=4,788) and the 2005 Costa Rican Longevity and Healthy Aging Study (N=2,827). Logistic regressions examined the effect of education level (low, medium, or high) and urban residence on the rates of self-reported mental health diagnoses, screening diagnosis, and psychotropic medication use with and without an associated psychiatric diagnosis. Rates of self-reported diagnoses were lower in the United States (12%) than in Costa Rica (20%), possibly reflecting differences in survey wording. In both countries, the odds of having depression were significantly lower among persons with high education. In Costa Rica, use of psychotropic medication among persons with self-reported diagnoses increased by education level. The educational gradients in medication use were different in the United States and Costa Rica, and stigma and access to care in these countries may play an important role in these differences, although type of insurance did not affect educational gradients in the United States. These analyses increase the evidence of the role of education in use of the health care system.

Acute medical assessment units: an efficient alternative to in-hospital acute medical care.

LENUS (Irish Health Repository)

Watts, M

2011-02-01

Acute Medical Assessment Units (AMAUs) are being proposed as an alternative to congested Emergency Departments (EDs for the assessment of patients with a range of acute medical problems. We retrospectively reviewed the discharge destination of patients referred to a newly established AMAU during a six-month period. During the same period we contrasted activity in the ED for a similar group of patients. 1,562 patients were assessed in the AMAU. 196 (12.5%) were admitted to an in-patient bed and 1,148 (73.5%) were entered into specific diagnosis-driven out-patient pathways. 1,465 patients attended the ED and 635 (43.3%) were admitted. Out-patient alternatives to expensive in-patient care need to be provided at the \\'coal face" of acute referral. The AMAU provides this, and as a consequence admission rates are relatively low. This is achieved by directly communicating with GPs, accessing senior clinical decision makers, and providing immediate access to diagnostically driven outpatient pathways.

Association of medication errors with drug classifications, clinical units, and consequence of errors: Are they related?

Science.gov (United States)

Muroi, Maki; Shen, Jay J; Angosta, Alona

2017-02-01

Registered nurses (RNs) play an important role in safe medication administration and patient safety. This study examined a total of 1276 medication error (ME) incident reports made by RNs in hospital inpatient settings in the southwestern region of the United States. The most common drug class associated with MEs was cardiovascular drugs (24.7%). Among this class, anticoagulants had the most errors (11.3%). The antimicrobials was the second most common drug class associated with errors (19.1%) and vancomycin was the most common antimicrobial that caused errors in this category (6.1%). MEs occurred more frequently in the medical-surgical and intensive care units than any other hospital units. Ten percent of MEs reached the patients with harm and 11% reached the patients with increased monitoring. Understanding the contributing factors related to MEs, addressing and eliminating risk of errors across hospital units, and providing education and resources for nurses may help reduce MEs. Copyright © 2016 Elsevier Inc. All rights reserved.

Medical tourism services available to residents of the United States.

Science.gov (United States)

Alleman, Brandon W; Luger, Tana; Reisinger, Heather Schacht; Martin, Rene; Horowitz, Michael D; Cram, Peter

2011-05-01

There are growing reports of United States (US) residents traveling overseas for medical care, but empirical data about medical tourism are limited. To characterize the businesses and business practices of entities promoting medical tourism and the types and costs of procedures being offered. DESIGN, PARTICIPANTS, AND OUTCOMES: Between June and August 2008, we conducted a telephone survey of all businesses engaged in facilitating overseas medical travel for US residents. We collected information from each company including: the number of employees; number of patients referred overseas; medical records security processes; destinations to which patients were referred; treatments offered; treatment costs; and whether patient outcomes were collected. We identified 63 medical tourism companies and 45 completed our survey (71%). Companies had a mean of 9.8 employees and had referred an average of 285 patients overseas (a total of approximately 13,500 patients). 35 (79%) companies reported requiring accreditation of foreign providers, 22 (50%) collected patient outcome data, but only 17 (39%) described formal medical records security policies. The most common destinations were India (23 companies, 55%), Costa Rica (14, 33%), and Thailand (12, 29%). The most common types of care included orthopedics (32 companies, 73%), cardiac care (23, 52%), and cosmetic surgery (29, 66%). 20 companies (44%) offered treatments not approved for use in the US--most commonly stem cell therapy. Average costs for common procedures, CABG ($18,600) and knee arthroplasty ($10,800), were similar to previous reports. The number of Americans traveling overseas for medical care with assistance from medical tourism companies is relatively small. Attention to medical records security and patient outcomes is variable and cost-savings are dependent on US prices. That said, overseas medical care can be a reasonable alternative for price sensitive patients in need of relatively common, elective medical

Medical review practices for driver licensing volume 3: guidelines and processes in the United States.

Science.gov (United States)

2017-04-01

This is the third of three reports examining driver medical review practices in the United States and how : they fulfill the basic functions of identifying, assessing, and rendering licensing decisions on medically or : functionally at-risk drivers. ...

Aspects of medical migration with particular reference to the United Kingdom and the Netherlands

NARCIS (Netherlands)

Herfs, Paulus

2014-01-01

Background In most countries of the European Economic Area (EEA), there is no large-scale migration of medical graduates with diplomas obtained outside the EEA, which are international medical graduates (IMGs). In the United Kingdom however, health care is in part dependent on the influx of IMGs. In

Psychiatry residents in a milieu participatory democracy: a resident's view.

Science.gov (United States)

Gersten, D

1978-11-01

Psychiatry residents respond with a variety of coping mechanisms to the lack of traditional structure in a milieu participatory democracy. To incorporate themselves into the system they must accept such democratic ideals as equality among staff and patients, group decision making, and free self-expression and give up some of their traditional ideas about staff and patient roles, treatment modalities, and the therapeutic environment. The author was a first-year resident in psychiatry on a university hospital inpatient therapeutic community; he discusses the conflicts between residents, who often adopt a "we-they" attitude, and the permanent staff, whose protectiveness of the ward community reflects their personal commitment to its ideals.

Cross-cultural medical education in the United States: key principles and experiences.

Science.gov (United States)

Betancourt, Joseph R; Cervantes, Marina C

2009-09-01

The field of cross-cultural care focuses on the ability to communicate effectively and provide quality health care to patients from diverse sociocultural backgrounds. In recent years, medical schools in the United States have increasingly recognized the growing importance of incorporating cross-cultural curricula into medical education. Cross-cultural medical education in the United States has emerged for four reasons: (1) the need for providers to have the skills to care for a diverse patient population; (2) the link between effective communication and health outcomes; (3) the presence of racial/ethnic disparities that are, in part, due to poor communication across cultures; and (4) medical school accreditation requirements. There are three major approaches to cross-cultural education: (1) the cultural sensitivity/awareness approach that focuses on attitudes; (2) the multicultural/categorical approach that focuses on knowledge; and (3) the cross-cultural approach that focuses on skills. The patient-based approach to cross-cultural care combines these three concepts into a framework that can be used to care for any patient, anytime, anywhere. Ultimately, if cross-cultural medical education is to evolve, students must believe it is important and understand that the categorical approach can lead to stereotyping; it should be taught using patient cases and highlighting clinical applications; it should be embedded in a longitudinal, developmentally appropriate fashion; and it should be integrated into the larger curriculum whenever possible. At the Harvard Medical School, we have tried to apply all of these lessons to our work, and we have started to develop a strategic integration process where we try to raise awareness, impart knowledge, and teach cross-cultural skills over the 4 years of schooling.

Patients' family satisfaction with needs met at the medical intensive care unit.

Science.gov (United States)

Khalaila, Rabia

2013-05-01

The current study investigated the perceived importance and the perceived met needs of family members in the medical intensive care unit and assessed family members' satisfaction with needs met. Studies conducted throughout the world over the past 30 years indicate that family needs are still neglected. Unmet needs of family members of patients in the intensive care unit lead to dissatisfaction with care. A cross-sectional study. A total of 70 family members of critically ill patients were included in this study conducted in a medical intensive care unit in Israel between October 2007-September 2008, using a structured interview. Three outcomes measured by the Family Satisfaction in the Intensive Care Unit Inventory were regressed separately for baseline variables and family needs met subscales as measured by the Critical Care Family Needs Inventory. Multivariate linear regression analysis was used to detect factors that could have predicted each outcome. The results showed differences between the perceived importance and the perceived met needs of family members. Satisfaction with care was positively related to meeting all needs domains except the information need. However, satisfaction with information and decision-making was related only to meeting information and emotional support needs. Continued unmet needs of family members of intensive care unit patients have a negative impact on family satisfaction. Only sweeping changes in clinical practice will succeed in meeting the unmet needs of patients' families. © 2012 Blackwell Publishing Ltd.

Social Milieu Oriented Routing: A New Dimension to Enhance Network Security in WSNs.

Science.gov (United States)

Liu, Lianggui; Chen, Li; Jia, Huiling

2016-02-19

In large-scale wireless sensor networks (WSNs), in order to enhance network security, it is crucial for a trustor node to perform social milieu oriented routing to a target a trustee node to carry out trust evaluation. This challenging social milieu oriented routing with more than one end-to-end Quality of Trust (QoT) constraint has proved to be NP-complete. Heuristic algorithms with polynomial and pseudo-polynomial-time complexities are often used to deal with this challenging problem. However, existing solutions cannot guarantee the efficiency of searching; that is, they can hardly avoid obtaining partial optimal solutions during a searching process. Quantum annealing (QA) uses delocalization and tunneling to avoid falling into local minima without sacrificing execution time. This has been proven a promising way to many optimization problems in recently published literatures. In this paper, for the first time, with the help of a novel approach, that is, configuration path-integral Monte Carlo (CPIMC) simulations, a QA-based optimal social trust path (QA_OSTP) selection algorithm is applied to the extraction of the optimal social trust path in large-scale WSNs. Extensive experiments have been conducted, and the experiment results demonstrate that QA_OSTP outperforms its heuristic opponents.

Patterns of Daily Costs Differ for Medical and Surgical Intensive Care Unit Patients.

Science.gov (United States)

Gershengorn, Hayley B; Garland, Allan; Gong, Michelle N

2015-12-01

Published studies suggest hospital costs on Day 1 in the intensive care unit (ICU) far exceed those of subsequent days, when costs are relatively stable. Yet, no study stratified patients by ICU type. To determine whether daily cost patterns differ by ICU type. We performed a retrospective study of adults admitted to five ICUs (two surgical: quaternary surgical ICU [SICU quat] and quaternary cardiac surgical ICU [CSICU quat]; two medical: tertiary medical ICU [MICU tertiary] and quaternary medical ICU [MICU quat]; one general: community medical surgical ICU [MSICU comm]) at Montefiore Medical Center in the Bronx, New York during 2013. After excluding costs clearly accrued outside the ICU, daily hospital costs were merged with clinical data. Patterns of daily unadjusted costs were evaluated in each ICU using median regression. Generalized estimating equations with first-order autocorrelation were used to identify factors independently associated with daily costs. Unadjusted daily costs were higher on Day 1 than on subsequent days only for surgical ICUs-SICU quat (median [interquartile range], $2,636 [$1,834-$4,282] on Day 1 vs. $1,840 [$1,501-$2,332] on Day 2; P cost from Days 1 to 2. After multivariate adjustment, there remained a significant decrease in cost from ICU Day 1 to 2 in surgical units with statistically similar Day 1 and 2 costs for other ICUs. Higher Day 1 costs are not seen in patients admitted to medical/nonsurgical ICUs.

Changing concepts of neuroanatomy teaching in medical education.

Science.gov (United States)

Hazelton, Lara

2011-10-01

Anatomy teaching is often described as foundational in the education of physicians, but in recent years there has been increasing pressure on teachers of neuroanatomy to justify its place in the curriculum. This article examines theoretical assumptions that have traditionally influenced the neuroanatomy curriculum and explains how evolution of thought in the field of medical education has led to a shift in how the pedagogy of neuroanatomy is conceptualized. The widespread adoption of competency-based education, the emphasis on outcome-based objectives, patient- and learner-centered approaches, and a renewed interest in humanistic aspects of medical education have all contributed to a changing educational milieu. These changes have led to a number of curricular innovations. However, questions remain as to what should be taught to medical learners, and how best to teach it.

Special Needs Dentistry: Interdisciplinary Management of Medically-Complex Patients at Hospital-Based Dental Units in Tasmania, Australia

Directory of Open Access Journals (Sweden)

Lim

2017-06-01

Full Text Available Background: Increasing awareness of the interactions between oral and general health has led to the establishment of Special Needs Dentistry as a dental specialty in many countries. This specialty assists with the interdisciplinary management of patients between the medical and dental professions particularly those with complex medical problems, intellectual and physical impairments, and psychiatric conditions that may affect their oral health or the manner in which they receive treatment. However, little is known about the utilisation of specialised services provided to facilitate individuals with these needs. Aim: The aim of this study was to understand current utilisation of hospital-based dental services established to provide medically-necessary dental care. Methods: A retrospective review of the demographics and medical status of patients treated at referral hospital-based dental clinics in the state of Tasmania was completed for the month of August 2015. Results: Patients treated at these units had a variety of medical backgrounds. Most (46.4% were referred from medical professionals within the hospital. On average, patients treated at these units had 2.56 medical conditions and were taking 3.59 medications each. Many of these were chronic medical conditions known to have an interaction with oral health. Conclusions: Our results demonstrate the growing recognition of dynamic interactions between oral and general health and the importance of these hospitalbased units and interprofessional relationships in providing timely and holistic health care to these patients.

Behavioral Management Leads to Reduction in Aggression in a Child and Adolescent Psychiatric Inpatient Unit

Science.gov (United States)

Dean, Angela J.; Duke, Suzanne G.; George, Michelle; Scott, James

2007-01-01

Objective: Aggression is common in children and adolescents admitted to psychiatric inpatient units. Few interventions for reducing aggressive behaviors have been identified. This study aimed to evaluate the impact of a milieu-based behavioral management program on the frequency of aggressive behaviors in a child and adolescent mental health…

Facilitated Nurse Medication-Related Event Reporting to Improve Medication Management Quality and Safety in Intensive Care Units.

Science.gov (United States)

Xu, Jie; Reale, Carrie; Slagle, Jason M; Anders, Shilo; Shotwell, Matthew S; Dresselhaus, Timothy; Weinger, Matthew B

Medication safety presents an ongoing challenge for nurses working in complex, fast-paced, intensive care unit (ICU) environments. Studying ICU nurse's medication management-especially medication-related events (MREs)-provides an approach to analyze and improve medication safety and quality. The goal of this study was to explore the utility of facilitated MRE reporting in identifying system deficiencies and the relationship between MREs and nurses' work in the ICUs. We conducted 124 structured 4-hour observations of nurses in three different ICUs. Each observation included measurement of nurse's moment-to-moment activity and self-reports of workload and negative mood. The observer then obtained MRE reports from the nurse using a structured tool. The MREs were analyzed by three experts. MREs were reported in 35% of observations. The 60 total MREs included four medication errors and seven adverse drug events. Of the 49 remaining MREs, 65% were associated with negative patient impact. Task/process deficiencies were the most common contributory factor for MREs. MRE occurrence was correlated with increased total task volume. MREs also correlated with increased workload, especially during night shifts. Most of these MREs would not be captured by traditional event reporting systems. Facilitated MRE reporting provides a robust information source about potential breakdowns in medication management safety and opportunities for system improvement.

Otolaryngology in the medical school curriculum: Current trends in the United States.

Science.gov (United States)

Boscoe, Elizabeth F; Cabrera-Muffly, Cristina

2017-02-01

To identify trends in medical school otolaryngology curriculum requirements. Survey of United States allopathic medical schools. A survey was sent to deans of curriculum at allopathic medical schools. We identified opportunities for medical students to learn basic concepts in otolaryngology during their undergraduate medical training. The opportunities were classified into preclinical and clinical as well as elective and mandatory rotations. Of the schools surveyed, 60% responded. Mean class size was 149 students. Sixty-eight percent of surveyed schools noted that 75% to 100% of their students participated in preclinical otolaryngology experiences, with 59% reporting a mandatory preclinical otolaryngology module for all students. Eighty-nine percent of schools offered otolaryngology as a clinical elective rotation, with a mean of 12 students participating yearly. Only 7% of schools required a mandatory otolaryngology clinical rotation. Our data suggest that medical students do not receive sufficient exposure to otolaryngology during medical school. Increased requirements for otolaryngology curriculum may be beneficial to all medical students, regardless of their specialty choice. NA. Laryngoscope, 00:000-000, 2016 127:346-348, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

On the scene: American University of Beirut Medical Center, Beirut, Lebanon.

Science.gov (United States)

Mouro, Gladys; Tashjian, Hera; Daaboul, Tania; Kozman, Katia; Alwan, Farah; Shamoun, Anthony

2011-01-01

American University of Beirut Medical Center is the first Magnet hospital in the Middle East. In this article, authors reflect back on the journey to excellence, specifically in establishing shared governance in a challenging cultural and organizational milieu. Perspectives from nurses at different levels are included to highlight their experiences throughout the journey. Evolution of the organization's shared governance model is described and initiatives of the councils are illustrated.

The Effect of Geographic Units of Analysis on Measuring Geographic Variation in Medical Services Utilization

Directory of Open Access Journals (Sweden)

Agnus M. Kim

2016-07-01

Full Text Available Objectives: We aimed to evaluate the effect of geographic units of analysis on measuring geographic variation in medical services utilization. For this purpose, we compared geographic variations in the rates of eight major procedures in administrative units (districts and new areal units organized based on the actual health care use of the population in Korea. Methods: To compare geographic variation in geographic units of analysis, we calculated the age–sex standardized rates of eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee-replacement surgery, caesarean section, hysterectomy, computed tomography scan, and magnetic resonance imaging scan from the National Health Insurance database in Korea for the 2013 period. Using the coefficient of variation, the extremal quotient, and the systematic component of variation, we measured geographic variation for these eight procedures in districts and new areal units. Results: Compared with districts, new areal units showed a reduction in geographic variation. Extremal quotients and inter-decile ratios for the eight procedures were lower in new areal units. While the coefficient of variation was lower for most procedures in new areal units, the pattern of change of the systematic component of variation between districts and new areal units differed among procedures. Conclusions: Geographic variation in medical service utilization could vary according to the geographic unit of analysis. To determine how geographic characteristics such as population size and number of geographic units affect geographic variation, further studies are needed.

Adsorption and desorption experiments in the natural redox milieu over several months, using technetium as an example

International Nuclear Information System (INIS)

Winkler, A.; Bruehl, H.; Trapp, C.

1986-01-01

Complicated experimental equipment has been developed in order to carry out long-term laboratory studies under true to reality, stable conditions simulating the natural milieu of the formation waters, i.e. the redox potential in the range + 200 to -70 mV. The single-pass column experiments have been made with loose rock samples from the Gorleben site and with natural formation water samples in order to study the adsorption and desorption and thus the mobility of technetium, as well as the building up of the geochemical equilibrium state, which has been studied in circulation columns. The results show that the process of Tc fixation in the loose rock in a lower redox milieu is not so much influenced by adsorption or desorption conditions but rather more by changes of the Eh-conditions, i.e. by the oxidation stage of the technetium. (RB) [de

[Analysis of cost and efficiency of a medical nursing unit using time-driven activity-based costing].

Science.gov (United States)

Lim, Ji Young; Kim, Mi Ja; Park, Chang Gi

2011-08-01

Time-driven activity-based costing was applied to analyze the nursing activity cost and efficiency of a medical unit. Data were collected at a medical unit of a general hospital. Nursing activities were measured using a nursing activities inventory and classified as 6 domains using Easley-Storfjell Instrument. Descriptive statistics were used to identify general characteristics of the unit, nursing activities and activity time, and stochastic frontier model was adopted to estimate true activity time. The average efficiency of the medical unit using theoretical resource capacity was 77%, however the efficiency using practical resource capacity was 96%. According to these results, the portion of non-added value time was estimated 23% and 4% each. The sums of total nursing activity costs were estimated 109,860,977 won in traditional activity-based costing and 84,427,126 won in time-driven activity-based costing. The difference in the two cost calculating methods was 25,433,851 won. These results indicate that the time-driven activity-based costing provides useful and more realistic information about the efficiency of unit operation compared to traditional activity-based costing. So time-driven activity-based costing is recommended as a performance evaluation framework for nursing departments based on cost management.

Profesional medical library education in the United States in relation to the qualifications of medical library manpower in Ohio.

Science.gov (United States)

Rees, A M; Rothenberg, L; Denison, B

1968-10-01

THE PRESENT SYSTEM OF EDUCATION FOR MEDICAL LIBRARY PRACTICE IN THE UNITED STATES CONSISTS OF FOUR MAJOR COMPONENTS: graduate degree programs in library science with specialization in medical librarianship; graduate degree programs in library science with no such specialization; postgraduate internships in medical libraries; continuing education programs. Data are presented illustrating the flow of graduates along these several educational pathways into medical library practice.The relevance of these educational components to the current medical library work force is discussed with reference to manpower data compiled for Ohio. The total number of medical library personnel in Ohio in 1968 is 316. Of this total, only forty-two (approximately 14 percent) have received any formal library training. Seventy persons have only a high school education. From these figures, it is concluded that there is no standard or essential qualification which is universally accepted as educational preparation for work in medical libraries; that the comparative sophistication of the educational programs in medical librarianship has yet to be reflected widely in general medical library practice; that an increasingly large number of non-professional or ancillary personnel are being, and will continue to be, utilized in medical libraries; that large numbers of untrained persons have sole responsibility for medical libraries; and that appropriate educational programs will have to be designed specifically for this type of personnel.

[The medical world of Juan Gil de Zamora's Historia Naturalis (ca. 1275-1296)].

Science.gov (United States)

García Ballester, L; Domínguez, A

1994-01-01

The article describes the authors and works which were quoted by the Franciscan Juan Gil de Zamora in his Historia naturalis, a scientific encyclopaedia written between c. 1275 and before 1296, probably in the Franciscan monastery of Zamora (Kingdom of Castille). Juan Gil made wide use of the Avicenna's Canon, Gilbertus de Aquila (Anglicus)'s Compendium medicine, and Salernitan medical literature. His work contributed to the diffusion of these medical authors and works throughout the Christian intellectual milieu of late medieval Castille. This diffusion was not without problems.

Modélisation de l'évaporation en milieu poreux: développement de modèles fondamentaux et appliqués

OpenAIRE

Debaste, Frédéric

2008-01-01

L'étude des phénomènes fondamentaux detransport et de thermodynamique apparaissant lors de l'évaporationen milieu poreux permet l'investigation d'applications pratiquesvariées. Dans ce travail, nous développons des modèles fondamentauxd'évaporation en milieu poreux que nous appliquons ensuite auséchage en lit fluidisé de deux matériaux granulaires poreux :lePVC et la levure.Les modèles mis au point sont réalisés suivant une approchemultiéchelle. Nous nous intéressons tout d'abord aux phénomèn...

Accommodating the medical use of marijuana: surveying the differing legal approaches in Australia, the United States and Canada.

Science.gov (United States)

Bogdanoski, Tony

2010-02-01

While the scientific and medical communities continue to be divided on the therapeutic benefits and risks of cannabis use, anecdotal evidence from medical users themselves suggests that using cannabis is indeed improving their quality of life by alleviating their pain and discomfort. Notwithstanding the benefits anecdotally claimed by these medical users and the existence of some scientific studies confirming their claims, criminal drug laws in all Australian and most United States jurisdictions continue to prohibit the possession, cultivation and supply of cannabis even for medical purposes. However, in contrast to Australia and most parts of the United States, the medical use of cannabis has been legal in Canada for about a decade. This article reviews these differing legal and regulatory approaches to accommodating the medical use of cannabis (namely, marijuana) as well as some of the challenges involved in legalising it for medical purposes.

Format of medical order sheet improves security of antibiotics prescription: The experience of an intensive care unit.

Science.gov (United States)

Wasserfallen, Jean-Blaise; Bütschi, Anne-Joëlle; Muff, Patrik; Biollaz, Jérôme; Schaller, Marie-Denise; Pannatier, André; Revelly, Jean-Pierre; Chiolero, René

2004-03-01

To assess whether formatting the medical order sheet has an effect on the accuracy and security of antibiotics prescription. Prospective assessment of antibiotics prescription over time, before and after the intervention, in comparison with a control ward. The medical and surgical intensive care unit (ICU) of a university hospital. All patients hospitalized in the medical or surgical ICU between February 1 and April 30, 1997, and July 1 and August 31, 2000, for whom antibiotics were prescribed. Formatting of the medical order sheet in the surgical ICU in 1998. Compliance with the American Society of Hospital Pharmacists' criteria for prescription safety was measured. The proportion of safe orders increased in both units, but the increase was 4.6 times greater in the surgical ICU (66% vs. 74% in the medical ICU and 48% vs. 74% in the surgical ICU). For unsafe orders, the proportion of ambiguous orders decreased by half in the medical ICU (9% vs. 17%) and nearly disappeared in the surgical ICU (1% vs. 30%). The only missing criterion remaining in the surgical ICU was the drug dose unit, which could not be preformatted. The aim of antibiotics prescription (either prophylactic or therapeutic) was indicated only in 51% of the order sheets. Formatting of the order sheet markedly increased security of antibiotics prescription. These findings must be confirmed in other settings and with different drug classes. Formatting the medical order sheet decreases the potential for prescribing errors before full computerized prescription is available.

Swapnaushadhi: the embedded logic of dreams and medical innovation in Bengal.

Science.gov (United States)

Mukharji, Projit Bihari

2014-09-01

Numerous medicines in South Asia have their origins in dreams. Deities, saints and other supernatural beings frequently appear in dreams to instruct dreamers about specific remedies, therapeutic techniques, modes of care etc. These therapies challenge available models of historicising dreams. Once we overcome these challenges and unearth the embedded logic of these dreams, we begin to discern in them a dynamic institution that enabled and sustained therapeutic change within a 'traditional' medical milieu.

Medical and Nonmedical Use of Prescription Opioids among High School Seniors in the United States

Science.gov (United States)

McCabe, Sean Esteban; West, Brady T.; Teter, Christian J.; Boyd, Carol J.

2012-01-01

Objective To determine the prevalence of medical and nonmedical use of prescription opioids among high school seniors in the United States, and to assess substance use behaviors based on medical and nonmedical use of prescription opioids. Design Nationally representative samples of high school seniors (modal age 18) were surveyed during the spring of their senior year via self-administered questionnaires. Setting Data were collected in public and private high schools. Participants The sample consisted of 7,374 students from three independent cohorts (2007-09). Main Outcome Measures Self-reports of medical and nonmedical use of prescription opioids and other substance use. Results An estimated 17.6% of high school seniors reported lifetime medical use of prescription opioids, while 12.9% reported nonmedical use of prescription opioids. Gender differences in the medical and nonmedical use were minimal, while racial/ethnic differences were extensive. Over 37% of nonmedical users reported intranasal administration of prescription opioids. An estimated 80% of nonmedical users with an earlier history of medical use had obtained prescription opioids from a prescription they had previously. The odds of substance use behaviors were greater among individuals who reported any history of nonmedical use of prescription opioids relative to those who reported medical use only. Conclusions Nearly one in every four high school seniors in the United States has ever had some exposure to prescription opioids either medically or nonmedically. The quantity of prescription opioids and number of refills prescribed to adolescents should be carefully considered and closely monitored to reduce subsequent nonmedical use of leftover medication. PMID:22566521

Assessment of teamwork during structured interdisciplinary rounds on medical units.

Science.gov (United States)

O'Leary, Kevin J; Boudreau, Yvonne N; Creden, Amanda J; Slade, Maureen E; Williams, Mark V

2012-01-01

Interdisciplinary rounds (IDR) provide a means to assemble hospital team members and improve collaboration. Little is known about teamwork during IDR. To evaluate and characterize teamwork during IDR. Cross-sectional observational study. Six medical units which had implemented structured interdisciplinary rounds (SIDR). We adapted the Observational Teamwork Assessment for Surgery (OTAS) tool, a behaviorally anchored rating scale shown to be reliable and valid in surgical settings. OTAS provides scores ranging from 0 to 6 (0 = problematic behavior; 6 = exemplary behavior) across 5 domains (communication, coordination, cooperation/backup behavior, leadership, and monitoring/situational awareness) and for prespecified subteams. Two researchers conducted direct observations using the adapted OTAS tool. We conducted 7-8 independent observations for each unit (total = 44) and 20 joint observations. Inter-rater reliability was excellent at the unit level (Spearman's rho = 0.75), and good across domains (rho = 0.53-0.68) and subteams (rho = 0.53-0.76) with the exception of the physician subteam, for which it was poor (rho = 0.35). Though teamwork scores were generally high, we found differences across units, with a median (interquartile range [IQR]) 4.5 (3.9-4.9) for the lowest and 5.4 (5.3-5.5) for the highest performing unit (P teamwork during SIDR across units, domains, and most subteams. Variation in performance suggests a need to improve consistency of teamwork and emphasizes the importance of leadership. Copyright © 2012 Society of Hospital Medicine.

A medical admission unit reduces duration of hospital stay and number of readmissions

DEFF Research Database (Denmark)

Vork, Jan C; Brabrand, Mikkel; Folkestad, Lars

2011-01-01

Political initiatives promoting a more efficient emergency admission process have triggered a reorganisation of the Danish health system with a view to creating fewer and larger admission units counting more experienced physicians. At our hospital, a medical admission unit (MAU) was established. ...... present the effect of this on the length of hospital stay, mortality rates and the number of readmissions for the last year with the previous structure and the first year of the new MAU structure....

Integration testing through reusing representative unit test cases for high-confidence medical software.

Science.gov (United States)

Shin, Youngsul; Choi, Yunja; Lee, Woo Jin

2013-06-01

As medical software is getting larger-sized, complex, and connected with other devices, finding faults in integrated software modules gets more difficult and time consuming. Existing integration testing typically takes a black-box approach, which treats the target software as a black box and selects test cases without considering internal behavior of each software module. Though it could be cost-effective, this black-box approach cannot thoroughly test interaction behavior among integrated modules and might leave critical faults undetected, which should not happen in safety-critical systems such as medical software. This work anticipates that information on internal behavior is necessary even for integration testing to define thorough test cases for critical software and proposes a new integration testing method by reusing test cases used for unit testing. The goal is to provide a cost-effective method to detect subtle interaction faults at the integration testing phase by reusing the knowledge obtained from unit testing phase. The suggested approach notes that the test cases for the unit testing include knowledge on internal behavior of each unit and extracts test cases for the integration testing from the test cases for the unit testing for a given test criteria. The extracted representative test cases are connected with functions under test using the state domain and a single test sequence to cover the test cases is produced. By means of reusing unit test cases, the tester has effective test cases to examine diverse execution paths and find interaction faults without analyzing complex modules. The produced test sequence can have test coverage as high as the unit testing coverage and its length is close to the length of optimal test sequences. Copyright © 2013 Elsevier Ltd. All rights reserved.

Effets des différents doses d'agar du milieu de culture sur l'induction ...

African Journals Online (AJOL)

SARAH

31 janv. 2014 ... récipients utilisés étaient des bacs en plastic munis du filtre d'aération sur le couvercle. Il a été garni de 100 ml de milieu de culture ... The containers used were plastic containers marked with the breather filter on the lid. ..... 1991; Brown et Atanassov, 1985 ; Reisch et Bingham,. 1980; Bingham et al., 1975).

Improving Catheter Associated Urinary Tract Infection Rates in the Medical Units

Science.gov (United States)

Taha, Haytham; Raji, Salama J.; Khallaf, Abeer; Abu Hija, Seham; Mathew, Raji; Rashed, Hanan; Du Plessis, Christelle; Allie, Zaytoen; Ellahham, Samer

2017-01-01

Sheikh Khalifa Medical City (SKMC) in Abu Dhabi is the main tertiary care referral hospital in the United Arab Emirates (UAE) with 560 bed capacity with a high occupancy rate. SKMC senior management has made a commitment to make quality and patient safety a top priority. Preventing health care associated infections, including Catheter Associated Urinary Tract Infection (CAUTI), is a high priority for our hospital. In order to improve CAUTI rates a multidisciplinary task force team was formed and led this performance improvement project. The purpose of this publication is to indicate the quality improvement interventions implemented to reduce CAUTI rates and the outcome of those interventions. We chose to conduct the pilot study in General Medicine as it is the busiest department in the hospital, with an average of 390 patients admitted per month during the study period. The study period was from March 2015 till April 2016. Our aim was to reduce CAUTI rates per 1000 device days in the medical units. Implemented interventions resulted in a reduction of CAUTI from 6.8 per 1000 device days in March 2015 to zero CAUTI in February through April 2016. PMID:28469893

[Medication reconciliation: an innovative experience in an internal medicine unit to decrease errors due to inacurrate medication histories].

Science.gov (United States)

Pérennes, Maud; Carde, Axel; Nicolas, Xavier; Dolz, Manuel; Bihannic, René; Grimont, Pauline; Chapot, Thierry; Granier, Hervé

2012-03-01

An inaccurate medication history may prevent the discovery of a pre-admission iatrogenic event or lead to interrupted drug therapy during hospitalization. Medication reconciliation is a process that ensures the transfer of medication information at admission to the hospital. The aims of this prospective study were to evaluate the interest in clinical practice of this concept and the resources needed for its implementation. We chose to include patients aged 65 years or over admitted in the internal medicine unit between June and October 2010. We obtained an accurate list of each patient's home medications. This list was then compared with medication orders. All medication variances were classified as intended or unintended. An internist and a pharmacist classified the clinical importance of each unintended variance. Sixty-one patients (mean age: 78 ± 7.4 years) were included in our study. We identified 38 unintended discrepancies. The average number of unintended discrepancies was 0.62 per patient. Twenty-five patients (41%) had one or more unintended discrepancies at admission. The contact with the community pharmacist permitted us to identify 21 (55%) unintended discrepancies. The most common errors were the omission of a regularly used medication (76%) and an incorrect dosage (16%). Our intervention resulted in order changes by the physician for 30 (79%) unintended discrepancies. Fifty percent of the unintended variances were judged by the internist and 76% by the pharmacist to be clinically significant. The admission to the hospital is a critical transition point for the continuity of care in medication management. Medication reconciliation can identify and resolve errors due to inaccurate medication histories. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Academic medicine amenities unit: developing a model to integrate academic medical care with luxury hotel services.

Science.gov (United States)

Kennedy, David W; Kagan, Sarah H; Abramson, Kelly Brennen; Boberick, Cheryl; Kaiser, Larry R

2009-02-01

The interface between established values of academic medicine and the trend toward inpatient amenities units requires close examination. Opinions of such units can be polarized, reflecting traditional reservations about the ethical dilemma of offering exclusive services only to an elite patient group. An amenities unit was developed at the University of Pennsylvania Health System in 2007, using an approach that integrated academic medicine values with the benefits of philanthropy and service excellence to make amenities unit services available to all patients. Given inherent internal political concerns, a broadly based steering committee of academic and hospital leadership was developed. An academically appropriate model was conceived, anchored by four principles: (1) integration of academic values, (2) interdisciplinary senior leadership, (3) service excellence, and (4) recalibrated occupancy expectations based on multiple revenue streams. Foremost is ensuring the same health care is afforded all patients throughout the hospital, thereby overcoming ethical challenges and optimizing teaching experiences. Service excellence frames the service ethic for all staff, and this, in addition to luxury hotel-style amenities, differentiates the style and feel of the unit from others in the hospital. Recalibrated occupancy creates program viability given revenue streams redefined to encompass gifts and patient revenue, including both reimbursement and self-pay. The medical-surgical amenities patient-care unit has enjoyed a successful first year and a growing stream of returning patients and admitting physicians. Implications for other academic medical centers include opportunities to extrapolate service excellence throughout the hospital and to cultivate philanthropy to benefit services throughout the medical center.

The current format and ongoing advances of medical education in the United States.

Science.gov (United States)

Gishen, Kriya; Ovadia, Steven; Arzillo, Samantha; Avashia, Yash; Thaller, Seth R

2014-01-01

The objective of this study was to examine the current system of medical education along with the advances that are being made to support the demands of a changing health care system. American medical education must reform to anticipate the future needs of a changing health care system. Since the dramatic transformations to medical education that followed the publication of the Flexner report in 1910, medical education in the United States has largely remained unaltered. Today, the education of future physicians is undergoing modifications at all levels: premedical education, medical school, and residency training. Advances are being made with respect to curriculum design and content, standardized testing, and accreditation milestones. Fields such as plastic surgery are taking strides toward improving resident training as the next accreditation system is established. To promote more efficacious medical education, the American Medical Association has provided grants for innovations in education. Likewise, the Accreditation Council for Graduate Medical Education outlined 6 core competencies to standardize the educational goals of residency training. Such efforts are likely to improve the education of future physicians so that they are able to meet the future needs of American health care.

Clinical neuro-oncology formal education opportunities for medical students in the United States and Canada.

Science.gov (United States)

Dixit, Karan S; Nicholas, Martin Kelly; Lukas, Rimas V

2014-12-01

To develop an understanding of the availability of the formal clinical neuro-oncology educational opportunities for medical students. The curriculum websites of all medical schools accredited by the Liaison Committee on Medical Education were reviewed for the presence of clinical neuro-oncology electives as well as other relevant data. Ten (6.8%) of medical schools accredited by the Liaison Committee on Medical Education offer formal neuro-oncology electives. Half are clustered in the Midwest. Forty percent are at institutions with neuro-oncology fellowships. All are at institutions with neurosurgery and neurology residency programs. Formal clinical neuro-oncology elective opportunities for medical students in the United States and Canada are limited. Additional such opportunities may be of value in the education of medical students. Copyright © 2014 Elsevier Inc. All rights reserved.

Group Milieu in systemic and psychodynamic group therapy

DEFF Research Database (Denmark)

Lau, Marianne Engelbrecht; Kristensen, Ellids

Objectives: A recent meta-analysis also concluded that psychotherapeutic approaches are beneficial for adult with a history of CSA and maintained for at least six months follow-up. The results suggest that different characteristics of therapy moderate the therapeutic outcome. We found in a random......Objectives: A recent meta-analysis also concluded that psychotherapeutic approaches are beneficial for adult with a history of CSA and maintained for at least six months follow-up. The results suggest that different characteristics of therapy moderate the therapeutic outcome. We found...... in a randomized study of systemic versus psychodynamic group therapy, that the short-term outcome for patients who received systemic group psychotherapy was significantly better than the outcome for patients who received psychodynamic group psychotherapy. The current study assessed the group milieu in both groups....... Methods: This randomized prospective study included 106 women: 52 assigned to psychodynamic group psychotherapy and 54 assigned to systemic group psychotherapy. The Group Environment Scale (GES) was filled in the mid phase of therapy and analysed in three dimensions and 10 subscales. Results: The systemic...

Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010.

Science.gov (United States)

Bachhuber, Marcus A; Saloner, Brendan; Cunningham, Chinazo O; Barry, Colleen L

2014-10-01

Opioid analgesic overdose mortality continues to rise in the United States, driven by increases in prescribing for chronic pain. Because chronic pain is a major indication for medical cannabis, laws that establish access to medical cannabis may change overdose mortality related to opioid analgesics in states that have enacted them. To determine the association between the presence of state medical cannabis laws and opioid analgesic overdose mortality. A time-series analysis was conducted of medical cannabis laws and state-level death certificate data in the United States from 1999 to 2010; all 50 states were included. Presence of a law establishing a medical cannabis program in the state. Age-adjusted opioid analgesic overdose death rate per 100 000 population in each state. Regression models were developed including state and year fixed effects, the presence of 3 different policies regarding opioid analgesics, and the state-specific unemployment rate. Three states (California, Oregon, and Washington) had medical cannabis laws effective prior to 1999. Ten states (Alaska, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Rhode Island, and Vermont) enacted medical cannabis laws between 1999 and 2010. States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate (95% CI, -37.5% to -9.5%; P = .003) compared with states without medical cannabis laws. Examination of the association between medical cannabis laws and opioid analgesic overdose mortality in each year after implementation of the law showed that such laws were associated with a lower rate of overdose mortality that generally strengthened over time: year 1 (-19.9%; 95% CI, -30.6% to -7.7%; P = .002), year 2 (-25.2%; 95% CI, -40.6% to -5.9%; P = .01), year 3 (-23.6%; 95% CI, -41.1% to -1.0%; P = .04), year 4 (-20.2%; 95% CI, -33.6% to -4.0%; P = .02), year 5 (-33.7%; 95% CI, -50.9% to -10.4%; P = .008), and year 6 (-33.3%; 95% CI, -44.7% to

The inflammatory milieu within the pancreatic cancer microenvironment correlates with clinicopathologic parameters, chemoresistance and survival

International Nuclear Information System (INIS)

Delitto, Daniel; Black, Brian S.; Sorenson, Heather L.; Knowlton, Andrea E.; Thomas, Ryan M.; Sarosi, George A.; Moldawer, Lyle L.; Behrns, Kevin E.; Liu, Chen; George, Thomas J.; Trevino, Jose G.; Wallet, Shannon M.; Hughes, Steven J.

2015-01-01

The tumor microenvironment impacts pancreatic cancer (PC) development, progression and metastasis. How intratumoral inflammatory mediators modulate this biology remains poorly understood. We hypothesized that the inflammatory milieu within the PC microenvironment would correlate with clinicopathologic findings and survival. Pancreatic specimens from normal pancreas (n = 6), chronic pancreatitis (n = 9) and pancreatic adenocarcinoma (n = 36) were homogenized immediately upon resection. Homogenates were subjected to multiplex analysis of 41 inflammatory mediators. Twenty-three mediators were significantly elevated in adenocarcinoma specimens compared to nonmalignant controls. Increased intratumoral IL-8 concentrations associated with larger tumors (P = .045) and poor differentiation (P = .038); the administration of neoadjuvant chemotherapy associated with reduced IL-8 concentrations (P = .003). Neoadjuvant therapy was also associated with elevated concentrations of Flt-3 L (P = .005). Elevated levels of pro-inflammatory cytokines IL-1β (P = .017) and TNFα (P = .033) were associated with a poor histopathologic response to neoadjuvant therapy. Elevated concentrations of G-CSF (P = .016) and PDGF-AA (P = .012) correlated with reduced overall survival. Conversely, elevated concentrations of FGF-2 (P = .038), TNFα (P = .031) and MIP-1α (P = .036) were associated with prolonged survival. The pancreatic cancer microenvironment harbors a unique inflammatory milieu with potential diagnostic and prognostic value

Acute medical complications in patients admitted to a stroke unit and safe transfer to rehabilitation.

Science.gov (United States)

Bonaiuti, Donatella; Sioli, Paolo; Fumagalli, Lorenzo; Beghi, Ettore; Agostoni, Elio

2011-08-01

Acute medical complications often prevent patients with stroke from being transferred from stroke units to rehabilitation units, prolonging the occupation of hospital beds and delaying the start of intensive rehabilitation. This study defined incidence, timing, duration and risk factors of these complications during the acute phase of stroke. A retrospective case note review was made of hospital admissions of patients with stroke not associated with other disabling conditions, admitted to a stroke unit over 12 months and requiring rehabilitation for gait impairment. In this cohort, a search was made of hypertension, oxygen de-saturation, fever, and cardiac and pulmonary symptoms requiring medical intervention. Included were 135 patients. Hypertension was the most common complication (16.3%), followed by heart disease (14.8%), oxygen de-saturation (7.4%), fever (6.7%) and pulmonary disease (5.2%). Heart disease was the earliest and shortest complication. Most complications occurred during the first week. Except for hypertension, all complications resolved within 2 weeks.

Comparison of intensive care unit medication errors reported to the United States' MedMarx and the United Kingdom's National Reporting and Learning System: a cross-sectional study.

Science.gov (United States)

Wahr, Joyce A; Shore, Andrew D; Harris, Lindsay H; Rogers, Philippa; Panesar, Sukhmeet; Matthew, Linda; Pronovost, Peter J; Cleary, Kevin; Pham, Julius C

2014-01-01

The objective was to compare the characteristics of medication errors reported to 2 national error reporting systems by conducting a cross-sectional analysis of errors reported from adult intensive care units to the UK National Reporting and Learning System and the US MedMarx system. Outcome measures were error types, severity of patient harm, stage of medication process, and involved medications. The authors analyzed 2837 UK error reports and 56 368 US reports. Differences were observed between UK and US errors for wrong dose (44% vs 29%), omitted dose (8.6% vs 27%), and stage of medication process (prescribing: 14% vs 49%; administration: 71% vs 42%). Moderate/severe harm or death was reported in 4.9% of UK versus 3.4% of US errors. Gentamicin was cited in 7.4% of the UK versus 0.7% of the US reports (odds ratio = 9.25). There were differences in the types of errors reported and the medications most often involved. These differences warrant further examination.

MEANINGS OF SPACE OF COTTAGE-TYPE RESIDENTIAL CENTER IN MILIEU THERAPY FOR EMOTIONALLY DISTURBED CHILDREN

OpenAIRE

Ishigaki, Aya; Kanno, Minoru; Onoda, Yasuaki; Sakaguchi, Taiyo

2004-01-01

The number of emotionally disturbed children in Japan has been increasing recently; However, only few attempts with an aim at improving children's living space have been made at treatment centers. We conducted some field surveys on the cottage-type residential center to examine the relationship among space, communication, and the effectiveness of therapy. In addition, to clarify conditions of treatment for children with emotional disturbances, the children's daily life with milieu therapy was...

Implementation of pharmacists’ interventions and assessment of medication errors in an intensive care unit of a Chinese tertiary hospital

Directory of Open Access Journals (Sweden)

Jiang SP

2014-10-01

Full Text Available Sai-Ping Jiang,1,* Jian Chen,2,* Xing-Guo Zhang,1 Xiao-Yang Lu,1 Qing-Wei Zhao1 1Department of Pharmacy, 2Intensive Care Unit, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China *These authors contributed equally to this work Background: Pharmacist interventions and medication errors potentially differ between the People’s Republic of China and other countries. This study aimed to report interventions administered by clinical pharmacists and analyze medication errors in an intensive care unit (ICU in a tertiary hospital in People’s Republic of China.Method: A prospective, noncomparative, 6-month observational study was conducted in a general ICU of a tertiary hospital in the People’s Republic of China. Clinical pharmacists performed interventions to prevent or resolve medication errors during daily rounds and documented all of these interventions and medication errors. Such interventions and medication errors were categorized and then analyzed.Results: During the 6-month observation period, a total of 489 pharmacist interventions were reported. Approximately 407 (83.2% pharmacist interventions were accepted by ICU physicians. The incidence rate of medication errors was 124.7 per 1,000 patient-days. Improper drug frequency or dosing (n=152, 37.3%, drug omission (n=83, 20.4%, and potential or actual occurrence of adverse drug reaction (n=54, 13.3% were the three most commonly committed medication errors. Approximately 339 (83.4% medication errors did not pose any risks to the patients. Antimicrobials (n=171, 35.0% were the most frequent type of medication associated with errors.Conclusion: Medication errors during prescription frequently occurred in an ICU of a tertiary hospital in the People’s Republic of China. Pharmacist interventions were also efficient in preventing medication errors. Keywords: pharmacist, medication error, preva­lence rate, type, severity, intensive care

Home iv Antibiotic Therapy through a Medical Day Care Unit

Directory of Open Access Journals (Sweden)

Marie Gourdeau

1993-01-01

Full Text Available An out-patient parenteral antibiotic therapy program provided through a medical day care unit was evaluated in a tertiary care hospital. From July 11, 1988 to December 31, 1990, 122 patients were treated either on site at the unit or at home with self-administered intravenous antibiotics. In all, 142 courses of parenteral antibiotics (mostly cephalosporins and clindamycin were given for a total of 124 infections, mostly bone and soft tissue infections (67 of 124, 54%. The duration of out-patient therapy ranged from two to 62 days with a mean duration of 9.4 days if treated at the unit, or 13.2 days in the home care model (1476 patient-days. Vein access was peripheral and catheters remained functional for an average of 4.9 days (range 0.5 to 22 days. Only two patients experienced adverse drug reactions that necessitated modification of treatment. One other case was readmitted to the hospital for surgical debridement. The average cost per patient-day was $66 compared with $375 for in-hospital therapy. This program proved to be safe, efficient, and cost-effective.

[Application of new technologies in the design, manufacture and use of technology deployment of field medical units and establishments].

Science.gov (United States)

Iakovlev, S V; Sidorov, V A; Korniushko, I G; Medvedev, V R; Matveev, A G

2011-11-01

Presented data is about attendance means of deployment of field medical units and pieces of army-level medical services and disaster medicine Defense Ministry did not ensure compliance with requirements to create optimal conditions for highly effective work of the medical staff, placing the wounded, the use of modern aids and appliances. The prospects of creation of mobile unit for high-availability modular pre-fabricated on the basis of tent structures, pneumoconstructions and removable habitable bodies, containers, tents, pneumocovers till 2020 are analyzed. Livelihood systems provide armor protection against fragments, bullets, flames, damaging factors of chemical and biological weapons.

New medical schools in the United States: forces of change past and present.

Science.gov (United States)

Smith, Lawrence

2009-01-01

The new millennium has ushered in a growth phase in the number of American medical schools. Historically the United States has built schools during bursts of activity with relative quiescence in between these periods. We had a twenty-two year period with no growth in medical school size or number. During that time there were significant changes in patient characteristics, student culture, financial reimbursement, quality, and manpower needs that have put stress on medical schools, hospitals, clinical practice and healthcare systems. In addition, there have been remarkable new opportunities in the way we teach, including changes in teaching methodology, educational technology, and a better understanding of how students actually learn. All of these advances have taken place during a period of enormous pressure to change residency programs, reorganize medical and clinical science, and question the very need for traditional departmental structures. It is likely that the new medical schools will emerge looking different from the older schools and they are likely to catalyze a period of curricular change.

Factors influencing a nurse's decision to question medication administration in a neonatal clinical care unit.

Science.gov (United States)

Aydon, Laurene; Hauck, Yvonne; Zimmer, Margo; Murdoch, Jamee

2016-09-01

The aim of this study was to identify factors that influence nurse's decisions to question concerning aspects of medication administration within the context of a neonatal clinical care unit. Medication error in the neonatal setting can be high with this particularly vulnerable population. As the care giver responsible for medication administration, nurses are deemed accountable for most errors. However, they are recognised as the forefront of prevention. Minimal evidence is available around reasoning, decision making and questioning around medication administration. Therefore, this study focuses upon addressing the gap in knowledge around what nurses believe influences their decision to question. A critical incident design was employed where nurses were asked to describe clinical incidents around their decision to question a medication issue. Nurses were recruited from a neonatal clinical care unit and participated in an individual digitally recorded interview. One hundred and three nurses participated between December 2013-August 2014. Use of the constant comparative method revealed commonalities within transcripts. Thirty-six categories were grouped into three major themes: 'Working environment', 'Doing the right thing' and 'Knowledge about medications'. Findings highlight factors that influence nurses' decision to question issues around medication administration. Nurses feel it is their responsibility to do the right thing and speak up for their vulnerable patients to enhance patient safety. Negative dimensions within the themes will inform planning of educational strategies to improve patient safety, whereas positive dimensions must be reinforced within the multidisciplinary team. The working environment must support nurses to question and ultimately provide safe patient care. Clear and up to date policies, formal and informal education, role modelling by senior nurses, effective use of communication skills and a team approach can facilitate nurses to

Variation in cash price of the generic medications most prescribed by dermatologists in pharmacies across the United States.

Science.gov (United States)

Alghanem, Noor; Abokwidir, Manal; Fleischer, Alan B; Feldman, Steven R; Alghanem, Ward

2017-03-01

The United States has the highest drug costs in the world. Consumers complain about large price differences at pharmacies on generic drugs. To evaluate variation in cash prices of generic medications most prescribed in dermatology across different drugstores and states in United States. The 11 generic drugs most prescribed by dermatologists according to National Ambulatory Medical Care Survey were assessed. By using Google, the most common used pharmacies in United States were listed, which are located at a random selection of six states. By calling the first available number of each pharmacy in the six states and asking about the generic cash price of the smallest stock size and the most prescribed type, the data were collected. Drug prices varied; the median cumulative price of the 11 medications was highest at Rite Aid ($1226) and lowest at Walmart ($795.34) with 35% difference. The prices at CVS differed by 20% across different states; however, the prices at Walmart, Rite Aid and Walgreens were consistent. New York has the highest and Iowa the lowest prices, especially at CVS, ($1160.79) versus ($931.32). There are varieties in the prices for the generic medications in different pharmacies and States.

Evaluation of the impact of implementation of a Medical Assessment and Planning Unit on length of stay

NARCIS (Netherlands)

Brand, Caroline A.; Kennedy, Marcus P.; King-Kallimanis, Bellinda L.; Williams, Ged; Bain, Christopher A.; Russell, David M.

2010-01-01

Objective: The Medical Assessment and Planning Unit (MAPU) model provides a multidisciplinary and 'front end loading' approach to acute medical care. The objective of this study was to evaluate the impact of a 10-bed MAPU in Royal Melbourne Hospital (RMH) on hospital length of stay. A pre-post study

United States Department of Health and Human Services Biodosimetry and radiological/nuclear medical countermeasure programs

International Nuclear Information System (INIS)

Homer, Mary J.; Raulli, Robert; Esker, John; Moyer, Brian; Wathen, Lynne; DiCarlo-Cohen, Andrea L.; Maidment, Bert W.; Rios, Carmen; Macchiarini, Francesca; Hrdina, Chad; Prasanna, Pataje G.

2016-01-01

The United States Department of Health and Human Services (HHS) is fully committed to the development of medical countermeasures to address national security threats from chemical, biological, radiological, and nuclear agents. Through the Public Health Emergency Medical Countermeasures Enterprise, HHS has launched and managed a multi-agency, comprehensive effort to develop and operationalize medical countermeasures. Within HHS, development of medical countermeasures includes the National Institutes of Health (NIH), (led by the National Institute of Allergy and Infectious Diseases), the Office of the Assistant Secretary of Preparedness and Response/Biomedical Advanced Research and Development Authority (BARDA); with the Division of Medical Countermeasure Strategy and Requirements, the Centers for Disease Control and Prevention, and the Food and Drug Administration as primary partners in this endeavor. This paper describes various programs and coordinating efforts of BARDA and NIH for the development of medical countermeasures for radiological and nuclear threats. (authors)

Innovative Information Systems in the Intensive Care Unit, King Saud Medical City in Saudi Arabia.

Science.gov (United States)

Al Saleem, Nouf; Al Harthy, Abdulrahman

2015-01-01

The purpose of this paper is to discuss the experience of implementing innovative information technology to improve the quality of services in one of the largest Intensive Care Units in Saudi Arabia. The Intensive Care Units in King Saud Medical City (ICU-KSMC) is the main ICU in the kingdom that represents the Ministry of Health. KSMC's ICU is also considered one of the largest ICU in the world as it consists of six units with 129 beds. Leaders in KSMC's ICU have introduced and integrated three information technologies to produce powerful, accurate, and timely information systems to overcome the challenges of the ICU nature and improve the quality of service to ensure patients' safety. By 2015, ICU in KSMC has noticed a remarkable improvement in: beds' occupation and utilization, staff communication, reduced medical errors, and improved departmental work flow, which created a healthy professional work environment. Yet, ICU in KSMC has ongoing improvement projects that include future plans for more innovative information technologies' implementation in the department.

Scale and scope economies in Mexican private medical units.

Science.gov (United States)

Keith, Jorge; Prior, Diego

2014-01-01

To evaluate technical efficiency and potential presence of scale and scope economies in Mexican private medical units (PMU) that will improve management decisions. We used data envelopment analysis methods with inputs and outputs for 2 105 Mexican PMU published in 2010 by the Instituto Nacional de Estadística y Geografía from the "Estadística de Unidades Médicas Privadas con Servicio de Hospitalización (PEC-6-20-A)" questionnaire. The application of the models used in the paper found that there is a marginal presence of economies of scale and scope in Mexican PMU. PMU in Mexico must focus to deliver their services on a diversified structure to achieve technical efficiency.

Incremental cost of PACS in a medical intensive care unit

Science.gov (United States)

Langlotz, Curtis P.; Cleff, Bridget; Even-Shoshan, Orit; Bozzo, Mary T.; Redfern, Regina O.; Brikman, Inna; Seshadri, Sridhar B.; Horii, Steven C.; Kundel, Harold L.

1995-05-01

Our purpose is to determine the incremental costs (or savings) due to the introduction of picture archiving and communication systems (PACS) and computed radiology (CR) in a medical intensive care unit (MICU). Our economic analysis consists of three measurement methods. The first method is an assessment of the direct costs to the radiology department, implemented in a spreadsheet model. The second method consists of a series of brief observational studies to measure potential changes in personnel costs that might not be reflected in administrative claims. The third method (results not reported here) is a multivariate modeling technique which estimates the independent effect of PACS/CR on the cost of care (estimated from administrative claims data), while controlling for clinical case- mix variables. Our direct cost model shows no cost savings to the radiology department after the introduction of PACS in the medical intensive care unit. Savings in film supplies and film library personnel are offset by increases in capital equipment costs and PACS operation personnel. The results of observational studies to date demonstrate significant savings in clinician film-search time, but no significant change in technologist time or lost films. Our model suggests that direct radiology costs will increase after the limited introduction of PACS/CR in the MICU. Our observational studies show a small but significant effect on clinician film search time by the introduction of PACS/CR in the MICU, but no significant effect on other variables. The projected costs of a hospital-wide PACS are currently under study.

Although Abundant in Tumor Tissue, Mast Cells Have No Effect on Immunological Micro-milieu or Growth of HPV-Induced or Transplanted Tumors

Directory of Open Access Journals (Sweden)

Shanawaz Mohammed Ghouse

2018-01-01

Full Text Available Summary: High numbers of mast cells populate the stroma of many types of neoplasms, including human papilloma virus-induced benign and malignant tumors in man and mouse. Equipped with numerous pattern recognition receptors and capable of executing important pro-inflammatory responses, mast cells are considered innate sentinels that significantly impact tumor biology. Mast cells were reported to promote human papilloma virus (HPV-induced epithelial hyperproliferation and neo-angiogenesis in an HPV-driven mouse model of skin cancer. We analyzed HPV-induced epithelial hyperplasia and squamous cell carcinoma formation, as well as growth of tumors inoculated into the dermis, in mice lacking skin mast cells. Unexpectedly, the absence of mast cells had no effect on HPV-induced epithelial growth or angiogenesis, on growth kinetics of inoculated tumors, or on the immunological tumor micro-milieu. Thus, the conspicuous recruitment of mast cells into tumor tissues cannot necessarily be equated with important mast cell functions in tumor growth. : Mast cells accumulate in high numbers in many human tumors, and they are widely viewed as important promoters of tumor growth. Ghouse et al. show that growth, angiogenesis, and the immunological micro-milieu of tumors growing in mice genetically deficient for mast cells are unchanged compared to control tumors. Keywords: mast cells, HPV-induced skin cancer, tumor angiogenesis, tumor micro-milieu

Evaluation of the Medical Care of Patients with Hypertension in an Emergency Department and in Ambulatory Hypertension Unit

Directory of Open Access Journals (Sweden)

Fernando Nobre

2002-02-01

Full Text Available OBJECTIVE: To evaluate the characteristics of the patients receiving medical care in the Ambulatory of Hypertension of the Emergency Department, Division of Cardiology, and in the Emergency Unit of the Clinical Hospital of the Ribeirão Preto Medical School. METHODS: Using a protocol, we compared the care of the same hypertensive patients in on different occasions in the 2 different places. The characteristics of 62 patients, 29 men with a mean age of 57 years, were analyzed between January 1996 and December 1997. RESULTS: The care of these patients resulted in different medical treatment regardless of their clinical features and blood pressure levels. Thus, in the Emergency Unit, 97% presented with symptoms, and 64.5% received medication to rapidly reduce blood pressure. In 50% of the cases, nifedipine SL was the elected medication. Patients who applied to the Ambulatory of Hypertension presenting with similar features, or, in some cases, presenting with similar clinically higher levels of blood pressure, were not prescribed medication for a rapid reduction of blood pressure at any of the appointments. CONCLUSION: The therapeutic approach to patients with high blood pressure levels, symptomatic or asymptomatic, was dependent on the place of treatment. In the Emergency Unit, the conduct was, in the majority of cases, to decrease blood pressure immediately, whereas in the Ambulatory of Hypertension, the same levels of blood pressure, in the same individuals, resulted in therapeutic adjustment with nonpharmacological management. These results show the need to reconsider the concept of hypertensive crises and their therapeutical implications.

An Update on the Status of Anatomical Sciences Education in United States Medical Schools

Science.gov (United States)

Drake, Richard L.; McBride, Jennifer M.; Pawlina, Wojciech

2014-01-01

Curricular changes continue at United States medical schools and directors of gross anatomy, microscopic anatomy, neuroscience/neuroanatomy, and embryology courses continue to adjust and modify their offerings. Developing and supplying data related to current trends in anatomical sciences education is important if informed decisions are going to…

Impact of Medical Tourism on Cosmetic Surgery in the United States

Science.gov (United States)

Franzblau, Lauren E.

2013-01-01

Summary: Developing countries have been attracting more international patients by building state-of-the-art facilities and offering sought-after healthcare services at a fraction of the cost of the US healthcare system. These price differentials matter most for elective procedures, including cosmetic surgeries, which are paid for out of pocket. It is unclear how this rise in medical tourism will affect the practice of plastic surgery, which encompasses a uniquely large number of elective procedures. By examining trends in the globalization of the cosmetic surgery market, we can better understand the current situation and what plastic surgeons in the United States can expect. In this article, we explore both domestic and foreign factors that affect surgical tourism and the current state of this industry. We also discuss how it may affect the practice of cosmetic surgery within the United States. PMID:25289258

Impact of medical tourism on cosmetic surgery in the United States.

Science.gov (United States)

Franzblau, Lauren E; Chung, Kevin C

2013-10-01

Developing countries have been attracting more international patients by building state-of-the-art facilities and offering sought-after healthcare services at a fraction of the cost of the US healthcare system. These price differentials matter most for elective procedures, including cosmetic surgeries, which are paid for out of pocket. It is unclear how this rise in medical tourism will affect the practice of plastic surgery, which encompasses a uniquely large number of elective procedures. By examining trends in the globalization of the cosmetic surgery market, we can better understand the current situation and what plastic surgeons in the United States can expect. In this article, we explore both domestic and foreign factors that affect surgical tourism and the current state of this industry. We also discuss how it may affect the practice of cosmetic surgery within the United States.

Antitumor action of 3-bromopyruvate implicates reorganized tumor growth regulatory components of tumor milieu, cell cycle arrest and induction of mitochondria-dependent tumor cell death.

Science.gov (United States)

Yadav, Saveg; Kujur, Praveen Kumar; Pandey, Shrish Kumar; Goel, Yugal; Maurya, Babu Nandan; Verma, Ashish; Kumar, Ajay; Singh, Rana Pratap; Singh, Sukh Mahendra

2018-01-15

Evidences demonstrate that metabolic inhibitor 3-bromopyruvate (3-BP) exerts a potent antitumor action against a wide range of malignancies. However, the effect of 3-BP on progression of the tumors of thymic origin remains unexplored. Although, constituents of tumor microenvironment (TME) plays a pivotal role in regulation of tumor progression, it remains unclear if 3-BP can alter the composition of the crucial tumor growth regulatory components of the external surrounding of tumor cells. Thus, the present investigation attempts to understand the effect of 3-BP administration to a host bearing a progressively growing tumor of thymic origin on tumor growth regulatory soluble, cellular and biophysical components of tumor milieu vis-à-vis understanding its association with tumor progression, accompanying cell cycle events and mode of cell death. Further, the expression of cell survival regulatory molecules and hemodynamic characteristics of the tumor milieu were analysed to decipher mechanisms underlying the antitumor action of 3-BP. Administration of 3-BP to tumor-bearing hosts retarded tumor progression accompanied by induction of tumor cell death, cell cycle arrest, declined metabolism, inhibited mitochondrial membrane potential, elevated release of cytochrome c and altered hemodynamics. Moreover, 3-BP reconstituted the external milieu, in concurrence with deregulated glucose and pH homeostasis and increased tumor infiltration by NK cells, macrophages, and T lymphocytes. Further, 3-BP administration altered the expression of key regulatory molecules involved in glucose uptake, intracellular pH and tumor cell survival. The outcomes of this study will help in optimizing the therapeutic application of 3-BP by targeting crucial tumor growth regulatory components of tumor milieu. Copyright © 2017 Elsevier Inc. All rights reserved.

Psychotropic Medication Use Among Adults With Schizophrenia and Schizoaffective Disorder in the United States.

Science.gov (United States)

Stroup, T Scott; Gerhard, Tobias; Crystal, Stephen; Huang, Cecilia; Tan, Zhiqiang; Wall, Melanie M; Mathai, Chacku M; Olfson, Mark

2018-05-01

The authors examined the use of different classes of psychotropic medication in outpatient treatment of schizophrenia and schizoaffective disorder. Data from the United States Medicaid program were used to examine psychotropic medication use in a cohort of patients who had a diagnosis of schizophrenia or schizoaffective disorder in the calendar year 2010. The cohort of Medicaid recipients who filled one or more prescriptions for a psychotropic medication in 2010 included 116,249 patients classified as having schizophrenia and 84,537 classified as having schizoaffective disorder. During 2010, 86.1% of patients with schizoaffective disorder and 70.1% with schizophrenia were treated with two or more different classes of psychotropic. Psychotropic medications other than antipsychotics were commonly prescribed for individuals with a diagnosis of schizophrenia or schizoaffective disorder. Their widespread use and uncertainty about their net benefits signal a need for research on their efficacy, safety, and appropriate use in these conditions.

Is “Warmth” a Mode of Social Behaviour? Considerations on a Cultural History of the Left-Alternative Milieu from the Late Sixties to the Mid Eighties

Directory of Open Access Journals (Sweden)

Sven Reichardt

2010-08-01

Full Text Available The article deals with the comprehensive counter-cultural milieu from the late 1960s until the early 1980s. Life style and habitus within this undogmatic and widely peaceful radical leftist milieu were practised according to a conduct of warmth. This alternative conduct of warmth corresponded with developments in the increasing individualized consumer society of the Federal Republic of Germany. The counter-cultural social behaviour was neither a departure into the land of freedom nor into a reign of normlessness. It was a form of self-guidance and governmentality with its own contradictions and coercions.

[Health care units image development on the market of medical services].

Science.gov (United States)

Kemicer-Chmielewska, Ewa; Karakiewicz, Beata

2010-01-01

The cause for this document is to present a deliberation on public health facility image development on the medical services market. Marketization of the health service, growing awareness of Polish citizens and their expectation of high service quality as well as increased competition in the healthcare system market is the reason why health unit managers need to put a lot of strength and effort in sustaining or improving the image of the facility they run. Such action gives a chance for obtaining a competitive advantage.

INTERPERSONAL COMMUNICATION IN MEDICAL UNITS

Directory of Open Access Journals (Sweden)

Irina Ionela ROTARIU

2015-12-01

Full Text Available Over the last few years there has been noticed an increase of the general interest in proper communication between medical specialists, on one hand, and the patients and their families, on the other. The benefits of properly performed communication certainly lead to an increase of public confidence in the medical system and therefore to the patients' improved satisfaction and contentment.

La réaction des pays d'Islam face aux Croisades et aux États latins, fin du XIe - milieu du XIIIe siècle

OpenAIRE

Van Renterghem , Vanessa

2000-01-01

Cet article, rédigé à l'occasion de la question d'agrégation d'histoire portant sur " Les relations entre les pays d'Islam et le monde latin du milieu du Xe au milieu du XIIIe siècle " (2000-2002), examine différents aspects des relations entre Croisés et musulmans, vues des pays d'Islam. Il s'intéresse tout d'abord à l'évolution de l'image des Croisés dans les sources arabes de l'époque ainsi qu'au sort des musulmans sous domination franque. Il retrace ensuite les différentes étapes de la ré...

Scale and scope economies in Mexican private medical units

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Jorge Keith

2014-07-01

Full Text Available Objective. To evaluate technical efficiency and potential presence of scale and scope economies in Mexican private medical units (PMU that will improve management decisions. Materials and methods. We used data envelopment analysis methods with inputs and outputs for 2 105 Mexican PMU published in 2010 by the Instituto Nacional de Estadística y Geografía from the “Estadística de Unidades Médicas Privadas con Servicio de Hospitalización (PEC-6-20-A” questionnaire. Results. The application of the models used in the paper found that there is a marginal presence of economies of scale and scope in Mexican PMU. Conclusions. PMU in Mexico must focus to deliver their services on a diversified structure to achieve technical efficiency.

Outline of the Future Agenda for Environmental Policy in the Netherlands; Hoofdlijnennotitie Toekomstagenda Milieu

Energy Technology Data Exchange (ETDEWEB)

NONE

2005-10-10

An overview is given of the targets for the environmental policy in the Netherlands, focusing on the strict decoupling of economic development and changes in the environmental impacts. Also, the Dutch government aims at decreasing the environmental effects of the past in order to minimize the consequences for public health and the environment. Finally, transferring environmental problems to other parts of the world of future generations must be prevented as much as possible. Targets concern Economy and innovation; Public health and safety; Energy and climate; and Nature and biodiversity. [Dutch] Het beleid uit het NMP4 en de nota Vaste waarden, nieuwe vormen is voor dit kabinet, binnen het kader van het Europese milieubeleid, nog steeds het vertrekpunt van het milieubeleid. De doelen van het bestaande milieubeleid staan niet ter discussie. De uitvoering en handhaving van het bestaande beleid staan voorop. Waar doelen niet worden gehaald is extra aandacht vereist en waar nodig moeten nieuwe doelen worden geformuleerd voor de periode na 2010. In lijn met het Hoofdlijnenakkoord houdt het kabinet ook in de Toekomstagenda Milieu vast aan de absolute ontkoppeling van economische groei en verandering in milieudruk. Absolute ontkoppeling betekent dat er geen nieuwe milieuschuld wordt opgebouwd. Het kabinet wil ook de in het verleden opgebouwde milieuschuld binnen een generatie zodanig verminderen dat er geen significante gevolgen voor gezondheid en milieu meer zijn. De afwenteling van onze milieuproblemen naar andere delen van de wereld, of naar toekomstige generaties, moet zoveel mogelijk worden voorkomen. Speerpunten zijn Economie en Innovaties; Gezond en Veilig; Energie en Klimaat; Natuur en Biodiversiteit.

Impact of Medical Tourism on Cosmetic Surgery in the United States

Directory of Open Access Journals (Sweden)

Lauren E. Franzblau, BS

2013-10-01

Full Text Available Summary: Developing countries have been attracting more international patients by building state-of-the-art facilities and offering sought-after healthcare services at a fraction of the cost of the US healthcare system. These price differentials matter most for elective procedures, including cosmetic surgeries, which are paid for out of pocket. It is unclear how this rise in medical tourism will affect the practice of plastic surgery, which encompasses a uniquely large number of elective procedures. By examining trends in the globalization of the cosmetic surgery market, we can better understand the current situation and what plastic surgeons in the United States can expect. In this article, we explore both domestic and foreign factors that affect surgical tourism and the current state of this industry. We also discuss how it may affect the practice of cosmetic surgery within the United States.

Interprofessional intensive care unit team interactions and medical crises: a qualitative study.

Science.gov (United States)

Piquette, Dominique; Reeves, Scott; Leblanc, Vicki R

2009-05-01

Research has suggested that interprofessional collaboration could improve patient outcomes in the intensive care unit (ICU). Maintaining optimal interprofessional interactions in a setting where unpredictable medical crises occur periodically is however challenging. Our study aimed to investigate the perceptions of ICU health care professionals regarding how acute medical crises affect their team interactions. We conducted 25 semi-structured interviews of ICU nurses, staff physicians, and respiratory therapists. All interviews were audio-taped and transcribed, and the analysis was undertaken using an inductive thematic approach. Our data indicated that the nature of interprofessional interactions changed as teams passed through three key temporal periods around medical crises. During the "pre-crisis period", interactions were based on the mutual respect of each other's expertise. During the "crisis period", hierarchical interactions were expected and a certain lack of civility was tolerated. During the "post-crisis period", divergent perceptions emerged amongst health professionals. Post-crisis team dispersion left the nurses with questions and emotions not expressed by other team members. Nurses believed that systematic interprofessional feedback sessions held immediately after a crisis could address some of their needs. Further research is needed to establish the possible benefits of strategies addressing ICU health care professionals' specific needs for interprofessional feedback after a medical crisis.

Ambient Noise Levels in Acute Neonatal Intensive Care Unit of a Tertiary Referral Hospital

OpenAIRE

Sonia R. B D'Souza; Leslie Edward Lewis; Vijay Kumar; Ramesh Bhat Y; Jayashree Purkayastha; Hari Prakash

2017-01-01

Background: Advances in neonatal care have resulted in improved survival of neonates admitted to the intensive care of the Neonatal Intensive Care Unit (NICU). However, the NCU may be an inappropriate milieu, with presence of overwhelming stimuli, most potent being the continuous presence of noise in the ambience of the NICU. Aim and Objectives: To determine and describe the ambient noise levels in the acute NICU of a tertiary referral hospital. Material and Methods...

Chernobyl: response of medical physics departments in the United Kingdom

Energy Technology Data Exchange (ETDEWEB)

Haywood, J K

1986-01-01

This conference drew attention to gaps in United Kingdom arrangements for dealing with the effects (both supposed and real) of accidents at civil nuclear installations on the populations which surround them; it showed how, in the case of the Chernobyl accident, Medical Physicists in the National Health Service responded to plug these gaps in spite of the organisational difficulties which the crisis presented; and it suggested a method of incorporating this hitherto underestimated resource into national planning for civil nuclear accidents. Reports are included from Newcastle, Charing Cross Hospital, The London Hospital, Cambridge, Westminster Hospital, Leeds, Liverpool, Cardiff, Canterbury, Swansea (environmental measurements) and Mount Vernon.

Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999–2010

Science.gov (United States)

Bachhuber, Marcus A.; Saloner, Brendan; Cunningham, Chinazo O.; Barry, Colleen L.

2015-01-01

IMPORTANCE Opioid analgesic overdose mortality continues to rise in the United States, driven by increases in prescribing for chronic pain. Because chronic pain is a major indication for medical cannabis, laws that establish access to medical cannabis may change overdose mortality related to opioid analgesics in states that have enacted them. OBJECTIVE To determine the association between the presence of state medical cannabis laws and opioid analgesic overdose mortality. DESIGN, SETTING, AND PARTICIPANTS A time-series analysis was conducted of medical cannabis laws and state-level death certificate data in the United States from 1999 to 2010; all 50 states were included. EXPOSURES Presence of a law establishing a medical cannabis program in the state. MAIN OUTCOMES AND MEASURES Age-adjusted opioid analgesic overdose death rate per 100 000 population in each state. Regression models were developed including state and year fixed effects, the presence of 3 different policies regarding opioid analgesics, and the state-specific unemployment rate. RESULTS Three states (California, Oregon, and Washington) had medical cannabis laws effective prior to 1999. Ten states (Alaska, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Rhode Island, and Vermont) enacted medical cannabis laws between 1999 and 2010. States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate (95% CI, −37.5% to −9.5%; P = .003) compared with states without medical cannabis laws. Examination of the association between medical cannabis laws and opioid analgesic overdose mortality in each year after implementation of the law showed that such laws were associated with a lower rate of overdose mortality that generally strengthened over time: year 1 (−19.9%; 95% CI, −30.6% to −7.7%; P = .002), year 2 (−25.2%; 95% CI, −40.6% to −5.9%; P = .01), year 3 (−23.6%; 95% CI, −41.1% to −1.0%; P = .04), year 4 (−20.2%; 95% CI, −33.6% to −4

Does reporting of plain chest radiographs affect the immediate management of patients admitted to a medical assessment unit?

International Nuclear Information System (INIS)

Grosvenor, L.J.; Verma, R.; O'Brien, R.; Entwisle, J.J.; Finlay, D.

2003-01-01

AIM: The purpose of our study was to investigate whether reporting of plain chest radiographs affects immediate management of patients admitted to a medical assessment unit. MATERIALS AND METHODS: During a 3 month period we prospectively evaluated 200 patients who had a plain chest radiograph on admission. After the post on-call ward round, an independent medical specialist registrar reviewed the notes, retrieving relevant clinical details. The plain chest films were reported independently by a trainee radiologist and consultant, reaching a consensus report. RESULTS: There was 93% agreement between trainee and consultant radiologists (95% CI=89-96%). Seventy percent had documented reports by the on-call medical team. There was disagreement between radiology and medical reports in 49% of reported films (95% CI=40-57%). The radiologist's report led to a direct change in the immediate management of 22 patients (11%). CONCLUSION: Only 70% of films had documented reports in the clinical notes despite this being a legal requirement. Radiology reporting does cause a direct change in patient management. Chest radiographs of patients admitted to a medical admissions unit should be reported by a radiologist with the minimum of delay

Usage patterns of stop smoking medications in Australia, Canada, the United Kingdom, and the United States: findings from the 2006-2008 International Tobacco Control (ITC) Four Country Survey.

Science.gov (United States)

Fix, Brian V; Hyland, Andrew; Rivard, Cheryl; McNeill, Ann; Fong, Geoffrey T; Borland, Ron; Hammond, David; Cummings, K Michael

2011-01-01

Varenicline is a new prescription stop smoking medication (SSM) that has been available in the United States since August 1, 2006, in the United Kingdom and other European Union countries since December 5, 2006, in Canada since April 12, 2007, and in Australia since January 1, 2008. There are few population-based studies that have examined use rates of varenicline and other stop smoking medications. We report data from the ITC Four Country survey conducted with smokers in the US, UK, Canada, and Australia who reported an attempt to quit smoking in past year in the 2006 survey (n = 4,022 participants), 2007 (n = 3,790 participants), and 2008 surveys (n = 2,735 participants) Respondents reported use of various stop smoking medications to quit smoking at each survey wave, along with demographic and smoker characteristics. The self-reported use of any stop smoking medication has increased significantly over the 3 year period in all 4 countries, with the sharpest increase occurring in the United States. Varenicline has become the second most used stop smoking medication, behind NRT, in all 4 countries since being introduced. Between 2006 and 2008, varenicline use rates increased from 0.4% to 21.7% in the US, 0.0% to 14.8% in Canada, 0.0% to 14.5% in Australia, and 0.0% to 4.4% in the UK. In contrast, use of NRT and bupropion remained constant in each country. Males and non-whites were significantly less likely to report using any SSM, while more educated smokers were significantly more likely to use any SSM, including varenicline. Our findings suggest that the introduction of varenicline led to an increase in the number of smokers who used evidence-based treatment during their quit attempts, rather than simply gaining market share at the expense of other medications. From a public health perspective, messages regarding increased success rates among medication users and the relative safety of stop smoking medications should be disseminated widely so as to reach all

Paediatric medical emergency calls to a Danish Emergency Medical Dispatch Centre

DEFF Research Database (Denmark)

Andersen, Kasper; Mikkelsen, Søren; Jørgensen, Gitte

2018-01-01

with a supporting physician-manned mobile emergency care unit (56.4%). The classification of medical issues and the dispatched pre-hospital units varied with patient age. DISCUSSION: We believe our results might help focus the paediatric training received by emergency medical dispatch staff on commonly encountered......BACKGROUND: Little is known regarding paediatric medical emergency calls to Danish Emergency Medical Dispatch Centres (EMDC). This study aimed to investigate these calls, specifically the medical issues leading to them and the pre-hospital units dispatched to the paediatric emergencies. METHODS: We...... records to establish how the medical issues leading to these calls were classified and which pre-hospital units were dispatched to the paediatric emergencies. We analysed the data using descriptive statistics. RESULTS: Of a total of 7052 emergency calls in February 2016, 485 (6.9%) concerned patients ≤ 15...

[Polish medical ethics in the period 1945-1980].

Science.gov (United States)

Wichrowski, Marek

2003-01-01

The purpose of this article is o present that main currents of Polish medical ethics in the years 1945-1980, which the author treats as the 'prehistory' of Poland's contemporary bioethics. The author begins by ascertaining the post-war disappearance of two Polish traditions--that of the Warsaw school of philosopher-physicians (known in the West as the Polish School of Philosophy of Medicine) and the Lwów-Warsaw School of Philosophy. The political system that come into being after 1945 was not conducive to the development of medical ethics, but several clear orientations may be discerned in the utterances of physicians, lawyers, moral technologlans and academic philosophers. The analysis begins with Catholic ethics in its archaic 1950s-vintage form. The author then presents the thinking of ethicians Independent of both the Church and Marxism (the milieu of the journal 'Etyka') as well as the deontological writings of physicians.

Library instruction in medical education: a survey of current practices in the United States and Canada.

Science.gov (United States)

Nevius, Amanda M; Ettien, A'Llyn; Link, Alissa P; Sobel, Laura Y

2018-01-01

The most recent survey on instruction practices in libraries affiliated with accredited medical institutions in the United States was conducted in 1996. The present study sought to update these data, while expanding to include Canadian libraries. Additional analysis was undertaken to test for statistically significant differences between library instruction in the United States and Canada and between libraries affiliated with highly ranked and unranked institutions. A twenty-eight-question survey was distributed to libraries affiliated with accredited US and Canadian medical schools to assess what and how often librarians teach, as well as how librarians are involved in the curriculum committee and if they are satisfied with their contact with students and faculty. Quantitative data were analyzed with SAS, R, and MedCalc. Most of the seventy-three responding libraries provided instruction, both asynchronously and synchronously. Library instruction was most likely to be offered in two years of medical school, with year one seeing the most activity. Database use was the most frequently taught topic, and libraries reported a median of five librarians providing instruction, with larger staffs offering slightly more education sessions per year. Libraries associated with highly ranked schools were slightly more likely to offer sessions that were integrated into the medical school curriculum in year four and to offer sessions in more years overall. In US and Canadian libraries, regardless of the rank of the affiliated medical school, librarians' provision of instruction in multiple formats on multiple topics is increasingly common.

A comparison of medical education in Germany and the United States: from applying to medical school to the beginnings of residency.

Science.gov (United States)

Zavlin, Dmitry; Jubbal, Kevin T; Noé, Jonas G; Gansbacher, Bernd

2017-01-01

Both Germany and the United States of America have a long tradition of science and medical excellence reaching back as far as the nineteenth century. The same tribute must be paid to the medical educational system in both countries. Despite significant initial similarities and cross-inspiration, the paths from enrolling in a medical university to graduating as a medical doctor in Germany and the US seem to have become much different. To fill a void in literature, the authors' objective therefore is to delineate both structures of medical education in an up-to-date review and examine their current differences and similarities. Recent medical publications, legal guidelines of governmental or official organizations, articles in media, as well as the authors' personal experiences are used as sources of this report. Tuition loans of over $200,000 are not uncommon for students in the US after graduating from medical schools, which are often private institutions. In Germany, however, the vast majority of medical universities are tax-funded and, for this reason, free of tuition. Significant differences and surprisingly multiple similarities exist between these two systems, despite one depending on government and the other on private organizations. Germany currently employs an integrated medical curriculum that typically begins right after high school and consists of a 2-year long pre-clinical segment teaching basic sciences and a 4-year clinical segment leading medical students to the practical aspects of medicine. On the other hand, the US education is a two-stage process. After successful completion of a Bachelor's degree in college, an American student goes through a 4-year medical program encompassing 2 years of basic science and 2 years of clinical training. In this review, we will address some of these similarities and major differences.

Noise exposure during prehospital emergency physicians work on Mobile Emergency Care Units and Helicopter Emergency Medical Services

DEFF Research Database (Denmark)

Hansen, Mads Christian Tofte; Schmidt, Jesper Hvass; Brøchner, Anne C

2017-01-01

BACKGROUND: Prehospital personnel are at risk of occupational hearing loss due to high noise exposure. The aim of the study was to establish an overview of noise exposure during emergency responses in Mobile Emergency Care Units (MECU), ambulances and Helicopter Emergency Medical Services (HEMS)....... initiatives. Although no hearing loss was demonstrated in the personnel of the ground-based units, a reduced function of the outer sensory hair cells was found in the HEMS group following missions.......BACKGROUND: Prehospital personnel are at risk of occupational hearing loss due to high noise exposure. The aim of the study was to establish an overview of noise exposure during emergency responses in Mobile Emergency Care Units (MECU), ambulances and Helicopter Emergency Medical Services (HEMS......). A second objective was to identify any occupational hearing loss amongst prehospital personnel. METHODS: Noise exposure during work in the MECU and HEMS was measured using miniature microphones worn laterally to the auditory canals or within the earmuffs of the helmet. All recorded sounds were analysed...

Moral distress among nurses in medical, surgical and intensive-care units.

Science.gov (United States)

Lusignani, Maura; Giannì, Maria Lorella; Re, Luca Giuseppe; Buffon, Maria Luisa

2017-09-01

To assess the frequency, intensity and level of moral distress perceived by nurses working in medical, surgical and intensive care units. Moral distress among nurses compromises their ability to provide optimal patient care and may cause them to leave their job. A cross-sectional questionnaire survey of 283 registered nurses was conducted to evaluate the frequency, intensity and levels of moral distress. A revised version of the Moral Distress Scale (MDS-R) was used. The highest level of moral distress was associated with the provision of treatments and aggressive care that were not expected to benefit the patients and the competency of the health-care providers. Multivariate regression showed that nurses working in medical settings, nurses with lower levels of experience working in medical, surgical or intensive care settings, and nurses who intend to leave their job experienced the highest levels of moral distress. The present study indicates that nurses experience an overall moderate level of moral distress. Gaining further insight into the issue of moral distress among nurses and the clinical situations that most frequently cause this distress will enable development of strategies to reduce moral distress and to improve nurse satisfaction and, consequently, patient care. © 2016 John Wiley & Sons Ltd.

La réflexion des ondes électromagnétiques du milieu de gyrotropie anisotrope, avec un axe d'anisotropie et un angle d'incidence arbitraires

Science.gov (United States)

Tchalyk, A.

1994-01-01

The interaction of plane electromagnetic wave with half-infinit gyrotropic media for different directions of propagation of incident microwave radiation and various directions of gyrotropic axis are investigated. The equations for calculation of wave's parameters exited in media and reflected from media-surface are obtained. On étudie l'interaction d'une onde électromagnétique plane avec un milieu gyrotrope à demi-infini dans le cas d'une direction arbitraire de propagation de la radiation électromagnétique incidente et de l'axe de gyrotropie. On a obtenu des expressions permettant de calculer les caractéristiques des ondes excitées dans et par le milieu.

The implementation and evaluation of cognitive milieu therapy for dual diagnosis inpatients: A pragmatic clinical trial

DEFF Research Database (Denmark)

Lykke, Jørn; Oestrich, Irene; Austin, Stephen

2010-01-01

milieu therapy (CMT) among a group of dual diagnosis inpatients. CMT is an integrated treatment for both mental illness and substance abuse based on cognitive behavioral principles and carried out within a supportive inpatient environment. A convenience sample of dual diagnosis inpatients (N = 136......Dual diagnosis is chronic psychiatric condition involving serious mental illness and substance abuse. Experts recommend the integration of treatment for concurrent substance abuse and serious psychiatric problems. The following pragmatic trial examined the implementation and outcomes of cognitive...

The problematization of medical tourism: a critique of neoliberalism.

Science.gov (United States)

Smith, Kristen

2012-04-01

The past two decades have seen the extensive privatisation and marketisation of health care in an ever reaching number of developing countries. Within this milieu, medical tourism is being promoted as a rational economic development strategy for some developing nations, and a makeshift solution to the escalating waiting lists and exorbitant costs of health care in developed nations. This paper explores the need to problematize medical tourism in order to move beyond one dimensional neoliberal discourses that have, to date, dominated the arena. In this problematization, the paper discusses a range of understandings and uses of the term 'medical tourism' and situates it within the context of the neoliberal economic development of health care internationally. Drawing on theory from critical medical anthropology and health and human rights perspectives, the paper critically analyzes the assumed independence between the medical tourism industry and local populations facing critical health issues, where social, cultural and economic inequities are widening in terms of access, cost and quality of health care. Finally, medical tourism is examined in the local context of India, critiquing the increasingly indistinct roles played by government and private sectors, whilst linking these shifts to global market forces. © 2012 Blackwell Publishing Ltd.

Neutrophils alter the inflammatory milieu by signal-dependent translation of constitutive messenger RNAs

Science.gov (United States)

Lindemann, Stephan W.; Yost, Christian C.; Denis, Melvin M.; McIntyre, Thomas M.; Weyrich, Andrew S.; Zimmerman, Guy A.

2004-05-01

The mechanisms by which neutrophils, key effector cells of the innate immune system, express new gene products in inflammation are largely uncharacterized. We found that they rapidly translate constitutive mRNAs when activated, a previously unrecognized response. One of the proteins synthesized without a requirement for transcription is the soluble IL-6 receptor , which translocates to endothelial cells and induces a temporal switch to mononuclear leukocyte recruitment. Its synthesis is regulated by a specialized translational control pathway that is inhibited by rapamycin, a bacterial macrolide with therapeutic efficacy in transplantation, inflammatory syndromes, and neoplasia. Signal-dependent translation in activated neutrophils may be a critical mechanism for alteration of the inflammatory milieu and a therapeutic target.

Medical Terminology of the Circulatory System. Medical Records. Instructional Unit for the Medical Transcriber.

Science.gov (United States)

Gosman, Minna L.

Developed as a result of an analysis of the task of transcribing as practiced in a health facility, this study guide was designed to teach the knowledge and skills required of a medical transcriber. The medical record department was identified as a major occupational area, and a task inventory for medical records was developed and used as a basis…

Medical Terminology of the Respiratory System. Medical Records. Instructional Unit for the Medical Transcriptionist.

Science.gov (United States)

Gosman, Minna L.

Following an analysis of the task of transcribing as practiced in a health facility, this study guide was designed to teach the knowledge and skills required of a medical transcriber. The medical record department was identified as a major occupational area, and a task inventory for medical records was developed and used as a basis for…

Medical Terminology of the Musculoskeletal System. Medical Records. Instructional Unit for the Medical Transcriber.

Science.gov (United States)

Gosman, Minna L.

Following an analysis of the task of transcribing as practiced in a health facility, this study guide was developed to teach the knowledge and skills required of a medical transcriber. The medical record department was identified as a major occupational area, and a task inventory for medical records was developed and used as a basis for a…

Pharmacist Remote Review of Medication Prescriptions for Appropriateness in Pediatric Intensive Care Unit.

Science.gov (United States)

Lazaryan, Moran; Abu-Kishk, Ibrahim; Rosenfeld-Yehoshua, Noa; Berkovitch, Sofia; Toledano, Michal; Reshef, Iris; Kanari, Tal; Ziv-Baran, Tomer; Berkovitch, Matitiahu

2016-01-01

One aspect of ordering and prescribing medication is the requirement for a trained professional to review medication orders or prescriptions for appropriateness. In practice, this review process is usually performed by a clinical pharmacist. However, in many medical centers there is a shortage of staff and a pharmacist is not always available. To determine whether remote review of medication orders by a pharmacist is a plausible method in a pediatric intensive care unit (PICU). A pharmacist from the pharmacy department reviewed medication orders of patients admitted to our PICU over a 7-month period for appropriateness. A special form for medical orders was filled in and sent to the physician in the PICU, who replied informing whether the recommendation had been accepted. The time spent by the pharmacist for this activity was recorded. The review time for one medical record was 8.9 (95% CI, 6.9-10.9) min. Every additional drug prescribed increased the total review time by 0.8 (95% CI, 0.45-1.11) min. The pharmacist filled in 186 forms on 117 admissions for 109 children. The median review time was 15 (12.8-18.8) and 12 (9-15) min, respectively, for patients with psychiatric-neurologic disorders compared to those without (p = 0.032). Usually, a daily workload of 240 min was needed for the pharmacist accompanying the round in contrast to 108 min per day needed to review all the medical records in 95% of the cases. The physician accepted 51.2%, rejected 11.9%, and made no comment on 36.9% of the recommendations. Hospitals facing budget shortages can carry out focused remote reviews of prescriptions by the pharmacist.

Smartphone and medical related App use among medical students and junior doctors in the United Kingdom (UK: a regional survey

Directory of Open Access Journals (Sweden)

Payne Karl Frederick

2012-10-01

Full Text Available Abstract Background Smartphone usage has spread to many settings including that of healthcare with numerous potential and realised benefits. The ability to download custom-built software applications (apps has created a new wealth of clinical resources available to healthcare staff, providing evidence-based decisional tools to reduce medical errors. Previous literature has examined how smartphones can be utilised by both medical student and doctor populations, to enhance educational and workplace activities, with the potential to improve overall patient care. However, this literature has not examined smartphone acceptance and patterns of medical app usage within the student and junior doctor populations. Methods An online survey of medical student and foundation level junior doctor cohorts was undertaken within one United Kingdom healthcare region. Participants were asked whether they owned a Smartphone and if they used apps on their Smartphones to support their education and practice activities. Frequency of use and type of app used was also investigated. Open response questions explored participants’ views on apps that were desired or recommended and the characteristics of apps that were useful. Results 257 medical students and 131 junior doctors responded, equating to a response rate of 15.0% and 21.8% respectively. 79.0% (n=203/257 of medical students and 74.8% (n=98/131 of junior doctors owned a smartphone, with 56.6% (n=115/203 of students and 68.4% (n=67/98 of doctors owning an iPhone. The majority of students and doctors owned 1–5 medical related applications, with very few owning more than 10, and iPhone owners significantly more likely to own apps (Chi sq, p Conclusions This study found a high level of smartphone ownership and usage among medical students and junior doctors. Both groups endorse the development of more apps to support their education and clinical practice.

The exercise-induced biochemical milieu enhances collagen content and tensile strength of engineered ligaments.

Science.gov (United States)

West, Daniel W D; Lee-Barthel, Ann; McIntyre, Todd; Shamim, Baubak; Lee, Cassandra A; Baar, Keith

2015-10-15

Exercise stimulates a dramatic change in the concentration of circulating hormones, such as growth hormone (GH), but the biological functions of this response are unclear. Pharmacological GH administration stimulates collagen synthesis; however, whether the post-exercise systemic milieu has a similar action is unknown. We aimed to determine whether the collagen content and tensile strength of tissue-engineered ligaments is enhanced by serum obtained post-exercise. Primary cells from a human anterior cruciate ligament (ACL) were used to engineer ligament constructs in vitro. Blood obtained from 12 healthy young men 15 min after resistance exercise contained GH concentrations that were ∼7-fold greater than resting serum (P Ligament constructs were treated for 7 days with medium supplemented with serum obtained at rest (RestTx) or 15 min post-exercise (ExTx), before tensile testing and collagen content analysis. Compared with RestTx, ExTx enhanced collagen content (+19%; 181 ± 33 vs. 215 ± 40 μg per construct P = 0.001) and ligament mechanical properties - maximal tensile load (+17%, P = 0.03 vs. RestTx) and ultimate tensile strength (+10%, P = 0.15 vs. RestTx). In a separate set of engineered ligaments, recombinant IGF-1, but not GH, enhanced collagen content and mechanics. Bioassays in 2D culture revealed that acute treatment with post-exercise serum activated mTORC1 and ERK1/2. In conclusion, the post-exercise biochemical milieu, but not recombinant GH, enhances collagen content and tensile strength of engineered ligaments, in association with mTORC1 and ERK1/2 activation. © 2015 The Authors. The Journal of Physiology © 2015 The Physiological Society.

Lormetazepam addiction: data analysis from an Italian medical unit for addiction

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Faccini M

2012-06-01

Full Text Available Marco Faccini,1 Roberto Leone,2 Benedetta Pajusco,1 Gianluca Quaglio,1 Rebecca Casari,1 Anna Albiero,1 Monia Donati,2 Fabio Lugoboni11Department of Internal Medicine, Addiction Unit, 2Pharmacology Unit, Reference Center for Education and Communication within the World Health Organization Program for International Drug Monitoring, University Hospital of Verona, Verona, ItalyBackground: The purpose of this study was to determine, in the context of a hospital addiction unit, which benzodiazepines were abused and to look for correlations with the characteristics of detoxified patients.Methods: A retrospective study was carried out using the database of hospital admissions to the addiction unit for detoxification from 2003 to 2010.Results: Of 879 admissions to the addiction unit during the seven-year period, 281 were for benzodiazepines. The percentage of patients addicted only to benzodiazepines was higher among females than males. Benzodiazepine consumption had started as a drug addiction behavior in only 10% of cases. The main sources of prescription identified were general practitioners (52% of cases or compliant pharmacists (25%. Overall, 15 different benzodiazepines were abused, with lormetazepam being the most commonly used (by 123 patients, 43.8% of the total.Conclusion: Our data show that, outside the population of multidrug addicts, there is an underestimated group of chronic benzodiazepine consumers who are often not referred to medical institutions for treatment. Even in the group of patients addicted to one substance only, we observed an abnormal number of requests for detoxification from lormetazepam, which appears to be more "popular" than other benzodiazepines. This drug should be prescribed according to stricter criteria and submitted to closer control.Keywords: lormetazepam, benzodiazepines, addiction, inpatient detoxification

Medical Device Regulation: A Comparison of the United States and the European Union.

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Maak, Travis G; Wylie, James D

2016-08-01

Medical device regulation is a controversial topic in both the United States and the European Union. Many physicians and innovators in the United States cite a restrictive US FDA regulatory process as the reason for earlier and more rapid clinical advances in Europe. The FDA approval process mandates that a device be proved efficacious compared with a control or be substantially equivalent to a predicate device, whereas the European Union approval process mandates that the device perform its intended function. Stringent, peer-reviewed safety data have not been reported. However, after recent high-profile device failures, political pressure in both the United States and the European Union has favored more restrictive approval processes. Substantial reforms of the European Union process within the next 5 to 10 years will result in a more stringent approach to device regulation, similar to that of the FDA. Changes in the FDA regulatory process have been suggested but are not imminent.

Evaluation of a Medical and Mental Health Unit compared with standard care for older people whose emergency admission to an acute general hospital is complicated by concurrent 'confusion': a controlled clinical trial. Acronym: TEAM: Trial of an Elderly Acute care Medical and mental health unit

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Gladman John RF

2011-05-01

Full Text Available Abstract Background Patients with delirium and dementia admitted to general hospitals have poor outcomes, and their carers report poor experiences. We developed an acute geriatric medical ward into a specialist Medical and Mental Health Unit over an eighteen month period. Additional specialist mental health staff were employed, other staff were trained in the 'person-centred' dementia care approach, a programme of meaningful activity was devised, the environment adapted to the needs of people with cognitive impairment, and attention given to communication with family carers. We hypothesise that patients managed on this ward will have better outcomes than those receiving standard care, and that such care will be cost-effective. Methods/design We will perform a controlled clinical trial comparing in-patient management on a specialist Medical and Mental Health Unit with standard care. Study participants are patients over the age of 65, admitted as an emergency to a single general hospital, and identified on the Acute Medical Admissions Unit as being 'confused'. Sample size is 300 per group. The evaluation design has been adapted to accommodate pressures on bed management and patient flows. If beds are available on the specialist Unit, the clinical service allocates patients at random between the Unit and standard care on general or geriatric medical wards. Once admitted, randomised patients and their carers are invited to take part in a follow up study, and baseline data are collected. Quality of care and patient experience are assessed in a non-participant observer study. Outcomes are ascertained at a follow up home visit 90 days after randomisation, by a researcher blind to allocation. The primary outcome is days spent at home (for those admitted from home, or days spent in the same care home (if admitted from a care home. Secondary outcomes include mortality, institutionalisation, resource use, and scaled outcome measures, including quality of

Usage Patterns of Stop Smoking Medications in Australia, Canada, the United Kingdom, and the United States: Findings from the 2006–2008 International Tobacco Control (ITC Four Country Survey

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David Hammond

2011-01-01

Full Text Available Varenicline is a new prescription stop smoking medication (SSM that has been available in the United States since August 1, 2006, in the United Kingdom and other European Union countries since December 5, 2006, in Canada since April 12, 2007, and in Australia since January 1, 2008. There are few population-based studies that have examined use rates of varenicline and other stop smoking medications. We report data from the ITC Four Country survey conducted with smokers in the US, UK, Canada, and Australia who reported an attempt to quit smoking in past year in the 2006 survey (n = 4,022 participants, 2007 (n = 3,790 participants, and 2008 surveys (n = 2,735 participants Respondents reported use of various stop smoking medications to quit smoking at each survey wave, along with demographic and smoker characteristics. The self-reported use of any stop smoking medication has increased significantly over the 3 year period in all 4 countries, with the sharpest increase occurring in the United States. Varenicline has become the second most used stop smoking medication, behind NRT, in all 4 countries since being introduced. Between 2006 and 2008, varenicline use rates increased from 0.4% to 21.7% in the US, 0.0% to 14.8% in Canada, 0.0% to 14.5% in Australia, and 0.0% to 4.4% in the UK. In contrast, use of NRT and bupropion remained constant in each country. Males and non-whites were significantly less likely to report using any SSM, while more educated smokers were significantly more likely to use any SSM, including varenicline. Our findings suggest that the introduction of varenicline led to an increase in the number of smokers who used evidence-based treatment during their quit attempts, rather than simply gaining market share at the expense of other medications. From a public health perspective, messages regarding increased success rates among medication users and the relative safety of stop smoking medications should be disseminated widely so as to

Factors associated with self-medication among expatriate high school students: a cross-sectional survey in United Arab Emirates

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Syed Ilyas Shehnaz

2013-09-01

Full Text Available The study aimed to assess factors associated with self-medication (SM among expatriate high school students of United Arab Emirates using a validated questionnaire. Most common reasons for self-medication in 324 participating students were: presence of mild illness and previous experiences. High risk practices like altering the dose, discontinuation of medication and self-medication without adult guidance were observed. The likelihood of SM was 4.9 times (95%C.I.: 2.0-12.2 in students not utilizing private healthcare services than those who were utilizing these services. Increased efforts are needed to prevent the risks of self-medication in adolescents through healthcare education for both parents and adolescents.

Rocky milieu: Challenges of effective integration of clinical risk management into hospitals in Iran

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Farokhzadian, Jamileh; Nayeri, Nahid Dehghan; Borhani, Fariba

2015-01-01

Healthcare risks and clinical risks have been recognized as a major challenge in healthcare. Clinical risks can never be eliminated and can have serious adverse effects on patient safety. Thus, a clinical risk management (CRM) system has been introduced in the healthcare system to improve quality services. The aim of this study was to explore nurses’ experiences related to the challenges of implementing CRM in the organizational context. This qualitative study was based on the conventional content analysis of the Lundman and Graneheim approach, and it consisted of 22 interview sessions with 20 nurses. The purposive sampling method was used to choose the participants from three hospitals affiliated with the Kerman University of Medical Sciences. We used semi-structured interviews and review of relevant documents to collect data. The analysis of the data led to the emergence of “rocky milieu” as the main theme, and it consisted of three categories that, along with their subcategories, explain the challenges of implementing CRM. The three categories and their subcategories were (1) organizational culture and leadership challenges (decision and performance of leadership and cultural resistance to change), (2) limitation of resources (financial, human, and physical and equipment resources), and (3) variations and complexities in working conditions (the emotional, psychological, and social atmosphere and the heaviness of workload). Attempts have been made to establish CRM through clinical governance and accreditation, but organizational challenges have created a rocky milieu for implementing CRM. However, from an organizational context concerning the suitability of healthcare in Iran, there are obvious needs to move toward quality improvement and safe practices through the effective implementation of CRM. PMID:25968444

Rocky milieu: Challenges of effective integration of clinical risk management into hospitals in Iran

Directory of Open Access Journals (Sweden)

Jamileh Farokhzadian

2015-05-01

Full Text Available Healthcare risks and clinical risks have been recognized as a major challenge in healthcare. Clinical risks can never be eliminated and can have serious adverse effects on patient safety. Thus, a clinical risk management (CRM system has been introduced in the healthcare system to improve quality services. The aim of this study was to explore nurses’ experiences related to the challenges of implementing CRM in the organizational context. This qualitative study was based on the conventional content analysis of the Lundman and Graneheim approach, and it consisted of 22 interview sessions with 20 nurses. The purposive sampling method was used to choose the participants from three hospitals affiliated with the Kerman University of Medical Sciences. We used semi-structured interviews and review of relevant documents to collect data. The analysis of the data led to the emergence of “rocky milieu” as the main theme, and it consisted of three categories that, along with their subcategories, explain the challenges of implementing CRM. The three categories and their subcategories were (1 organizational culture and leadership challenges (decision and performance of leadership and cultural resistance to change, (2 limitation of resources (financial, human, and physical and equipment resources, and (3 variations and complexities in working conditions (the emotional, psychological, and social atmosphere and the heaviness of workload. Attempts have been made to establish CRM through clinical governance and accreditation, but organizational challenges have created a rocky milieu for implementing CRM. However, from an organizational context concerning the suitability of healthcare in Iran, there are obvious needs to move toward quality improvement and safe practices through the effective implementation of CRM.

Pharmacist Remote Review of Medication Prescriptions for Appropriateness in Pediatric Intensive Care Unit

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Moran Lazaryan

2016-08-01

Full Text Available Background: One aspect of ordering and prescribing medication is the requirement for a trained professional to review medication orders or prescriptions for appropriateness. In practice, this review process is usually performed by a clinical pharmacist. However, in many medical centers there is a shortage of staff and a pharmacist is not always available.Objective: To determine whether remote review of medication orders by a pharmacist is a plausible method in a pediatric intensive care unit (PICU. Methods: A pharmacist from the pharmacy department reviewed medication orders of patients admitted to our PICU over a 7-month period for appropriateness. A special form for medical orders was filled in and sent to the physician in the PICU, who replied informing whether the recommendation had been accepted. The time spent by the pharmacist for this activity was recorded.Results: The review time for one medical record was 8.9 (95% CI, 6.9-10.9 minutes. Every additional drug prescribed increased the total review time by 0.8 (95% CI, 0.45-1.11 minutes. The pharmacist filled in 186 forms on 117 admissions for 109 children. The median review time was 15 (12.8-18.8 and 12 (9-15 minutes, respectively, for patients with psychiatric-neurologic disorders compared to those without (p=0.032. Usually, a daily workload of 240 minutes was needed for the pharmacist accompanying the round in contrast to 108 minutes per day needed to review all the medical records in 95% of the cases. The physician accepted 51.2%, rejected 11.9% and made no comment on 36.9% of the recommendations. Conclusion: Hospitals facing budget shortages can carry out focused remote reviews of prescriptions by the pharmacist.

CAR T cell therapy for breast cancer: harnessing the tumor milieu to drive T cell activation.

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Bajgain, Pradip; Tawinwung, Supannikar; D'Elia, Lindsey; Sukumaran, Sujita; Watanabe, Norihiro; Hoyos, Valentina; Lulla, Premal; Brenner, Malcolm K; Leen, Ann M; Vera, Juan F

2018-05-10

The adoptive transfer of T cells redirected to tumor via chimeric antigen receptors (CARs) has produced clinical benefits for the treatment of hematologic diseases. To extend this approach to breast cancer, we generated CAR T cells directed against mucin1 (MUC1), an aberrantly glycosylated neoantigen that is overexpressed by malignant cells and whose expression has been correlated with poor prognosis. Furthermore, to protect our tumor-targeted cells from the elevated levels of immune-inhibitory cytokines present in the tumor milieu, we co-expressed an inverted cytokine receptor linking the IL4 receptor exodomain with the IL7 receptor endodomain (4/7ICR) in order to transform the suppressive IL4 signal into one that would enhance the anti-tumor effects of our CAR T cells at the tumor site. First (1G - CD3ζ) and second generation (2G - 41BB.CD3ζ) MUC1-specific CARs were constructed using the HMFG2 scFv. Following retroviral transduction transgenic expression of the CAR±ICR was assessed by flow cytometry. In vitro CAR/ICR T cell function was measured by assessing cell proliferation and short- and long-term cytotoxic activity using MUC1+ MDA MB 468 cells as targets. In vivo anti-tumor activity was assessed using IL4-producing MDA MB 468 tumor-bearing mice using calipers to assess tumor volume and bioluminescence imaging to track T cells. In the IL4-rich tumor milieu, 1G CAR.MUC1 T cells failed to expand or kill MUC1+ tumors and while co-expression of the 4/7ICR promoted T cell expansion, in the absence of co-stimulatory signals the outgrowing cells exhibited an exhausted phenotype characterized by PD-1 and TIM3 upregulation and failed to control tumor growth. However, by co-expressing 2G CAR.MUC1 (signal 1 - activation + signal 2 - co-stimulation) and 4/7ICR (signal 3 - cytokine), transgenic T cells selectively expanded at the tumor site and produced potent and durable tumor control in vitro and in vivo. Our findings demonstrate the feasibility of targeting breast

The medical examination in United States immigration applications: the potential use of genetic testing leads to heightened privacy concerns.

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Burroughs, A Maxwell

2005-01-01

The medical examination has been an integral part of the immigration application process since the passing of the Immigration Act of 1891. Failing the medical examination can result in denial of the application. Over the years the medical examination has been expanded to include questioning about diseases that are scientifically shown to be rooted in an individual's genetic makeup. Recent advances in the fields of genomics and bioinformatics are making accurate and precise screening for these conditions a reality. Government policymakers will soon be faced with decisions regarding whether or not to sanction the use of these newly-developed genetic tests in the immigration application procedure. The terror threat currently facing the United States may ultimately bolster the argument in favor of genetic testing and/or DNA collection of applicants. However, the possibility of a government mandate requiring genetic testing raises a host of ethical issues; including the threat of eugenics and privacy concerns. Genetic testing has the ability to uncover a wealth of sensitive medical information about an individual and currently there are no medical information privacy protections afforded to immigration applicants. This article examines the potential for genetic testing in the immigration application process and the ethical issues surrounding this testing. In particular, this article explores the existing framework of privacy protections afforded to individuals living in the United States and how this and newly-erected standards like those released by the Health and Human Services (HHS) might apply to individuals seeking to immigrate to the United States.

Exchange sex among people receiving medical care for HIV in the United States - medical monitoring project 2009-2013.

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Olaiya, Oluwatosin; Nerlander, Lina; Mattson, Christine L; Beer, Linda

2018-04-20

Many studies of persons who exchange sex for money or drugs have focused on their HIV acquisition risk, and are often limited to select populations and/or geographical locations. National estimates of exchange sex among people living with HIV (PLWH) who are in medical care, and its correlates, are lacking. To address these gaps, we analyzed data from the Medical Monitoring Project, a surveillance system that produces nationally representative estimates of behavioral and clinical characteristics of PLWH receiving medical care in the United States, to estimate the weighted prevalence of exchange sex overall, and by selected socio-demographic, behavioral and clinical characteristics. We found 3.6% of sexually active adults reported exchange sex in the past 12 months. We found a higher prevalence of exchange sex among transgender persons, those who experienced homelessness, and those with unmet needs for social and medical services. Persons who exchanged sex were more likely to report depression and substance use than those who did not exchange sex. We found a higher prevalence of sexual behaviors that increase the risk of HIV transmission and lower viral suppression among persons who exchanged sex. PLWH who exchanged sex had a higher prevalence of not being prescribed ART, and not being ART adherent than those who did not exchange sex. We identify several areas for intervention, including: provision of or referral to services for unmet needs (such as housing or shelter), enhanced delivery of mental health and substance abuse screening and treatment, risk-reduction counseling, and ART prescription and adherence support services.

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

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Christopher E. McCoy

2014-11-01

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

The United States facing their petroleum dependence; Les Etats-Unis face a leur dependance petroliere

Energy Technology Data Exchange (ETDEWEB)

Noel, P. [Institut francais des Relations Internationals, 75 - Paris (France); Universite Pierre Mendes-France-IEPE-CNRS, 38 - Grenoble (France)

2002-06-01

In the framework of ''the energy crisis of 2000-2001'', the Cheney report and the petroleum dependence, this study presents a critical examination of the United States petroleum situation, its perception in the american political milieu and the public policies implementing during the last ten years. The first section is devoted to the petroleum supply. In the second section, the american petroleum policy and the energy safety are studied. (A.L.B.)

[Helicopters and medical first aid units. Role of Medical First Aid Unit 94].

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Huguenard, P; Hanote, P; Metrot, J

1975-10-01

For the transport of injured and sick patients, the helicopter (even the mono-turbine type) offers greater advantages when compared to land vehicles: - more comfort (less vibrations, accelerations and decelerations); - a greater speed, that is to say a 61 p. 100 gain of time upon the distance and a gain from 29 up to 44 p. 100 upon the total amount of time taken up by each transport. This gain in time enables valuable specialised medical teams to be more available: - more precise time-tables than by land which namely makes it easier to receive the patients. The drawbacks are linked with the risks which are not nonexistent but rather less serious than by land. The drawbacks also depend upon the weather-conditions (although this factor does not matter much in our area), upon nuisances such as the noise (which is more important but far more transitory than by ambulance) and chiefly upon the cost of air-transport. In fact, the mean cost of a medical land transport amounts roughly to one thousand Francs, a quarter of which only does represent the actual cost of medical aid. For a similar transport, the helicopter comes to a 47 mns flight. There are several ways of making good use of a helicopter. Practical problems have been solved. The "SAMU 94" experience goes back to 1973 and includes over 500 transports by helicopter essentially with the help of the teams and the helicopters belonging to the Paris Base (Civil Protection and the Fire-Brigade). For flights over urban areas, it is to be desired in the future that only twin-turbine helicopters should be used.

The implementation and evaluation of cognitive milieu therapy for dual diagnosis inpatients: A pragmatic clinical trial

DEFF Research Database (Denmark)

Lykke, Jørn; Oestrich, I.; Austin, Stephen

2010-01-01

milieu therapy (CMT) among a group of dual diagnosis inpatients. CMT is an integrated treatment for both mental illness and substance abuse based on cognitive behavioral principles and carried out within a supportive inpatient environment. A convenience sample of dual diagnosis inpatients (N = 136......) was assessed pre- and post-intervention from an inpatient setting where CMT was the mode of treatment. Psychopathology was measured using the Brief Psychiatric Rating Scale and substance abuse measured with the DrugCheck scale, breath/urine samples, and the Severity of Dependence Scale. Functioning...

First trimester medication abortion practice in the United States and Canada.

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Heidi E Jones

Full Text Available We conducted a cross-sectional survey of abortion facilities from professional networks in the United States (US, n = 703 and Canada (n = 94 to estimate the prevalence of medication abortion practices in these settings and to look at regional differences. Administrators responded to questions on gestational limits, while up to five clinicians per facility reported on 2012 medication abortion practice. At the time of fielding, mifepristone was not approved in Canada. 383 (54.5% US and 78 (83.0% Canadian facilities participated. In the US, 95.3% offered first trimester medication abortion compared to 25.6% in Canada. While 100% of providers were physicians in Canada, just under half (49.4% were advanced practice clinicians in the US, which was more common in Eastern and Western states. All Canadian providers used misoprostol; 85.3% with methotrexate. 91.4% of US providers used 200 mg of mifepristone and 800 mcg of misoprostol, with 96.7% reporting home misoprostol administration. More than three-quarters of providers in both countries required an in-person follow-up visit, generally with ultrasound. 87.7% of US providers routinely prescribed antibiotics compared to 26.2% in Canada. Nonsteroidal anti-inflammatory drugs were the most commonly reported analgesic, with regional variation in opioid narcotic prescription. In conclusion, medication abortion practice follows evidence-based guidelines in the US and Canada. Efforts to update practice based on the latest evidence for reducing in-person visits and increasing provision by advanced practice clinicians could strengthen these services and reduce barriers to access. Research is needed on optimal antibiotic and analgesic use.

The Effects of Korean Medical Service Quality and Satisfaction on Revisit Intention of the United Arab Emirates Government Sponsored Patients.

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Lee, Seoyoung; Kim, Eun-Kyung

2017-06-01

The purpose of this study was to investigate medical service quality, satisfaction and to examine factors influencing hospital revisit intention of the United Arab Emirates government sponsored patients in Korea. A total of 152 UAE government sponsored patients who visited Korean hospitals participated in the questionnaire survey from August to November 2016. Stepwise multiple regression was used to identify the factors that affected the revisit intention of the participants. The mean scores of medical service quality, satisfaction, and revisit intention were 5.72 out of 7, 88.88 out of 100, 4.59 out of 5, respectively. Medical service quality and satisfaction, Medical service quality and revisit intention, satisfaction and revisit intention were positively correlated. Medical service of physician, visiting routes and responsiveness of medical service quality explained about 23.8% of revisit intention. There are needs for physicians to communicate with patients while ensuring sufficient consultation time based on excellent medical skills and nurses to respond immediately for the patients' needs through an empathic encounter in order to improve medical service quality and patient satisfaction so that to increase the revisit intention of the United Arab Emirates government sponsored patients. Further, it is necessary for the hospitals to have support plans for providing country specialized services in consideration of the UAE culture to ensure that physicians' and nurses' competencies are not undervalued by non-medical service elements such as interpreters and meals. Copyright © 2017. Published by Elsevier B.V.

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

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

2010-01-01

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

Ethical issues in advertising and promotion of medical units.

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Solomon, Maria; Radu, Gabriel; Hostiuc, Marinela; Margan, M Madalin; Bulescu, I Alexandru; Purcarea, Victor Lorin

2016-01-01

Bioethics tries to define the medical activity and any other related activity needed to maintain the function of a health institution, through the development of principles and moral values. Bioethics is quite broad and has a background that combines various disciplines such as medicine, philosophy, law, sociology, and theology. Advertising and promotion are part of the strategy aimed at developing and maintaining relationships with the targeted audience (patients). To regulate this activity, it was necessary to develop ethical rules of healthcare marketing. The content of promotional messages must be truthful and should not create unjustified expectations. The doctor or the healthcare unit must be able to provide the services claimed in the advertisement. From an ethical point of view, marketing communication should be more consistent with reality, even if its purpose is to shed light on more attractive issues. In this context, the categories and groups vulnerable to certain content of the advertising message should be mentioned. A patient with a serious suffering will be easily influenced and will tend to trust any promise easily, with the desire to heal. Ethically, the information presented must not alter the reality and should not give false hopes to patients. Those responsible for marketing in the healthcare field must keep in mind the ethics code of the medical profession, must maintain an honest marketing communication, which does not create inaccurate expectations, must not denigrate other colleagues, and must use a message whose content should respect the dignity of the profession.

[Children's medically complex diseases unit. A model required in all our hospitals].

Science.gov (United States)

Climent Alcalá, Francisco José; García Fernández de Villalta, Marta; Escosa García, Luis; Rodríguez Alonso, Aroa; Albajara Velasco, Luis Adolfo

2018-01-01

The increase in survival of children with severe diseases has led to the rise of children with chronic diseases, sometimes with lifelong disabilities. In 2008, a unit for the specific care of medically complex children (MCC) was created in Hospital La Paz. To describe the work and care activities of this Unit. Patients and methods An analysis was performed on all discharge reports of the Unit between January 2014 and July 2016. The MCC Unit has 6 beds and daily outpatient clinic. A total of 1,027 patients have been treated since the creation of the unit, with 243 from 2014. The median age was 24.2 months (IQ: 10.21-84.25). The large majority (92.59%) have multiple diseases, the most frequent chronic conditions observed were neurological (76.95%), gastrointestinal (63.78%), and respiratory diseases (61.72%). More than two-thirds (69.54%) of MCC are dependent on technology, 53.49% on respiratory support, and 35.80% on nutritional support. Hospital admission rates have increased annually. There have been 403 admissions since 2014, of which 8.93% were re-admissions within 30 days of hospital discharge. The median stay during 2014-2016 was 6 days (IQ: 3-14). The occupancy rate has been above 100% for this period. Currently, 210 patients remain on follow-up (86.42%), and 11 children (4.53%) were discharged to their referral hospitals. The mortality rate is 9.05% (22 deaths). The main condition of these 22 patients was neurological (9 patients). Infectious diseases were the leading cause of death. MCC should be treated in specialized units in tertiary or high-level hospitals. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Integral sustainable development: The example of local geographic milieu

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Vujadinović Snežana

2010-01-01

Full Text Available The local geographic milieu plays a significant role in development of every man because of its orientation in space, a sense of security and belonging to the community and the place where he lives or who perform his activities. In other words, one needs to fall in a particular social group that inhabits an area or to perform some activities able in a space, because that is something that stands out from the rest of the world and marking his individuality. The main long-term goal of development of each local community is to increase the quality of life of all its members, job creation, integration of the local community in a wider social system through health, educational and cultural institutions, creating a network of relationships and connections and correlations of all the actors from the state and public sector up to private enterprise, local authorities and local associations. Of particular importance for Serbia, is a question of development of local rural communities, which is closely linked to issues of sustainable and balanced spatial, socio-economic and demographic development. This issue becomes more important in efforts to prevent existing urban-centric trends and highlighted the economic and demographic polarization of Serbia. .

Barriers to Exercise in Younger and Older Non-Exercising Adult Women: A Cross Sectional Study in London, United Kingdom

OpenAIRE

Ansari, Walid El; Lovell, Geoff

2009-01-01

A survey of 100 women in the south of London, United Kingdom (UK) compared exercise barrier intensities between non-exercising younger (20-27 years) and older (28-35 years) adult women; and examined childcare duties as perceived barriers to exercise. Perceived barriers to exercise were examined using an Exercise Benefits/Barriers Scale (EBBS) comprising four subscales (exercise milieu; time expenditure; physical exertion; family discouragement). Participants’ number of children was also noted...

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

Science.gov (United States)

Watkins, Terri; Whisman, Lynn; Booker, Pamela

2016-01-01

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

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

Science.gov (United States)

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

2017-12-01

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

Enterococcal bacteremia is associated with prolonged stay in the medical intensive care unit

Directory of Open Access Journals (Sweden)

Viju Moses

2012-01-01

Full Text Available Background: Although enterococci are relatively common nosocomial pathogens in surgical intensive care units (ICUs, their significance in blood cultures from patients in the medical ICU is unclear. Materials and Methods: In this retrospective study spanning 2 years, the clinical and microbiological characteristics of enterococcal bacteremia among medical ICU patients were evaluated. Results: Of 1325 admissions, 35 with enterococcal bacteremia accounted for 14.8% of positive blood cultures. They were significantly older (P=0.03 and had various co-morbidities. Most had vascular (96.9% and urinary (85.3% catheters, and 67.7% were mechanically ventilated. In addition to blood, enterococci were isolated from vascular catheters (8.6% and other sites (20%, while no focus was identified in 77% of patients. Prior use of broad-spectrum antimicrobials was nearly universal. All isolates tested were sensitive to vancomycin and linezolid. Resistance to ampicillin and gentamicin were 44.7% and 52.6%, respectively. Compared with other medical ICU patients, patients with enterococcal bacteremia had a longer ICU stay (P<0.0001 and a trend toward higher ICU mortality (P=0.08. Conclusions: Enterococcal bacteremia is an important nosocomial infection in the medical ICU, with a predilection for older patients with multiple comorbidities. Its occurrence is associated with a significantly longer ICU stay and a trend to a higher mortality. The choice of antibiotics should be dictated by local susceptibility data.

[Medication errors in a neonatal unit: One of the main adverse events].

Science.gov (United States)

Esqué Ruiz, M T; Moretones Suñol, M G; Rodríguez Miguélez, J M; Sánchez Ortiz, E; Izco Urroz, M; de Lamo Camino, M; Figueras Aloy, J

2016-04-01

Neonatal units are one of the hospital areas most exposed to the committing of treatment errors. A medication error (ME) is defined as the avoidable incident secondary to drug misuse that causes or may cause harm to the patient. The aim of this paper is to present the incidence of ME (including feeding) reported in our neonatal unit and its characteristics and possible causal factors. A list of the strategies implemented for prevention is presented. An analysis was performed on the ME declared in a neonatal unit. A total of 511 MEs have been reported over a period of seven years in the neonatal unit. The incidence in the critical care unit was 32.2 per 1000 hospital days or 20 per 100 patients, of which 0.22 per 1000 days had serious repercussions. The ME reported were, 39.5% prescribing errors, 68.1% administration errors, 0.6% were adverse drug reactions. Around two-thirds (65.4%) were produced by drugs, with 17% being intercepted. The large majority (89.4%) had no impact on the patient, but 0.6% caused permanent damage or death. Nurses reported 65.4% of MEs. The most commonly implicated causal factor was distraction (59%). Simple corrective action (alerts), and intermediate (protocols, clinical sessions and courses) and complex actions (causal analysis, monograph) were performed. It is essential to determine the current state of ME, in order to establish preventive measures and, together with teamwork and good practices, promote a climate of safety. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Mediterranean diet cools down the inflammatory milieu in type 2 diabetes: the MÉDITA randomized controlled trial.

Science.gov (United States)

Maiorino, Maria Ida; Bellastella, Giuseppe; Petrizzo, Michela; Scappaticcio, Lorenzo; Giugliano, Dario; Esposito, Katherine

2016-12-01

Mediterranean-style diets provide cardiovascular benefits and increase insulin sensitivity. There is little evidence that adherence to Mediterranean diet may influence the levels of the inflammatory milieu in type 2 diabetes. The aim of this study was to assess whether Mediterranean diet influences both C-reactive protein (CRP) and adiponectin in newly diagnosed type 2 diabetes, and whether adherence to Mediterranean diet affects their circulating levels. In a two-arm, single-center trial, 215 men and women with newly diagnosed type 2 diabetes were randomized to a Mediterranean diet (n = 108, 54 males and 54 females) or a low-fat diet (n = 107, 52 males and 55 females), with a total follow-up of 8.1 years. At baseline visit and at 1 year, body weight, HOMA index, CRP, and adiponectin and its fractions were assessed. Adherence to the diets was assessed by calculating the Mediterranean-diet score. At 1 year, CPR fell by 37 % and adiponectin rose by 43 % in the Mediterranean diet group, while remaining unchanged in the low-fat diet group. The pattern of adiponectin fractions (high and non-high molecular weight) showed a response similar to that of total adiponectin. Diabetic patients with the highest scores (6-9 points) of adherence to Mediterranean diet had lower circulating CRP level and higher circulating total adiponectin levels than the diabetic patients who scored Mediterranean diet cools down the inflammatory milieu of type 2 diabetes.

Prevalence of GMC performance assessments in the United Kingdom: a retrospective cohort analysis by country of medical qualification

OpenAIRE

Mehdizadeh, L.; Potts, H. W. W.; Sturrock, A.; Dacre, J.

2017-01-01

Background The demographics of doctors working in the UK are changing. The United Kingdom (UK) has voted to leave the European Union (EU) and there is heightened political discourse around the world about the impact of migration on healthcare services. Previous work suggests that foreign trained doctors perform worse than UK graduates in postgraduate medical examinations. We analysed the prevalence by country of primary medical qualification of doctors who were required to take an assessment ...

Sodome à Paris : protohistoire de l’homosexualité masculine fin XVIIIe-milieu XIXe siècle

OpenAIRE

Pastorello, Thierry

2018-01-01

Entre la fin du XVIIIe siècle et jusqu’aux alentours du milieu du XIXe siècle, l’homosexualité masculine, comme catégorie désignant et stigmatisant certains hommes, est en voie de construction. Nous avons pris pour exemple Paris. Ce travail examine ce processus, par un croisement des discours et des vécus. Le cadre parisien offre un laboratoire suffisamment important : les faits d’homosexualité peuvent être observés à travers tout un ensemble de comportements et de pratiques identifiables dan...

Que sait-on de la biodisponibilité des contaminants dissous dans le milieu aquatique ?

Directory of Open Access Journals (Sweden)

GOURLAY-FRANCÉ, Catherine

2010-05-01

Full Text Available La biodisponibilité d'une substance chimique désigne sa capacité à interagir avec les organismes vivants. Nous présentons ici les principaux facteurs environnementaux qui peuvent modifier et contrôler la biodisponibilité des substances chimiques (métaux, contaminants organiques hydrophobes, pesticides dans le milieu aquatique. Trois outils d'échantillonnage intégratifs sont présentés. Ils permettent d'améliorer la caractérisation chimique de l'exposition en se rapprochant de l'évaluation d'une concentration biodisponible, éventuellement intégrée dans le temps. Enfin, la prise en compte de la biodisponibilité des substances dans l'évaluation du risque chimique est discutée.

Medical tourism: the trend toward outsourcing medical procedures to foreign countries.

Science.gov (United States)

York, Diane

2008-01-01

The rising costs of medical treatment in the United States are fueling a movement to outsource medical treatment. Estimates of the number of Americans traveling overseas for treatment range from 50,000 to 500,000. Charges for common procedures such as heart bypass can be $11,000 in Thailand compared to $130,000 in the United States. Knee replacement in the United States can cost $40,000 compared to $13,000 in Singapore.A new industry, medical tourism, has been created to advise patients on the appropriate facility in the right country for their condition, handle all travel arrangements, teleconference with physicians, and send medical records. To respond to the growth in medical travel, the Joint Commission (formerly the Joint Commission on Accreditation of Health Care Organizations) initiated the Joint Commission International (JCI) to accredit hospitals worldwide. Although outcome statistics from hospitals outside the United States are rare, first-person reports on quality are numerous. Making surgery possible for uninsured and underinsured individuals or self-insured state, municipal, and private entities is a major benefit of medical tourism. Mitigating against medical travel are the lack of legal remedies in place for malpractice and the possibility that travel itself can impose risk to patients. For example, lengthy air flights where the patient is in a fixed position for hours at a time can cause embolisms. If the trend toward medical tourism continues, continuing education, credentialing, and certification services may be required to help assure patient safety.

Medical aspects of quality assurance in the United States

International Nuclear Information System (INIS)

Hanks, G.E.

1997-01-01

Three powerful national programs have been developed, and their acceptance and utilization in the United States have been accelerated by the recent development of managed competition. The first program was a model quality assurance program for day to day use in an individual radiation oncology facility. In addition to maintaining the physical aspects of the department, the medical side includes indicator items in patient evaluation and treatment and other measures that are periodically monitored. The entire process is comprehensive and is accepted by the Joint Commission on Hospital Accreditation as being satisfactory evidence of ongoing quality assurance and quality improvement. The second program was the development of a set of standards for radiation oncology in the United States. These standards were developed in the past and have recently been expanded into a more comprehensive document that describes the appropriate performance by this specialty. The third program was a Practice Accreditation program. The Practice Accreditation program is an on-site review of structure and processes of patient care by a radiation oncologist and data manager. This intense on-site review generated data that is then compared to similar facilities and to national averages to judge the adequacy of patient management in the facility. We have observed recently that various managed care programs require this practice accreditation before their patients can be treated in contracting facilities. Lastly, the Council of the American College of Radiology has made some extremely positive statements in support of improving radiation oncology practice, and the positive effects of these council resolutions can be clearly shown on the practice

Variability in United States Allopathic Medical School Tuition.

Science.gov (United States)

Gil, Joseph A; Park, Sarah H; Daniels, Alan H

2015-11-01

Over the course of the last generation, the cost of medical school attendance and medical student debt has increased drastically. Medical student debt has been reported as high as $350,000, and the Association of American Medical Colleges (AAMC) reports that medical school tuition continues to increase annually. The increasing cost of medical education and associated financial burden is now beginning to deter potential applicants from pursuing a career in medicine. In this study we aimed to assess medical school tuition across the US. We hypothesized that the cost of medical school attendance is variable across all regions of the US, and as a result, the financial burden on medical students is inconsistent. All 123 allopathic medical schools accredited by the AAMC were assessed in this investigation. In-state and out-of-state tuitions for the year 2016 were obtained from U.S. News and World Report. Additionally, medical school size was collected. Regions were defined according to the US Census Bureau definition, with the US being divided into 4 regions: Northeast, Midwest, South, and West. There was no difference in average medical school size among the 4 regions (P > .05). Average in-state tuition was $38,291.56 ± $9801.38 (95% confidence interval [CI], $34,658.07-$41,513.46) in the Midwest, $45,923.04 ± $9178.87 (95% CI, $42,566.28-$49,216.78) in the Northeast, $32,287.78 ± $12,277.53 (95% CI, $28,581.90-$35,378.68) in the South, and $37,745.40 ± $11,414.37 (95% CI, $30,063.28-$40,458.99) in the West. In-state tuition in the South was significantly lower than in the Northeast, West, and Midwest (P tuition in the Northeast was significantly higher than in the South, West, and Midwest (P tuition is $54,104.04 ± $8227.65 (95% CI, $51,207.6-$57,000.39) in the Midwest, $53,180.10 ± $3963.71 (95% CI, $51,761.71-$54,598.50) in the Northeast, $48,191.86 ± $12,578.13 (95% CI, $44,595.84-$51,787.89) in the South, and $52,920.47 ± $7400.83 (95% CI, $49

[Systemic candidiasis in medical intensive care unit: analysis of risk factors and the contribution of colonization index].

Science.gov (United States)

Massou, S; Ahid, S; Azendour, H; Bensghir, M; Mounir, K; Iken, M; Lmimouni, B E; Balkhi, H; Drissi Kamili, N; Haimeur, C

2013-06-01

Description of the epidemiological and clinical characteristics of the patients introducing risk factors of invasive candidiasis. Analysis of risk factors for candidiasis invasive and evaluation of the contribution of colonization index (CI) in the diagnosis of the systematic candidiasis in medical intensive care. Prospective observational study (October 2007 to October 2009). The selected patients present risk factors of system IC candidiasis with an infectious syndrome or clinical signs suggestive of Candida infection and hospitalized more than 48 hours in medical intensive care unit. Pittet's colonization index was calculated at admission and then once a week added to a blood culture. Patients were classified according to level of evidence of Candida infection and the degree of colonization (CIcandidiasis. In multivariate analysis, the corticosteroid therapy was associated with a high colonisation (IC ≥ 0.5) and neutropenia with a high risk of systemic candidiasis. The positive predictive value of CI was 26%. The negative predictive value was 98%, the sensitivity and specificity was 93% and 48% respectively. CI has the advantage to provide a quantified data of the patient's situation in relation to the colonization. But, it isn't helpful with patients having an invasive candidiasis in medical intensive care unit. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Factors influencing medical students' self-assessment of examination performance accuracy: A United Arab Emirates study.

Science.gov (United States)

Shaban, Sami; Aburawi, Elhadi H; Elzubeir, Khalifa; Elango, Sambandam; El-Zubeir, Margaret

2016-01-01

Assessment of one's academic capabilities is essential to being an effective, self-directed, life-long learner. The primary objective of this study was to analyze self-assessment accuracy of medical students attending the College of Medicine and Health Sciences, United Arab Emirates University, by examining their ability to assess their own performance on an MCQ examination. 1 st and 2 nd year medical students (n = 235) self-assessed pre and post-examination performance were compared with objectively measured scores (actual examination performance). Associations between accuracy of score prediction (pre and post assessment), and students' gender, year of education, perceived preparation, confidence and anxiety were also determined. Expected mark correlated significantly with objectively assessed marks (r = 0.407; P self-assessment accuracy. Findings reinforce existing evidence indicating that medical students are poor self-assessors. There are potentially multiple explanations for misjudgment of this multidimensional construct that require further investigation and change in learning cultures. The study offers clear targets for change aimed at optimizing self-assessment capabilities.

Doctors qualifying from United Kingdom medical schools during the calendar years 1977 and 1983.

Science.gov (United States)

Parkhouse, J; Parkhouse, H F

1989-01-01

At the conclusion of undergraduate medical education in the United Kingdom most students pass a university qualifying examination and obtain a degree in medicine and surgery. Some students pass an external non-university qualifying examination in medicine as an alternative to obtaining a degree, and some do both. The degree may be obtained in the same year as the non-university qualifying examination, or in a different year. Some students from a medical school intake qualify in a later year than expected, for various reasons. Data from university, Health Department and other sources may relate to the academic year, the calendar year, or a fixed date such as 30 September. It is not a simple exercise, therefore, to define the exact number of people who qualify to practise medicine, for the first time, in any given 'year'. In counting qualifiers from individual medical schools, the problems are further compounded by the movement of students between the preclinical and clinical stages of the course, particularly from Oxford and Cambridge to London teaching hospitals. This paper analyses the situation for the calendar years 1977 and 1983, showing a decline in the number of students obtaining double (i.e. both university and non-university) qualifications. The number of UK graduates not registering with the General Medical Council to practise, at least for a time, in the UK was small, and the population base compiled for Medical Career Research Group studies was reasonably accurate in each of the 2 years examined.

Medication Errors in Patients with Enteral Feeding Tubes in the Intensive Care Unit.

Science.gov (United States)

Sohrevardi, Seyed Mojtaba; Jarahzadeh, Mohammad Hossein; Mirzaei, Ehsan; Mirjalili, Mahtabalsadat; Tafti, Arefeh Dehghani; Heydari, Behrooz

2017-01-01

Most patients admitted to Intensive Care Units (ICU) have problems in using oral medication or ingesting solid forms of drugs. Selecting the most suitable dosage form in such patients is a challenge. The current study was conducted to assess the frequency and types of errors of oral medication administration in patients with enteral feeding tubes or suffering swallowing problems. A cross-sectional study was performed in the ICU of Shahid Sadoughi Hospital, Yazd, Iran. Patients were assessed for the incidence and types of medication errors occurring in the process of preparation and administration of oral medicines. Ninety-four patients were involved in this study and 10,250 administrations were observed. Totally, 4753 errors occurred among the studied patients. The most commonly used drugs were pantoprazole tablet, piracetam syrup, and losartan tablet. A total of 128 different types of drugs and nine different oral pharmaceutical preparations were prescribed for the patients. Forty-one (35.34%) out of 116 different solid drugs (except effervescent tablets and powders) could be substituted by liquid or injectable forms. The most common error was the wrong time of administration. Errors of wrong dose preparation and administration accounted for 24.04% and 25.31% of all errors, respectively. In this study, at least three-fourth of the patients experienced medication errors. The occurrence of these errors can greatly impair the quality of the patients' pharmacotherapy, and more attention should be paid to this issue.

A unique collaboration of female medical providers within the United States Armed Forces: rehabilitation of a marine with post-concussive vestibulopathy.

Science.gov (United States)

Gottshall, Kim; Gray, Nicola; Drake, Angela I

2005-01-01

Uncle Sam's loyal nieces have come a long way from the days of World War I. The development of occupational and physical therapy was heavily influenced by an early relationship with medical specialists during the First World War. This relationship can be considered largely responsible for the eventual acceptance (by the Armed Forces) of women working in this area. Over the past decade active duty women have seen many changes in opportunities to serve and are now stationed aboard aircraft carriers, performing roles previously considered for male personnel. We report a case study of the medical care provided by both military and civilian women working for the United States Armed Forces. Initial assessment was conducted in a battalion aid station of a United States Marine Corp base and the subject was then referred to a military medical center with highly technical vestibular assessment and rehabilitation services. The subject's case represents a unique collaboration of women therapists, enabling a Marines' access to timely and accurate assessment, treatment and ultimately, successful return to active duty. This case study is one of many examples of the acceptance and successful integration of women as providers of medical care within the Military's medical framework.

Medication errors in the adult emergency unit of a tertiary care teaching hospital in Addis Ababa

Directory of Open Access Journals (Sweden)

Gediwon Negash

2013-01-01

Conclusion: Incidence and types of medication errors committed in Tikur Anbesa Specialized Hospital Adult Emergency Unit were substantiated; moreover, necessary information on factors within the healthcare delivery system that predispose healthcare professionals to commit errors have been pointed, which should be addressed by healthcare professionals through multidisciplinary efforts and involvement of decision makers at national level.

[From empowerment to customer satisfaction: experience of a medical oncology unit].

Science.gov (United States)

Cifaldi, L; Gareri, R; Cristina, G; Felicetti, V; Gremigni, U

2009-01-01

The purpose of the study was the objective assessment of the outpatients satisfaction of the Medical Oncology Unit in Colleferro (USL Roma G), Italy. A retrospective survey conducted on 584 patients using a closed questionnaire focusing on nine items assess the degree of satisfaction expressed by patients relating to the different aspects of the service. The main aspects object of analysis were the accommodation, the relationship with the staff, the comfort of the structure and the health assistance received. The survey showed a high percentage of overall satisfaction for each of the nine parameters evaluated. There were no significant differences appreciated on a personal variables. The evaluation of customer satisfaction is a useful tool to measure patients approval and to meet their needs.

The effect of a medication reconciliation program in two intensive care units in the Netherlands: a prospective intervention study with a before and after design

NARCIS (Netherlands)

Bosma, L.B.E. (Liesbeth B. E.); N.G.M. Hunfeld (Nicola); R.A.M. Quax; E. Meuwese (Edmé); Melief, P.H.G.J. (Piet H. G. J.); J. van Bommel (Jasper); S.S. Tan (Siok Swan); van Kranenburg, M.J. (Maaike J.); P.M.L.A. van den Bemt (Patricia)

2018-01-01

textabstractBackground: Medication errors occur frequently in the intensive care unit (ICU) and during care transitions. Chronic medication is often temporarily stopped at the ICU. Unfortunately, when the patient improves, the restart of this medication is easily forgotten. Moreover, temporal ICU

Prescription medication by physiotherapists: a Brazilian view of the United Kingdom, Canada, Australia and New Zealand

Directory of Open Access Journals (Sweden)

Valton da Silva Costa

Full Text Available Abstract Many health systems (HS have adopted novel models of care which have included non-medical prescription (NMP by physiotherapists. The aim of this study was to verify in the literature the existence of this practice and its possible benefits. A literature review was carried out through search on Science Direct, PubMed, SciELO, Lilacs and Google Scholar, and in the World Confederation for Physical Therapy and Chartered Society of Physiotherapy websites. In recent decades the United Kingdom adopted the NMP for health professionals, followed by Canada. In Australia and New Zealand physiotherapists have acted in the prescription and administration of medications under medical orders, which is the first step into independent prescription. Brazilian physiotherapists cannot prescribe any medication, despite of high demands from patients in the Brazilian HS, shortage of physicians in many regions and bureaucracy in accessing health services. The adoption of NMP by physiotherapists may play an important role in the HS, and it seems to be an inevitable achievement in the next years in Australia and New Zealand. The main benefits include decreasing bureaucracy for assistance, population demands for medication as well as major professional refinement.

Measuring and benchmarking safety culture: application of the safety attitudes questionnaire to an acute medical admissions unit.

Science.gov (United States)

Relihan, E; Glynn, S; Daly, D; Silke, B; Ryder, S

2009-12-01

To assess the safety culture in an acute medical admissions unit (AMAU) of a teaching hospital in order to benchmark results against international data and guide a unit-based, integrated, risk management strategy. The safety attitudes questionnaire (SAQ), a validated instrument for the measurement of safety culture was applied to an AMAU. All AMAU healthcare staff (n = 92) were surveyed: doctors, nurses, healthcare assistants (HCAs) and allied healthcare professionals (AHPs). Safety attitude scores for the overall unit and individual caregiver types were assessed across six domains of safety culture. When compared against an international benchmark, the AMAU scored significantly higher for four of the six safety domains: p < 0.01 for 'teamwork climate', 'safety climate' and 'stress recognition' and p < 0.05 for 'job satisfaction'. The difference between nurse manager scores and the overall mean for the study group was statistically significant for the domains of 'teamwork climate' (p < 0.05) and 'safety climate' (p < 0.01). HCAs scored significantly lower relative to staff overall with regard to 'working conditions' (p < 0.05) and 'perceptions of management' (p < 0.01). The SAQ was successfully applied to an AMAU setting giving a valuable insight into staff issues of concern across the safety spectrum: employee and environmental safety, clinical risk management and medication safety.

The influencing factors of energy poverty in rural Cameroon; Les determinants de la pauvrete energetique en milieu rural au Cameroun

Energy Technology Data Exchange (ETDEWEB)

Kamdem, Maxime; Edzengte, Joseph

2010-09-15

The objective of this study is to assess the influencing factors of energy poverty in rural Cameroon. The method used is in two stages: the first stage is a statistical analysis that has allowed to determine the level of energy poverty in rural areas, which is 7.5%. The second stage assesses the influencing factors of this poverty type. The results show that the revenue impacts on energy poverty, as well as the size of the household, in which the arrival of an additional person increases by 1.16% the chances that the household will suffer from energy poverty. [French] L'objectif de cette etude est d'evaluer les determinants de la pauvrete energetique en milieu rural au Cameroun. La methode mise en oeuvre procede en deux etapes : la premiere est une analyse statistique qui a permis de determiner le seuil de pauvrete energetique en milieu rural, qui se situe a 7,5%. La deuxieme etape evalue les determinants de ce type de pauvrete. Les resultats indiquent que le revenu explique la pauvrete energetique, de meme que la taille du menage dont l'arrivee d'une personne supplementaire accroit de 1,16% les chances de ce menage d'etre pauvre sur le plan energetique.

Evaporation in porous media modelling :fundamental and applied models development /Modélisation de l'évaporation en milieu poreux :développement de modèles fondamentaux et appliqués

OpenAIRE

Debaste, Frédéric

2008-01-01

L'étude des phénomènes fondamentaux de transport et de thermodynamique apparaissant lors de l'évaporation en milieu poreux permet l'investigation d'applications pratiques variées. Dans ce travail, nous développons des modèles fondamentaux d'évaporation en milieu poreux que nous appliquons ensuite au séchage en lit fluidisé de deux matériaux granulaires poreux :le PVC et la levure. Les modèles mis au point sont réalisés suivant une approche multiéchelle. Nous nous intér...

GATEWAY Report Brief: Evaluating Tunable LED Lighting in the Swedish Medical Behavioral Health Unit

Energy Technology Data Exchange (ETDEWEB)

None, None

2017-08-23

Summary of a GATEWAY report evaluation of a tunable LED lighting system installed in the new Swedish Medical Behavioral Health Unit in Seattle that incorporates color-tunable luminaires in common areas, and uses advanced controls for dimming and color tuning, with the goal of providing a better environment for staff and patients. The report reviews the design of the tunable lighting system, summarizes two sets of measurements, and discusses the circadian, energy, and commissioning implications as well as lessons learned from the project.

[Changing medical practices and nosocomial infection rates in French maternity units from 1997 to 2000].

Science.gov (United States)

Vincent-Boulétreau, A; Caillat-Vallet, E; Dumas, A M; Ayzac, L; Chapuis, C; Emery, M N; Girard, R; Haond, C; Lafarge-Leboucher, J; Tissot-Guerraz, F; Fabry, J

2005-04-01

In this study we describe the changes in medical practices and nosocomial infection rates in obstetrics observed through a surveillance network in the South East of France. The maternity units which belong to this network participated in voluntary surveillance using the network's methodology. The criteria for the diagnosis of nosocomial infections were in accordance with the methods described by the Centers for Disease Control and Prevention. 101240 pregnancies including 18503 caesareans (18.3%) were included in the network from 1997 to 2000. During the study period, nosocomial infection rates following caesarean section and vaginal delivery decreased respectively from 7.8% to 4.3% (p infection control programs in maternity units has been confirmed by the results of this surveillance network. During the study period, both obstetrics-related risk factors for nosocomial infection and observed hospital-acquired infection rates were dramatically reduced, what prove an improvement of quality of care in maternity units.

The practical of precaution/isolation from the medical diagnosis in infectious disease unit

Directory of Open Access Journals (Sweden)

Rosely Moralez de Figueiredo

2006-12-01

Full Text Available With the aim of analyzing the use of an infectious disease unit in a medium size general hospital, 95 patients records were examined; 72,6% of the patients were male; the average age was 41 and the average permanence in hospital was 15, 7 days. The death rate was 12,6%. The main medical diagnosis were AIDS in 52,4% and tuberculosis in 6,3% of patients. The speciality infectology was responsible for 35,8% of confinements. Regarding precautions for transmission 14,7% needed air precautions, 8,5% contact precautions, 1,1% droplets and the other 75,7% only standard precautions. A variety of criteria for confinement, not only the infectious nature of the disease, stands out in the unit; the generic term “isolation” is maintained in the records. Unification of the practical employed, education programs in service that aim at appropriation and the use of technical knowledge about precautions by the whole health team are advised.

L'industrie photovoltaïque en Suisse occidentale : l’émergence d’un milieu valorisateur multi-local

OpenAIRE

Livi, Christian; Jeannerat, Hugues; Crevoisier, Olivier

2013-01-01

Développée à partir des années 1980, différents modèles territoriaux d’innovation ont mis en perspective comment certains systèmes de production régionaux se développent à partir de dynamiques d’innovation et d’apprentissage propres à certains milieu locaux. Ces modèles reflètent une globalisation économique caractérisée par une mobilité accrue des biens et services mais limitée des facteurs de production à la base de l’innovation telle que la connaissance et le capital de développement. Cet ...

The effect of the TIM program (Transfer ICU Medication reconciliation) on medication transfer errors in two Dutch intensive care units : Design of a prospective 8-month observational study with a before and after period

NARCIS (Netherlands)

B.E. Bosma (Bertha); E. Meuwese (Edmé); S.S. Tan (Siok Swan); J. van Bommel (Jasper); Melief, P.H.G.J. (Piet Herman Gerard Jan); N.G.M. Hunfeld (Nicola); P.M.L.A. van den Bemt (Patricia)

2017-01-01

markdownabstract__Background:__ The transfer of patients to and from the Intensive Care Unit (ICU) is prone to medication errors. The aim of the present study is to determine whether the number of medication errors at ICU admission and discharge and the associated potential harm and costs are

Challenges Facing Medical Residents' Satisfaction in the Middle East: A Report From United Arab Emirates.

Science.gov (United States)

Abdulrahman, Mahera; Qayed, Khalil I; AlHammadi, Hisham H; Julfar, Adnan; Griffiths, Jane L; Carrick, Frederick R

2015-01-01

PHENOMENON: Medical residents' satisfaction with the quality of training for medical residency training specialists is one of the core measures of training program success. It will also therefore contribute to the integrity of healthcare in the long run. Yet there is a paucity of research describing medical residents' satisfaction in the Middle East, and there are no published studies that measure the satisfaction of medical residents trained within the United Arab Emirates (UAE). This makes it difficult to develop a quality residency training program that might meet the needs of both physicians and society. The authors designed a questionnaire to assess medical residents' satisfaction with the Dubai residency training program in order to identify insufficiencies in the training, clinical, and educational aspects. The survey was a self-report questionnaire composed of different subscales covering sociodemographic and educational/academic profile of the residents along with their overall satisfaction of their training, curriculum, work environment, peer teamwork, and their personal opinion on their medical career. Respondents showed a substantial level of satisfaction with the residency training. The vast majority of residents (80%, N = 88) believe that their residency program curriculum and rotation was "good," "very good," or "excellent." Areas of dissatisfaction included salary, excessive paperwork during rotations, and harassment. INSIGHTS: This is the first report that studies the satisfaction of medical residents in all specialties in Dubai, UAE. Our findings provide preliminary evidence on the efficiency of different modifications applied to the residency program in UAE. To our knowledge, there has not been any previous study in the Middle East that has analyzed this aspect of medical residents from different specialties. The authors believe that this report can be used as a baseline to monitor the effectiveness of interventions applied in the future toward

Patterns of medical management of overactive bladder (OAB) and benign prostatic hyperplasia (BPH) in the United States.

Science.gov (United States)

Anger, Jennifer T; Goldman, Howard B; Luo, Xuemei; Carlsson, Martin O; Chapman, Douglass; Zou, Kelly H; Russell, David; Ntanios, Fady; Esinduy, Canan B; Clemens, J Quentin

2018-01-01

Overactive bladder (OAB) and benign prostatic hyperplasia (BPH) are highly prevalent conditions that place a large burden on the United States (US) health care system. We sought to analyze patterns of prescription medication usage for incident OAB in men and women, and for incident BPH in men using US health insurance claims data. This study used Truven Health MarketScan® Commercial and Medicare Supplemental Research databases. The data were pooled from diverse points of care. BPH subjects included men age 18+ with the first and last two diagnoses of BPH ≥30 days apart and no BPH diagnosis for 1 year prior. OAB subjects included men and women age 18+, who were diagnosed similarly with incident OAB. The type of medication, medication continuation (persistence), and switching to a different medication were analyzed through September 30, 2013. Medication persistence was much higher overall for BPH than OAB (56% vs 34%, respectively, P BPH age 65+ (62%). Patients age 18-64 were less likely to continue medication than older adults (age 65+) for both BPH and OAB. A 9.4% of patients in the OAB cohort and 6.9% of men with BPH switched from one medication to another. Persistence was higher with BPH than OAB medications overall, whereas switching rates were higher in the OAB group. The lower persistence of OAB medication may be due to less efficacy or tolerability. The possibility of under treatment of OAB also warrants future investigations. © 2017 Wiley Periodicals, Inc.

Medical Tourism: The Trend toward Outsourcing Medical Procedures to Foreign Countries

Science.gov (United States)

York, Diane

2008-01-01

The rising costs of medical treatment in the United States are fueling a movement to outsource medical treatment. Estimates of the number of Americans traveling overseas for treatment range from 50,000 to 500,000. Charges for common procedures such as heart bypass can be $11,000 in Thailand compared to $130,000 in the United States. Knee…

The Medical Ethics Curriculum in Medical Schools: Present and Future.

Science.gov (United States)

Giubilini, Alberto; Milnes, Sharyn; Savulescu, Julian

2016-01-01

In this review article we describe the current scope, methods, and contents of medical ethics education in medical schools in Western English speaking countries (mainly the United Kingdom, the United States, and Australia). We assess the strengths and weaknesses of current medical ethics curricula, and students' levels of satisfaction with different teaching approaches and their reported difficulties in learning medical ethics concepts and applying them in clinical practice. We identify three main challenges for medical ethics education: counteracting the bad effects of the "hidden curriculum," teaching students how to apply ethical knowledge and critical thinking to real cases in clinical practice, and shaping future doctors' right character through ethics education. We suggest ways in which these challenges could be addressed. On the basis of this analysis, we propose practical guidelines for designing, implementing, teaching, and assessing a medical ethics program within a four-year medical course. Copyright 2016 The Journal of Clinical Ethics. All rights reserved.

Care bundle for ventilator-associated pneumonia in a medical intensive care unit in Northern Taiwan

Directory of Open Access Journals (Sweden)

Wen-Ping Zeng

2015-01-01

Full Text Available Background: Ventilator-associated pneumonia (VAP occurs in patients requiring mechanical ventilators for more than 48 h. VAP is the most common nosocomial infection and the leading cause of complications and death in intensive care units (ICUs. Materials and Methods: Two historical comparison groups of 375 patients who used mechanical ventilators for more than 48 h in the medical ICU (MICU from December 1, 2011 to May 31, 2012 and December 1, 2013 to May 31, 2014 were enrolled in this study. There were 194 adult patients in the control group that received traditional care, and there were 181 patients in the experimental VAP care bundle group. Our VAP care bundle entailed several preventive strategies including daily assessments of sedation, daily consideration of weaning and extubation by the doctors and respiratory therapists charged with the care of the patients, maintenance of the intra-cuff pressure values at approximately 20-30 cm H 2 O, hand hygiene, daily oral hygiene, personal protective equipment for suctioning, the placement of patients in semi-recumbent positions with the head of the bed elevated to at least 30°, aspiration of an endotracheal tube and oral cavity prior to position changes, daily cleaning of the ventilator and suction bottle with sterile distilled water, weekly replacement of the ventilator circuit and heater, sterilization of the circuit by pasteurization, and the use of an independent care room. The data were collected by reviewing the patients′ medical records and by retrieving information from the Nosocomial Infection Control Unit of one medical center in Northern Taiwan. Results: The incidence of VAP in the VAP care bundle group (0.281 cases per 1000 ventilator days was significantly lower than that in the control group (0.495 cases per 1000 ventilator days. We estimated that the occurrence of VAP in the MICU increased the medical costs by an average of NT $68317 per patient. Conclusions: VAP care bundle is an

Dense medium ore concentrates of Bois-Noirs; Minerais des bois noirs, concentres de milieu dense

Energy Technology Data Exchange (ETDEWEB)

Le Bris, J; Leduc, M

1959-01-20

The chemical treatment of uranium concentrates of Bois-Noirs ore obtained by heavy medium are discussed. The first part deals with sulfuric acid attack on the concentrate, and the second part with the separation of the solution from residues by filtration. A third part deals with this separation by decantation. The fourth part deals with the carbonation of the pickling solutions obtained. (author) [French] Le present rapport est relatif a l'etude du traitement chimique de concentres uraniferes de minerais des Bois-Noirs obtenus par milieu dense. Une premiere partie est consacree a l'attaque sulfurique des concentres, une deuxieme partie a Ia separation de Ia solution d'attaque des residus par decantation. Une quatrieme partie a la carbonatation des solutions d'attaque obtenues. (auteur)

Forced swimming sabotages the morphological and synaptic maturation of newborn granule neurons and triggers a unique pro-inflammatory milieu in the hippocampus.

Science.gov (United States)

Llorens-Martín, María; Jurado-Arjona, Jerónimo; Bolós, Marta; Pallas-Bazarra, Noemí; Ávila, Jesús

2016-03-01

Recent experimental data suggest that mood disorders are related to inflammatory phenomena and have led to the "inflammatory hypothesis of depression". Given that the hippocampus is one of the most affected areas in these disorders, we used a model of acute stress (the Porsolt test) to evaluate the consequences of forced swimming on two crucial events related to the pathophysiology of major depression: the functional maturation of newborn granule neurons; and the hippocampal inflammatory milieu. Using PSD95:GFP-expressing retroviruses, we found that forced swimming selectively alters the dendritic morphology of newborn neurons and impairs their connectivity by reducing the number and volume of their postsynaptic densities. In addition, acute stress triggered a series of morphological changes in microglial cells, together with an increase in microglial CD68 expression, thus suggesting the functional and morphological activation of this cell population. Furthermore, we observed an intriguing change in the hippocampal inflammatory milieu in response to forced swimming. Importantly, the levels of several molecules affected by acute stress (such as Interleukin-6 and eotaxin) have been described to also be altered in patients with depression and other mood disorders. Copyright © 2015 Elsevier Inc. All rights reserved.

The Sociology of the Deceased Harvard Medical Unit at Boston City Hospital.

Science.gov (United States)

Tishler, Peter V

2015-12-01

Many graduates of the Harvard Medical Unit (HMU) at Boston City Hospital, in either the clinical training/residency program or the research program at the Thorndike Memorial Laboratory, contributed in major ways to the HMU and constantly relived their HMU experiences. The HMU staff physicians, descending from founder and mentor physicians Francis W. Peabody, Soma Weiss, and George R. Minot, were dedicated to the teaching, development, and leadership of its clinical and research trainees, whose confidence and dedication to patient care as a result of their mentorship led many to lifelong achievements as clinicians, teachers, and mentors. Their experience also led to a lifelong love of the HMU (despite its loss), camaraderie, happiness, and intense friendships with their associates.

Emphasizing humanities in medical education: Promoting the integration of medical scientific spirit and medical humanistic spirit.

Science.gov (United States)

Song, Peipei; Tang, Wei

2017-05-23

In the era of the biological-psychological-social medicine model, an ideal of modern medicine is to enhance the humanities in medical education, to foster medical talents with humanistic spirit, and to promote the integration of scientific spirit and humanistic spirit in medicine. Throughout the United States (US), United Kingdom (UK), other Western countries, and some Asian countries like Japan, many medical universities have already integrated the learning of medical humanities in their curricula and recognized their value. While in China, although medical education reform over the past decade has emphasized the topic of medical humanities to increase the professionalism of future physicians, the integration of medical humanity courses in medical universities has lagged behind the pace in Western countries. In addition, current courses in medical humanities were arbitrarily established due to a lack of organizational independence. For various reasons like a shortage of instructors, medical universities have failed to pay sufficient attention to medical humanities education given the urgent needs of society. The medical problems in contemporary Chinese society are not solely the purview of biomedical technology; what matters more is enhancing the humanities in medical education and fostering medical talents with humanistic spirit. Emphasizing the humanities in medical education and promoting the integration of medical scientific spirit and medical humanistic spirit have become one of the most pressing issues China must address. Greater attention should be paid to reasonable integration of humanities into the medical curriculum, creation of medical courses related to humanities and optimization of the curriculum, and actively allocating abundant teaching resources and exploring better methods of instruction.

Trends, productivity losses, and associated medical conditions among toxoplasmosis deaths in the United States, 2000-2010.

Science.gov (United States)

Cummings, Patricia L; Kuo, Tony; Javanbakht, Marjan; Sorvillo, Frank

2014-11-01

Few studies have quantified toxoplasmosis mortality, associated medical conditions, and productivity losses in the United States. We examined national multiple cause of death data and estimated productivity losses caused by toxoplasmosis during 2000-2010. A matched case-control analysis examined associations between comorbid medical conditions and toxoplasmosis deaths. In total, 789 toxoplasmosis deaths were identified during the 11-year study period. Blacks and Hispanics had the highest toxoplasmosis mortality compared with whites. Several medical conditions were associated with toxoplasmosis deaths, including human immunodeficiency virus (HIV), lymphoma, leukemia, and connective tissue disorders. The number of toxoplasmosis deaths with an HIV codiagnosis declined from 2000 to 2010; the numbers without such a codiagnosis remained static. Cumulative disease-related productivity losses for the 11-year period were nearly $815 million. Although toxoplasmosis mortality has declined in the last decade, the infection remains costly and is an important cause of preventable death among non-HIV subgroups. © The American Society of Tropical Medicine and Hygiene.

Cochlear implants and medical tourism.

Science.gov (United States)

McKinnon, Brian J; Bhatt, Nishant

2010-09-01

To compare the costs of medical tourism in cochlear implant surgery performed in India as compared to the United States. In addition, the cost savings of obtaining cochlear implant surgery in India were compare d to those of other surgical interventions obtained as a medical tourist. Searches were conducted on Medline and Google using the search terms: 'medical tourism', 'medical offshoring', 'medical outsourcing', 'cochlear implants' and 'cochlear implantation'. The information regarding cost of medical treatment was obtained from personal communication with individuals familiar with India's cochlear implantation medical tourism industry. The range of cost depended on length of stay as well as the device chosen. Generally the cost, inclusive of travel, surgery and device, was in the range of $21,000-30,000, as compared to a cost range of $40,000-$60,000 in the US. With the escalating cost of healthcare in the United States, it is not surprising that some patients would seek to obtain surgical care overseas at a fraction of the cost. Participants in medical tourism often have financial resources, but lack health insurance coverage. While cardiovascular and orthopedic surgery performed outside the United States in India at centers that cater to medical tourists are often performed at one-quarter to one-third of the cost that would have been paid in the United States, the cost differential for cochlear implants is not nearly as favorable.

More medical comorbidities in patients with bipolar disorder from the United States than from the Netherlands and Germany

NARCIS (Netherlands)

Post, R.M.; Altshuler, L.L.; Leverich, G.S.; Frye, M.A.; Suppes, T.; McElroy, S.L.; Keck, P.E.; Nolen, W.A.; Kupka, R.W.; Grunze, H.; Rowe, M.

2014-01-01

Medical comorbidities are common in patients with bipolar (BP) disorder but have not been previously examined for differences between United States and Europe. More than 900 outpatients with BP I and BP II disorder (mean age, 41 years) filled out a questionnaire including the occurrence of 30 listed

More Medical Comorbidities in Patients With Bipolar Disorder From the United States Than From the Netherlands and Germany

NARCIS (Netherlands)

Post, Robert M.; Altshuler, Lori L.; Leverich, Gabriele S.; Frye, Mark A.; Suppes, Trish; McElroy, Susan L.; Keck, Paul E.; Nolen, Willem A.; Kupka, Ralph W.; Grunze, Heinz; Rowe, Mike

Medical comorbidities are common in patients with bipolar (BP) disorder but have not been previously examined for differences between United States and Europe. More than 900 outpatients with BP I and BP II disorder (mean age, 41 years) filled out a questionnaire including the occurrence of 30 listed

The Effects of Korean Medical Service Quality and Satisfaction on Revisit Intention of the United Arab Emirates Government Sponsored Patients

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Seoyoung Lee, RN, MSN

2017-06-01

Conclusions: There are needs for physicians to communicate with patients while ensuring sufficient consultation time based on excellent medical skills and nurses to respond immediately for the patients' needs through an empathic encounter in order to improve medical service quality and patient satisfaction so that to increase the revisit intention of the United Arab Emirates government sponsored patients. Further, it is necessary for the hospitals to have support plans for providing country specialized services in consideration of the UAE culture to ensure that physicians' and nurses' competencies are not undervalued by non-medical service elements such as interpreters and meals.

Rapid control of a methicillin resistant Staphylococcus aureus (MRSA) outbreak in a medical surgical intensive care unit (ICU).

Science.gov (United States)

Khan, Anjum; Lampitoc, Marianita; Salaripour, Maryam; McKernan, Patricia; Devlin, Roslyn; Muller, Matthew P

2009-01-01

Outbreaks of methicillin resistant Staphylococcus aureus in the intensive care unit setting can be prolonged and difficult to control. This report describes the rapid control of an outbreak of methicillin resistant Staphylococcus aureus in a 24-bed open-concept medical surgical intensive care unit with a baseline methicillin resistant Staphylococcus aureus acquisition rate of 1.5 cases per 1000 patient days. This institution's infection control policy mandates an outbreak investigation if two cases of hospital-acquired methicillin resistant Staphylococcus aureus colonization or infection are identified in an intensive care unit within a four-week period. In July 2007, methicillin resistant Staphylococcus aureus was identified in the sputum of two patients within a one-week period. Screening of all patients in the intensive care unit identified one additional case and a fourth case was identified from a clinical specimen before control measures were implemented. Initial control measures included healthcare worker education, enhanced surveillance, patient cohorting, and enhanced environmental cleaning. Despite these measures, three more cases occurred. All patients were then placed in contact isolation, healthcare workers were screened, and the nursing staff was cohorted. After two weeks without a case, two additional cases were identified. Decolonization of all positive patients was initiated. No further cases occurred over a five-week period and the outbreak was declared over. The outbreak resulted in nine cases of methicillin resistant Staphylococcus aureus colonization (n = 8) or infection (n = 1) over an 11-week period. Only one of 175 healthcare workers was colonized and it was not the outbreak strain. Early detection and the stepwise addition of infection control measures resulted in the rapid control of an outbreak of methicillin resistant Staphylococcus aureus in a medical surgical intensive care unit without unit closure. A low threshold of suspicion and

La formation des enseignants intervenant en milieu carcéral en France

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Hugo Barini

2014-04-01

Full Text Available L'enseignement en milieu carcéral est un droit auquel tout détenu a accès. Parmi les enseignements proposés aux détenus, la formation en français langue étrangère (FLE. Dans cet environnement de travail particulier, l'enseignant doit faire face à certaines difficultés et contraintes. Pour intervenir dans cet environnement particulier, des formations sont proposées aux enseignants : formations initiales pour les enseignants titulaires de l’Education nationale, formation de terrain pour les enseignants bénévoles. Toutefois, bien que la discipline enseignée soit le FLE, les enseignants titulaires d’un Master FLE ne peuvent intervenir dans des structures carcérales. Il est alors nécessaire de s’interroger sur les formations reçues par ces différents profils d’enseignants dont les compétences doivent être relatives au contexte d’enseignement, au public détenu non-francophone, ainsi qu’à la discipline enseignée.

Self-medication and related health complaints among expatriate high school students in the United Arab Emirates

Science.gov (United States)

Shehnaz, Syed Ilyas; Khan, Nelofer; Sreedharan, Jayadevan; Issa, Khaled Jamal; Arifulla, Mohamed

Background Self-medication, often without adult guidance, has been reported to be a common practice during adolescence. Similar to other preventable health-risk behaviors initiated in early adolescence, it has become a cause for concern universally. Objective This study examines the prevalence of self-medication with both prescribed and non-prescribed (OTC) medications, related health complaints, sources of drugs, and sources of drug recommendation, and gender differences related to self-medication among expatriate high school students in the United Arab Emirates (UAE). Methods A cross-sectional survey was conducted among 324 expatriate students through a validated, self-administered questionnaire and data was analyzed using SPSS 19 version. Means and proportions were calculated and Pearson Chi-square test of significance was used to analyze association among variables. Results Majority of the participating students, almost equally distributed by gender, was aged 16 to 17 years. The period prevalence rate of self-medication with prescribed and OTC medications were 89.2%, which did not vary with age, gender, ethnicity or parents’ educational level. The most common sources of drug and drug recommendation were community pharmacies and parents respectively. Headache and fever were the common self-medicated conditions and consequently, analgesics and antipyretics were most commonly used both in the previous two weeks and the previous year prior to the survey. A high prevalence of self-medication with antibiotics (53%) and sedative/hypnotics (27%) was also observed. A female excess emerged for certain health complaints and use of medicines except for the use of anti-allergic and herbal/homeopathic drugs. Conclusions This is the first study to explore self-medication practices among high school students in UAE and provides baseline data critical in creating awareness about the risks and benefits of self-medication. Health care providers, educators and parents should be

The Sociology of the Deceased Harvard Medical Unit at Boston City Hospital

Science.gov (United States)

Tishler, Peter V.

2015-01-01

Many graduates of the Harvard Medical Unit (HMU) at Boston City Hospital, in either the clinical training/residency program or the research program at the Thorndike Memorial Laboratory, contributed in major ways to the HMU and constantly relived their HMU experiences. The HMU staff physicians, descending from founder and mentor physicians Francis W. Peabody, Soma Weiss, and George R. Minot, were dedicated to the teaching, development, and leadership of its clinical and research trainees, whose confidence and dedication to patient care as a result of their mentorship led many to lifelong achievements as clinicians, teachers, and mentors. Their experience also led to a lifelong love of the HMU (despite its loss), camaraderie, happiness, and intense friendships with their associates. PMID:26604868

Return of TRIGA fuel from the Medical University of Hanover (MHH) to the United States

International Nuclear Information System (INIS)

Hampel, Gabriele; Klaus, Uwe; Schmidt, Thomas

1999-01-01

The Medical University of Hanover (MHH) returned its TRIGA fuel to the United States in the summer of 1999. This paper deals with the procedure for handling the fuel elements within and outside the reactor facility. It describes the dry loading technology, taking into account the special conditions relevant to the MHH. It also includes the time scale for both the various steps of the procedure and the entire process, as well as the main results of the radiological surveys. (author)

Care bundle for ventilator-associated pneumonia in a medical intensive care unit in Northern Taiwan

OpenAIRE

Wen-Ping Zeng; Han Su; Chein-Wen Chen; Shu-Meng Cheng; Li-Fang Chang; Wen-Chii Tzeng; Bing-Hsiean Tzeng

2015-01-01

Background: Ventilator-associated pneumonia (VAP) occurs in patients requiring mechanical ventilators for more than 48 h. VAP is the most common nosocomial infection and the leading cause of complications and death in intensive care units (ICUs). Materials and Methods: Two historical comparison groups of 375 patients who used mechanical ventilators for more than 48 h in the medical ICU (MICU) from December 1, 2011 to May 31, 2012 and December 1, 2013 to May 31, 2014 were enrolled in this stud...

15th Anniversary of the Molecular Techniques Unit at the Department of Forensic Medicine at Wroclaw Medical University.

Science.gov (United States)

Pluta, Dominika; Tokarski, Miron; Karpiewska, Anna; Dobosz, Tadeusz

2017-01-01

Molecular Techniques Unit at the Department of Forensic Medicine, Wroclaw Medical University has been operating since December 2003. Soon it will be 15 years since its establishment. This anniversary become an inspiration to write down the story of this institution whose origins illustrate the immense changes that have taken place in forensic genetics. The aim of our work was also to consolidate the professional achievements of Professor Tadeusz Dobosz, chief of the Unit, one of the pioneers of introducing DNA testing technology into Polish forensic medicine. The most important achievements of the Unit include participation in two EU research projects, the development of a non-destructive method of extraction of genetic material, research in field of gene therapy and certification of the Laboratory of the Molecular Techniques Unit by the Polish Accreditation Center (PCA) confirming compliance with the requirements of the PN-EN ISO/IEC 17025:2005 standard.

Status of medical mycology education.

Science.gov (United States)

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

2003-12-01

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

[Work setting, satisfaction and burnout of the nurses in critical care units and hospitalization units. RN4CAST-Spain project].

Science.gov (United States)

Fuentelsaz-Gallego, C; Moreno-Casbas, T; Gómez-García, T; González-María, E

2013-01-01

To know if there are differences between the critical care units and the medical-surgical care units regarding the perception of the nurses working in National Health System hospitals about their work environment, burnout level and job satisfaction. A cross-sectional study was conducted with 6,417 nurses from the medical-surgical care units and with 1,122 nurses from critical care units of 59 Spanish hospitals with more than 150 beds. Socio-demographic, job satisfaction, perception of work environment (Practice Environment Scale of the Nursing Work Index [PES-NWI questionnaire]) and burnout measured with the Maslach Burnout Inventory (MBI) data were collected. The PES-NWI showed differences in 4 out of its 5 factors. It showed better values in medical-surgical units in all the factors, except for Staffing and resource adequacy (P<.001), where critical care units showed a mean level of agreement of 2.41 versus 2.19 for the medical-surgical units. Regarding burnout, this was higher in the medical-surgical care units (P=.039) where 23% (952) of the nurses had high levels. Job satisfaction was lower in the critical care units (P=.044) with 70% (578) of nurses being very or strongly satisfied. The opinion of the nurses, working in critical care units about their hospital is unfavorable. They showed lower levels of burnout than those working in medical-surgical units. Copyright © 2013 Elsevier España, S.L. y SEEIUC. All rights reserved.

[Ethics, medical ethics, and occupational medicine: is their dialogue possible?].

Science.gov (United States)

Buzzi, Elisa

2016-01-20

Today's medicine faces some critical moral challenges, yet the medical class suffers from an increasingly evident malaise: a growing dissatisfaction with an ethical demand often perceived as a cumbersome burden of rules and prohibitions, which risk to erode the fiduciary relations with patients. Such a negative appraisal is partly due to a narrow interpretation of the meaning of ethics, a misconception whose roots are in the positivistic stance that permeates our culture, and in its almost exclusively technological bent. This radical orientation of our culture shows itself in the vanishing of the idea of an intrinsic ethical dimension of medicine and consequent eclipse of traditional medical ethics, currently all but assimilated by bioethics. Maintaining a clear distinction between medical ethics and bioethics is a fundamental condition for guaranteeing an original ethical reflection in medicine, thereby fostering a constructive dialogue between philosophical and medical ethics. In this sense, occupational medicine holds a very propitious position, at the cross-roads to some of the most important dimensions in human life and society: health, work, environment. In a milieu which is too often inclined to efface the living human being and the deepest needs of humanity, the moral commitment of medical profession to the care of the integral reality of the embodied human person is one of the most important ethical challenges facing occupational medicine and a most valuable contribution to the current ethical debate.

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.

Observations of the role of science in the United States medical cannabis state policies: Lessons learnt.

Science.gov (United States)

Grbic, Jelica; Goddard, Perilou; Ryder, David

2017-04-01

Clinical trials have shown cannabis to be effective in the treatment of some medical conditions and there is mounting public and political pressure to enact laws enabling the use of cannabis for medicinal purposes. To date, 28 United States (U.S.) states and the District of Columbia have enacted medical cannabis laws. This study sought to identify the main issues pertaining to the development of medical cannabis laws in the U.S, including the role of scientific evidence. Data were collected from three groups of participants: government officials, lobbyists and medical professionals involved in the medical cannabis debate in five selected states in the U.S.; researchers from the same five states conducting funded research in the alcohol and other drugs field; and members of the International Society for the Study of Drug Policy. The data were analysed using thematic analysis. Six major themes emerged in relation to the factors influencing policy: scientific evidence plays a limited role in the development of policy; the available research is limited and mixed; there is a need for clearer communication and active dissemination of evidence to policy makers; researchers need to consider what research is likely to impact on policy; scientific evidence is not a major factor in policy development; and there is a need to consider evidence within a political context. Researchers need to be aware of the political context in which medical cannabis laws are or are not enacted and consider ways in which research findings can achieve a higher profile within this context. Copyright © 2016. Published by Elsevier B.V.

Une formation mixte (synchrone et asynchrone offerte en ligne pour le développement des compétences des enseignants dans leur milieu de travail : étude de cas

Directory of Open Access Journals (Sweden)

Louise Sauvé

2008-01-01

Full Text Available Apprendre tout au long de la vie amène de plus en plus les adultes, confrontés au fait de devoir concilier emploi, travail et études, à rechercher des solutions de formation à la carte selon des horaires fragmentés, près de leur lieu de travail ou de leur milieu de vie. Les technologies Web s’avèrent des outils par excellence pour soutenir ces formations puisqu’elles offrent flexibilité, accessibilité, communication et interaction tout en permettant une variété d’approches éducatives. Cet article présente le contexte et les résultats d’une étude de cas auprès de formateurs en milieu de travail ainsi que le programme de formation personnalisé de formateurs en ligne, Form@tion.

Considerations for Defining Cytokine Dose, Duration, and Milieu That Are Appropriate for Modeling Chronic Low-Grade Inflammation in Type 2 Diabetes

Directory of Open Access Journals (Sweden)

Craig S. Nunemaker

2016-01-01

Full Text Available Proinflammatory cytokines have been implicated in the pathophysiology of both type 1 diabetes (T1D and type 2 diabetes (T2D. T1D is an autoimmune disease involving the adaptive immune system responding to pancreatic beta-cells as antigen-presenting cells. This attracts immune cells that surround pancreatic islets (insulitis and secrete cytokines, such as IL-1beta, IFN-gamma, and TNF-alpha, in close proximity to pancreatic beta-cells. In contrast, there is little evidence for such a focused autoimmune response in T2D. Instead, the innate immune system, which responds to cellular damage and pathogens, appears to play a key role. There are three major sources of proinflammatory cytokines that may impact islet/beta-cell function in T2D: (1 from islet cells, (2 from increased numbers of intraislet macrophages/immune cells, and (3 from increased circulating levels of proinflammatory cytokines due to obesity, presumably coming from inflamed adipose tissue. These differences between T1D and T2D are reflected by significant differences in the cytokine concentration, duration, and milieu. This review focuses on chronic versus acute cytokine action, cytokine concentrations, and cytokine milieu from the perspective of the pancreatic islet in T2D. We conclude that new cytokine models may be needed to reflect the pathophysiology of T2D more effectively than what are currently employed.

Testosterone supplementation, glucocorticoid milieu and bone homeostasis in the ageing male.

Science.gov (United States)

Ajdžanović, Vladimir Z; Filipović, Branko R; Šošić Jurjević, Branka T; Milošević, Verica Lj

2017-08-01

Male ageing is entwined with a continuous fall in free testosterone levels, which contributes to the pathogenesis of bone loss. Glucocorticoid excess, either dependent on the ageing process or iatrogenically induced, was found to additionally impair the bone structure and metabolism. Cautious testosterone supplementation in this respect may positively affect the glucocorticoid milieu and bone homeostasis, while testosterone-induced changes in the glucocorticoid output could serve as a determinant of bone-related therapeutic outcome. Namely, bone mineral content/density, the parameters of trabecular bone structure as well as bone strength are enhanced, serum calcitonin levels tend to increase, while serum osteocalcin, serum parathyroid hormone and urinary calcium decrease, all upon testosterone administration to the ageing male. In parallel, testosterone application decreases glucocorticoid secretion in the animal models of male ageing, while clinical data in this field are still inconsistent. Importantly, a physiological link exists between testosterone-induced changes in glucocorticoid levels and the tendency of bone status improvement in the ageing male. We believe that the assessment of circulating adrenocorticotropic hormone concentrations together with glucocorticoid levels, reflecting the hypothalamic-pituitary-adrenal axis feedback loop operativeness during testosterone supplementation, represents a well-balanced bone-related therapeutic update. © 2017 Société Française de Pharmacologie et de Thérapeutique.

Trends, Productivity Losses, and Associated Medical Conditions Among Toxoplasmosis Deaths in the United States, 2000–2010

Science.gov (United States)

Cummings, Patricia L.; Kuo, Tony; Javanbakht, Marjan; Sorvillo, Frank

2014-01-01

Few studies have quantified toxoplasmosis mortality, associated medical conditions, and productivity losses in the United States. We examined national multiple cause of death data and estimated productivity losses caused by toxoplasmosis during 2000–2010. A matched case–control analysis examined associations between comorbid medical conditions and toxoplasmosis deaths. In total, 789 toxoplasmosis deaths were identified during the 11-year study period. Blacks and Hispanics had the highest toxoplasmosis mortality compared with whites. Several medical conditions were associated with toxoplasmosis deaths, including human immunodeficiency virus (HIV), lymphoma, leukemia, and connective tissue disorders. The number of toxoplasmosis deaths with an HIV codiagnosis declined from 2000 to 2010; the numbers without such a codiagnosis remained static. Cumulative disease-related productivity losses for the 11-year period were nearly $815 million. Although toxoplasmosis mortality has declined in the last decade, the infection remains costly and is an important cause of preventable death among non-HIV subgroups. PMID:25200264

Clinical medical sciences for undergraduate dental students in the United Kingdom and Ireland - a curriculum.

LENUS (Irish Health Repository)

Mighell, A J

2011-08-01

The technical aspects of dentistry need to be practised with insight into the spectrum of human diseases and illnesses and how these impact upon individuals and society. Application of this insight is critical to decision-making related to the planning and delivery of safe and appropriate patient-centred healthcare tailored to the needs of the individual. Provision for the necessary training is included in undergraduate programmes, but in the United Kingdom and Ireland there is considerable variation between centres without common outcomes. In 2009 representatives from 17 undergraduate dental schools in the United Kingdom and Ireland agreed to move towards a common, shared approach to meet their own immediate needs and that might also be of value to others in keeping with the Bologna Process. To provide a clear identity the term \\'Clinical Medical Sciences in Dentistry\\' was agreed in preference to other names such as \\'Human Disease\\' or \\'Medicine and Surgery\\'. The group was challenged to define consensus outcomes. Contemporary dental education documents informed, but did not drive the process. The consensus curriculum for undergraduate Clinical Medical Sciences in Dentistry teaching agreed by the participating centres is reported. Many of the issues are generic and it includes elements that are likely to be applicable to others. This document will act as a focus for a more unified approach to the outcomes required by graduates of the participating centres and act as a catalyst for future developments that ultimately aim to enhance the quality of patient care.

Modeling nurses' attitude toward using automated unit-based medication storage and distribution systems: an extension of the technology acceptance model.

Science.gov (United States)

Escobar-Rodríguez, Tomás; Romero-Alonso, María Mercedes

2013-05-01

This article analyzes the attitude of nurses toward the use of automated unit-based medication storage and distribution systems and identifies influencing factors. Understanding these factors provides an opportunity to explore actions that might be taken to boost adoption by potential users. The theoretical grounding for this research is the Technology Acceptance Model. The Technology Acceptance Model specifies the causal relationships between perceived usefulness, perceived ease of use, attitude toward using, and actual usage behavior. The research model has six constructs, and nine hypotheses were generated from connections between these six constructs. These constructs include perceived risks, experience level, and training. The findings indicate that these three external variables are related to the perceived ease of use and perceived usefulness of automated unit-based medication storage and distribution systems, and therefore, they have a significant influence on attitude toward the use of these systems.

Deaths associated with insertion of nasogastric tubes for enteral nutrition in the medical intensive care unit: Clinical and autopsy findings

Science.gov (United States)

Smith, Avery L.; Santa Ana, Carol A.; Fordtran, John S.; Guileyardo, Joseph M.

2018-01-01

ABSTRACT It is generally assumed that blind insertion of nasogastric tubes for enteral nutrition in patients admitted to medical intensive care units is safe; that is, does not result in life-threatening injury. If death occurs in temporal association with insertion of a nasogastric tube, caregivers typically attribute it to underlying diseases, with little or no consideration of iatrogenic death due to tube insertion. The clinical and autopsy results in three recent cases at Baylor University Medical Center challenge the validity of these notions. PMID:29904295

Comparative cardiovascular safety of dementia medications

DEFF Research Database (Denmark)

Fosbøl, Emil L; Peterson, Eric D; Holm, Ellen

2012-01-01

To compare the cardiovascular safety of currently marketed dementia medications in new users in the United States and Denmark.......To compare the cardiovascular safety of currently marketed dementia medications in new users in the United States and Denmark....

Accreditation of undergraduate medical training programs: practices in nine developing countries as compared with the United States.

Science.gov (United States)

Cueto, Jose; Burch, Vanessa C; Adnan, Nor Azila Mohd; Afolabi, Bosede B; Ismail, Zalina; Jafri, Wasim; Olapade-Olaopa, E Oluwabunmi; Otieno-Nyunya, Boaz; Supe, Avinash; Togoo, Altantsetseg; Vargas, Ana Lia; Wasserman, Elizabeth; Morahan, Page S; Burdick, William; Gary, Nancy

2006-07-01

Undergraduate medical training program accreditation is practiced in many countries, but information from developing countries is sparse. We compared medical training program accreditation systems in nine developing countries, and compared these with accreditation practices in the United States of America (USA). Medical program accreditation practices in nine developing countries were systematically analyzed using all available published documents. Findings were compared to USA accreditation practices. Accreditation systems with explicitly defined criteria, standards and procedures exist in all nine countries studied: Argentina, India, Kenya, Malaysia, Mongolia, Nigeria, Pakistan, Philippines and South Africa. Introduction of accreditation processes is relatively recent, starting in 1957 in India to 2001 in Malaysia. Accrediting agencies were set up in these countries predominantly by their respective governments as a result of legislation and acts of Parliament, involving Ministries of Education and Health. As in the USA, accreditation: (1) serves as a quality assurance mechanism promoting professional and public confidence in the quality of medical education, (2) assists medical schools in attaining desired standards, and (3) ensures that graduates' performance complies with national norms. All nine countries follow similar accreditation procedures. Where mandatory accreditation is practiced, non-compliant institutions may be placed on probation, student enrollment suspended or accreditation withdrawn. Accreditation systems in several developing countries are similar to those in the developed world. Data suggest the trend towards instituting quality assurance mechanisms in medical education is spreading to some developing countries, although generalization to other areas of the world is difficult to ascertain.

An Analysis of Information Technology Adoption by IRBs of Large Academic Medical Centers in the United States.

Science.gov (United States)

He, Shan; Botkin, Jeffrey R; Hurdle, John F

2015-02-01

The clinical research landscape has changed dramatically in recent years in terms of both volume and complexity. This poses new challenges for Institutional Review Boards' (IRBs) review efficiency and quality, especially at large academic medical centers. This article discusses the technical facets of IRB modernization. We analyzed the information technology used by IRBs in large academic institutions across the United States. We found that large academic medical centers have a high electronic IRB adoption rate; however, the capabilities of electronic IRB systems vary greatly. We discuss potential use-cases of a fully exploited electronic IRB system that promise to streamline the clinical research work flow. The key to that approach utilizes a structured and standardized information model for the IRB application. © The Author(s) 2014.

Cerebral angioplasty practice at major medical centers in the United States

International Nuclear Information System (INIS)

Chaturvedi, S.; St Pierre, M.E.; Bertasio, B.

2000-01-01

Concern has been expressed recently regarding the proliferation of angioplasty and/or stenting of cerebral vessels. However, little is known about the volume of angioplasties being performed or the number of experienced interventionalists. A questionnaire was mailed to directors of accredited radiology residency programs in the United States, to define the level of expertise available at teaching hospitals in terms of angioplasty and/or stenting. Of 200 programs surveyed, 111 responded (56 %). Of 111 program directors 47 (42 %) indicated that cerebral angioplasty was being performed at their center. The greatest experience is currently for angioplasty of post-subarachnoid hemorrhage vasospasm (mean 16 procedures performed) and the least experience for dilation of basilar artery atherosclerosis (mean five procedures performed). The reported stroke and/or death rate in centers performing angioplasty of the extracranial carotid system is 1.5 %. Comparisons with other medical specialties (e. g., cardiologists, neurologists, neurosurgeons) are necessary to determine the full scope of extracranial neurovascular procedures being performed and the corresponding complication rates. (orig.)

Paediatric medical emergency calls to a Danish Emergency Medical Dispatch Centre: a retrospective, observational study.

Science.gov (United States)

Andersen, Kasper; Mikkelsen, Søren; Jørgensen, Gitte; Zwisler, Stine Thorhauge

2018-01-05

Little is known regarding paediatric medical emergency calls to Danish Emergency Medical Dispatch Centres (EMDC). This study aimed to investigate these calls, specifically the medical issues leading to them and the pre-hospital units dispatched to the paediatric emergencies. We performed a retrospective, observational study on paediatric medical emergency calls managed by the EMDC in the Region of Southern Denmark in February 2016. We reviewed audio recordings of emergency calls and ambulance records to identify calls concerning patients ≤ 15 years. We examined EMDC dispatch records to establish how the medical issues leading to these calls were classified and which pre-hospital units were dispatched to the paediatric emergencies. We analysed the data using descriptive statistics. Of a total of 7052 emergency calls in February 2016, 485 (6.9%) concerned patients ≤ 15 years. We excluded 19 and analysed the remaining 466. The reported medical issues were commonly classified as: "seizures" (22.1%), "sick child" (18.9%) and "unclear problem" (12.9%). The overall most common pre-hospital response was immediate dispatch of an ambulance with sirens and lights with a supporting physician-manned mobile emergency care unit (56.4%). The classification of medical issues and the dispatched pre-hospital units varied with patient age. We believe our results might help focus the paediatric training received by emergency medical dispatch staff on commonly encountered medical issues, such as the symptoms and conditions pertaining to the symptom categories "seizures" and "sick child". Furthermore, the results could prove useful in hypothesis generation for future studies examining paediatric medical emergency calls. Almost 7% of all calls concerned patients ≤ 15 years. Medical issues pertaining to the symptom categories "seizures", "sick child" and "unclear problem" were common and the calls commonly resulted in urgent pre-hospital responses.

The Medical Research Council (UK)/Uganda Virus Research Institute Uganda Research Unit on AIDS--'25 years of research through partnerships'.

Science.gov (United States)

Kaleebu, P; Kamali, A; Seeley, J; Elliott, A M; Katongole-Mbidde, E

2015-02-01

For the past 25 years, the Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS has conducted research on HIV-1, coinfections and, more recently, on non-communicable diseases. Working with various partners, the research findings of the Unit have contributed to the understanding and control of the HIV epidemic both in Uganda and globally, and informed the future development of biomedical HIV interventions, health policy and practice. In this report, as we celebrate our silver jubilee, we describe some of these achievements and the Unit's multidisciplinary approach to research. We also discuss the future direction of the Unit; an exemplar of a partnership that has been largely funded from the north but led in the south. © 2014 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

The impact of safety organizing, trusted leadership, and care pathways on reported medication errors in hospital nursing units.

Science.gov (United States)

Vogus, Timothy J; Sutcliffe, Kathleen M

2011-01-01

Prior research has found that safety organizing behaviors of registered nurses (RNs) positively impact patient safety. However, little research exists on the joint benefits of safety organizing and other contextual factors that help foster safety. Although we know that organizational practices often have more powerful effects when combined with other mutually reinforcing practices, little research exists on the joint benefits of safety organizing and other contextual factors believed to foster safety. Specifically, we examined the benefits of bundling safety organizing with leadership (trust in manager) and design (use of care pathways) factors on reported medication errors. A total of 1033 RNs and 78 nurse managers in 78 emergency, internal medicine, intensive care, and surgery nursing units in 10 acute-care hospitals in Indiana, Iowa, Maryland, Michigan, and Ohio who completed questionnaires between December 2003 and June 2004. Cross-sectional analysis of medication errors reported to the hospital incident reporting system for the 6 months after the administration of the survey linked to survey data on safety organizing, trust in manager, use of care pathways, and RN characteristics and staffing. Multilevel Poisson regression analyses indicated that the benefits of safety organizing on reported medication errors were amplified when paired with high levels of trust in manager or the use of care pathways. Safety organizing plays a key role in improving patient safety on hospital nursing units especially when bundled with other organizational components of a safety supportive system.

Characteristics of Transgender Women Living with HIV Receiving Medical Care in the United States.

Science.gov (United States)

Mizuno, Yuko; Frazier, Emma L; Huang, Ping; Skarbinski, Jacek

2015-09-01

Little has been reported from population-based surveys on the characteristics of transgender persons living with HIV. Using Medical Monitoring Project (MMP) data, we describe the characteristics of HIV-infected transgender women and examine their care and treatment needs. We used combined data from the 2009 to 2011 cycles of MMP, an HIV surveillance system designed to produce nationally representative estimates of the characteristics of HIV-infected adults receiving medical care in the United States, to compare demographic, behavioral, and clinical characteristics, and met and unmet needs for supportive services of transgender women with those of non-transgender persons using Rao-Scott chi-square tests. An estimated 1.3% of HIV-infected persons receiving care in the United States self-identified as transgender women. Transgender women were socioeconomically more marginalized than non-transgender men and women. We found no differences between transgender women and non-transgender men and women in the percentages prescribed antiretroviral therapy (ART). However, a significantly lower percentage of transgender women compared to non-transgender men had 100% ART dose adherence (78.4% vs. 87.4%) and durable viral suppression (50.8% vs. 61.4%). Higher percentages of transgender women needed supportive services. No differences were observed in receipt of most of supportive services, but transgender women had higher unmet needs than non-transgender men for basic services such as food and housing. We found little difference between transgender women and non-transgender persons in regards to receipt of care, treatment, and most of supportive services. However, the noted disparities in durable viral suppression and unmet needs for basic services should be explored further.

Globalization of health care delivery in the United States through medical tourism.

Science.gov (United States)

Kumar, Sameer; Breuing, Richard; Chahal, Rajneet

2012-01-01

This study highlights some of the inefficiencies in the U.S. health care system and determines what effect medical tourism has had on the U.S. and global health care supply chains. This study also calls attention to insufficient health communication efforts to inform uninsured or underinsured medical tourists about the benefits and risks and determines the managerial and cost implications of various surgical procedures on the global health care system into the future. This study evaluated 3 years (2005, 2007, and 2011) of actual and projected surgical cost data. The authors selected 3 countries for analysis: the United States, India, and Thailand. The surgeries chosen for evaluation were total knee replacement (knee arthroplasty), hip replacement (hip arthroplasty), and heart bypass (coronary artery bypass graft). Comparisons of costs were made using Monte Carlo simulation with variability encapsulated by triangular distributions. The results are staggering. In 2005, the amount of money lost to India and Thailand on just these 3 surgeries because of cost inefficiencies in the U.S. health care system was between 1.3 to 2 billion dollars. In 2011, because many more Americans are expected to travel overseas for health care, this amount is anticipated to rise to between 20 and 30.2 billion dollars. Therefore, more attention should be paid to health communication efforts that truly illustrate the benefits/risks of medical travel. The challenge of finding reliable data for surgeries performed and associated surgical cost estimates was mitigated by the use of a Monte Carlo simulation of triangular distributions. The implications from this study are clear: If the U.S. health care industry is unable to eliminate waste and inefficiency and thus curb rising costs, it will continue to lose surgical revenue to foreign health providers. Copyright © Taylor & Francis Group, LLC

21 CFR 890.5950 - Powered heating unit.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Powered heating unit. 890.5950 Section 890.5950...) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Therapeutic Devices § 890.5950 Powered heating unit. (a) Identification. A powered heating unit is a device intended for medical purposes that...

Medical education research in GCC countries.

Science.gov (United States)

Meo, Sultan Ayoub; Hassan, Asim; Aqil, Mansoor; Usmani, Adnan Mahmood

2015-02-01

Medical education is an essential domain to produce physicians with high standards of medical knowledge, skills and professionalism in medical practice. This study aimed to investigate the research progress and prospects of GCC countries in medical education during the period 1996-2013. In this study, the research papers published in various global scientific journals during the period 1996-2013 were accessed. We recorded the total number of research documents having an affiliation with GCC Countries including Saudi Arabia, Bahrain, Kuwait, Qatar, United Arab Emirates and Oman. The main source for information was Institute of Scientific Information (ISI) Web of Science, Thomson Reuters. In ISI-Web of Science, Saudi Arabia contributed 40797 research papers, Kuwait 1666, United Arab Emirates 3045, Qatar 4265, Bahrain 1666 and Oman 4848 research papers. However, in Medical Education only Saudi Arabia contributed 323 (0.79%) research papers, Kuwait 52 (0.03%), United Arab Emirates 41(0.01%), Qatar 37(0.008%), Bahrain 28 (0.06%) and Oman 22 (0.45%) research papers in in ISI indexed journals. In medical education the Hirsch index (h-index) of Saudi Arabia is 14, United Arab Emirates 14, Kuwait 11, Qatar 8, Bahrain 8 and Oman 5. GCC countries produced very little research in medical education during the period 1996-2013. They must improve their research outcomes in medical education to produce better physicians to enhance the standards in medical practice in the region.

Direct medical mental health care costs of schizophrenia in France, Germany and the United Kingdom - findings from the European Schizophrenia Cohort (EuroSC).

Science.gov (United States)

Heider, Dirk; Bernert, Sebastian; König, Hans-Helmut; Matschinger, Herbert; Hogh, Theresa; Brugha, Traolach S; Bebbington, Paul E; Azorin, Michel; Angermeyer, Matthias C; Toumi, Mondher

2009-05-01

To quantify and compare the resource consumption and direct costs of medical mental health care of patients suffering from schizophrenia in France, Germany and the United Kingdom. In the European Cohort Study of Schizophrenia, a naturalistic two-year follow-up study, patients were recruited in France (N=288), Germany (N=618), and the United Kingdom (N=302). Data about the use of services and medication were collected. Unit cost data were obtained and transformed into United States Dollar Purchasing Power Parities (USD-PPP). Mean service use and costs were estimated using between-effects regression models. In the French/German/UK sample estimated means for a six-month period were respectively 5.7, 7.5 and 6.4 inpatient days, and 11.0, 1.3, and 0.7 day-clinic days. After controlling for age, sex, number of former hospitalizations and psychopathology (CGI score), mean costs were 3700/2815/3352 USD-PPP. Service use and estimated costs varied considerably between countries. The greatest differences were related to day-clinic use. The use of services was not consistently higher in one country than in the others. Estimated costs did not necessarily reflect the quantity of service use, since unit costs for individual types of service varied considerably between countries.

Integration des sciences et de la langue: Creation et experimentation d'un modele pedagogique pour ameliorer l'apprentissage des sciences en milieu francophone minoritaire

Science.gov (United States)

Cormier, Marianne

Les faibles resultats en sciences des eleves du milieu francophone minoritaire, lors d'epreuves au plan national et international, ont interpelle la recherche de solutions. Cette these avait pour but de creer et d'experimenter un modele pedagogique pour l'enseignement des sciences en milieu linguistique minoritaire. En raison de la presence de divers degres de francite chez la clientele scolaire de ce milieu, plusieurs elements langagiers (l'ecriture, la discussion et la lecture) ont ete integres a l'apprentissage scientifique. Nous avions recommande de commencer le processus d'apprentissage avec des elements langagiers plutot informels (redaction dans un journal, discussions en dyades...) pour progresser vers des activites langagieres plus formelles (redaction de rapports ou d'explications scientifiques). En ce qui a trait a l'apprentissage scientifique, le modele preconisait une demarche d'evolution conceptuelle d'inspiration socio-constructiviste tout en s'appuyant fortement sur l'apprentissage experientiel. Lors de l'experimentation du modele, nous voulions savoir si celui-ci provoquait une evolution conceptuelle chez les eleves, et si, simultanement, le vocabulaire scientifique de ces derniers s'enrichissait. Par ailleurs, nous cherchions a comprendre comment les eleves vivaient leurs apprentissages dans le cadre de ce modele pedagogique. Une classe de cinquieme annee de l'ecole de Grande-Digue, dans le Sud-est du Nouveau-Brunswick, a participe a la mise a l'essai du modele en etudiant les marais sales locaux. Lors d'entrevues initiales, nous avons remarque que les connaissances des eleves au sujet des marais sales etaient limitees. En effet, s'ils etaient conscients que les marais etaient des lieux naturels, ils ne pouvaient pas necessairement les decrire avec precision. Nous avons egalement constate que les eleves utilisaient surtout des mots communs (plantes, oiseaux, insectes) pour decrire le marais. Les resultats obtenus indiquent que les eleves ont

Comparing the effect of non-medical mechanical restraint preventive factors between psychiatric units in Denmark and Norway

DEFF Research Database (Denmark)

Bak, Jesper; Zoffmann, V.; Sestoft, D.M.

2015-01-01

was not supported by earlier research, the identification of the patient's crisis triggers; therefore, more research on the mechanisms involved is needed. CLINICAL IMPLICATIONS: None of the six MR preventive factors presents any adverse effects; therefore, units in Denmark and Norway may consider investigating......-medical origin may explain the differing number of MR episodes between Denmark and Norway. METHODS: This study is a cross-sectional survey of psychiatric units. Linear regression was used to assess the confounding effects of the MR preventive factors, i.e. whether a difference in the impact of these factors...... the effect of implementing, the identification of the patient's crisis triggers, an increased number of staff per patient, increased staff education, a better work environment and reduced use of substitute staff in practice....

Les compétences infirmières forensiques en milieu carcéral face aux patients atteints de troubles mentaux: une revue de littérature étoffée

OpenAIRE

Davet, Eloïse; Friedli, Karen; Machuret, Bastien; Reyff, Marie de

2015-01-01

Le but de cette revue de littérature étoffée est de mettre en évidence les compétences des infirmières forensiques travaillant, en milieu carcéral, avec des patients atteints de troubles mentaux.

Methods for improvement of some parameters of medical X-ray diagnostic equipment. Basic faults in selection of appropriate new or used units

International Nuclear Information System (INIS)

Tonev, M.; Danev, N.; Constantinov, B.

2004-01-01

An analysis is made of the factors determining the quality and performance of the main types of medical equipment: conventional radiographic and fluoroscopic X-ray unit; X-ray computer tomograph (CT); angiographic, mammographic, densitometric and dental X-ray equipment; magnetic resonance MRI. The aim is to give certain directions for the method one should adopt on choosing and purchasing X-ray equipment. Also one should take into consideration the new Health law and the Regulation for radiation protection of persons undergoing medical examination or treatment. The problems can be solved with the close cooperation between radiologists, medical physicists and x-ray engineers

Barriers to exercise in younger and older non-exercising adult women: a cross sectional study in London, United Kingdom.

Science.gov (United States)

El Ansari, Walid; Lovell, Geoff

2009-04-01

A survey of 100 women in the south of London, United Kingdom (UK) compared exercise barrier intensities between non-exercising younger (20-27 years) and older (28-35 years) adult women; and examined childcare duties as perceived barriers to exercise. Perceived barriers to exercise were examined using an Exercise Benefits/Barriers Scale (EBBS) comprising four subscales (exercise milieu; time expenditure; physical exertion; family discouragement). Participants' number of children was also noted. Non-exercising older women reported significantly higher total exercise barriers, as well as across three barrier subscales: exercise milieu, time expenditure, and family discouragement. For both age groups, significant correlation existed between number of children and women's total exercise barrier scores. Number of children explained approximately 25% and approximately 30% of the variance of younger and older women's total barrier scores respectively. For both women groups, the strongest correlation between exercise barrier and number of children was for the time expenditure subscale. Broad grouping of 20-35 year old non-exercising women does not reflect a homogenous sample. Age categories employing narrower age brackets are recommended. Issues surrounding family responsibilities e.g. childcare duties may be shared between these groups and require further research and policy attention.

Aspects of medical migration with particular reference to the United Kingdom and the Netherlands.

Science.gov (United States)

Herfs, Paul G P

2014-10-14

In most countries of the European Economic Area (EEA), there is no large-scale migration of medical graduates with diplomas obtained outside the EEA, which are international medical graduates (IMGs). In the United Kingdom however, health care is in part dependent on the influx of IMGs. In 2005, of all the doctors practising in the UK, 31% were educated outside the country. In most EEA-countries, health care is not dependent on the influx of IMGs.The aim of this study is to present data relating to the changes in IMG migration in the UK since the extension of the European Union in May 2004. In addition, data are presented on IMG migration in the Netherlands. These migration flows show that migration patterns differ strongly within these two EU-countries. This study makes use of registration data on migrating doctors from the General Medical Council (GMC) in the UK and from the Dutch Department of Health. Moreover, data on the ratio of medical doctors in relation to a country's population were extracted from the World Health Organization (WHO). The influx of IMGs in the UK has changed in recent years due to the extension of the European Union in 2004, the expansion of UK medical schools and changes in the policy towards non-EEA doctors.The influx of IMGs in the Netherlands is described in detail. In the Netherlands, many IMGs come from Afghanistan, Iraq and Surinam. There are clear differences between IMG immigration in the UK and in the Netherlands. In the UK, the National Health Service continues to be very reliant on immigration to fill shortage posts, whereas the number of immigrant doctors working in the Netherlands is much smaller. Both the UK and the Netherlands' regulatory bodies have shared great concerns about the linguistic and communication skills of both EEA and non-EEA doctors seeking to work in these countries. IMG migration is a global and intricate problem. The source countries, not only those where English is the first or second language, experience

The Necessity of Implementing a Quality Management System in the Romanian Medical Units. An Approach from the Patient’s Point of View

Directory of Open Access Journals (Sweden)

Roxana Sârbu

2011-11-01

Full Text Available The medical services organizations activate in a specific featured environment, extremely sensitive, dynamic and most of the times unpredictable. In order to develop their activity at a high qualitative level, medical units must possess the ability of accepting the changes that might occur, of identifying and valorizing the possible opportunities and, at the same time, they must have the ability of avoiding risks as much as possible. The medical field considers quality a variable which is hard to quantify and which could be perceived as the result of the comparison between the medical service desired/requested by the client and the provided health service or the extent to which the provided service corresponds to the client’s expectations. The current paper refers to the growing problems of the Romanian health system and it also takes into consideration the deficiencies which influence the quality of the provided services. The approach manner of this particular theme is realized by taking into account the quality management system. At the same time, there is made an analysis of the consumer’s perception regarding both the quality of health services and the necessity of implementing a quality management system in all units providing health services. The research is based on a rich study of the professional literature, on articles and scientific papers in this field of activity. The data was collected by applying a questionnaire to the population which has been provided medical services over the past year.

Validation of the Inventaire du Milieu Familial Questionnaire (French version of the Infant/Toddler HOME) into the Brazilian Portuguese language.

Science.gov (United States)

Sudbrack, Simone; Barbosa, Fernanda P; Mattiello, Rita; Booij, Linda; Estorgato, Geovana R; Dutra, Moisés S; Assunção, Fabiana D de; Nunes, Magda L

2018-04-22

To validate the Brazilian Portuguese version of the Family Environment Assessment questionnaire (Inventaire du Milieu Familial). The validation process was carried out in two stages. First, translation and back-translation were performed, and in the second phase, the questionnaire was applied in 72 families of children between 0 and 24 months for the validation process. The tool consists of the following domains: mother's communication ability; behavior; organization of the physical and temporal environment; collection/quantity of toys; maternal attitude of constant attention toward her baby; diversification of stimuli; baby's behavior. The following was performed for the scale validation: 1 - content analysis (judgment); 2 - construct analysis (factorial analysis - Kaiser-Meyer-Olkin, Bartlett, and Pearson's correlation tests); 3 - criterion analysis (calculation of Cronbach's alpha coefficient, intraclass correlations, and split-half correlations). The mean age of the children was 9±6.7 months, and of these, 35 (48.6%) were males. Most correlations between items and domains were significant. In the factorial analysis of the scale, Kaiser-Meyer-Olkin values were 0.76, Bartlett's test showed a p-value<0.001, and correlation between items and domains showed a p-value<0.01. Regarding the validity, Cronbach's alpha was 0.92 (95% CI: 0.89-0.94). The intraclass correlation among the evaluators was 0.97 (0.96-0.98) and split-half correlations, r: 0.60, with p<0.01. The Portuguese version of the Inventaire du Milieu Familial showed good to excellent performance regarding the assessed psychometric properties. Copyright © 2018. Published by Elsevier Editora Ltda.

Etude expérimentale du séchage convectif à haute température d'un milieu granulaire

OpenAIRE

Messai , Souad; Sghaier , Jalila; Lecomte , Didier; Belghith , Ali

2008-01-01

International audience; Dans ce travail on présente une étude expérimentale et numérique du séchage convectif à haute température d'un milieu granulaire formé par des particules poreuses sphériques. La partie expérimentale a été consacrée à l'utilisation de l'air humide comme agent séchant. En prenant deux valeurs d'humidité relative de l'air, nous avons mis en évidence l'importance de ce paramètre sur le processus du séchage. Nous avons mesuré simultanément la cinétique de séchage du lit fix...

Emergency feasibility in medical intensive care unit of extracorporeal life support for refractory cardiac arrest.

Science.gov (United States)

Mégarbane, Bruno; Leprince, Pascal; Deye, Nicolas; Résière, Dabor; Guerrier, Gilles; Rettab, Samia; Théodore, Jonathan; Karyo, Souheil; Gandjbakhch, Iradj; Baud, Frédéric J

2007-05-01

To report the feasibility, complications, and outcomes of emergency extracorporeal life support (ECLS) in refractory cardiac arrests in medical intensive care unit (ICU). Prospective cohort study in the medical ICU in a university hospital in collaboration with the cardiosurgical team of a neighboring hospital. Seventeen patients (poisonings: 12/17) admitted over a 2-year period for cardiac arrest unresponsive to cardiopulmonary resuscitation (CPR) and advanced cardiac life support, without return of spontaneous circulation. ECLS femoral implantation under continuous cardiac massage, using a centrifugal pump connected to a hollow-fiber membrane oxygenator. Stable ECLS was achieved in 14 of 17 patients. Early complications included massive transfusions (n=8) and the need for surgical revision at the cannulation site for bleeding (n=1). Four patients (24%) survived at medical ICU discharge. Deaths resulted from multiorgan failure (n=8), thoracic bleeding(n=2), severe sepsis (n=2), and brain death (n=1). Massive hemorrhagic pulmonary edema during CPR (n=5) and major capillary leak syndrome (n=6) were observed. Three cardiotoxic-poisoned patients (18%, CPR duration: 30, 100, and 180 min) were alive at 1-year follow-up without sequelae. Two of these patients survived despite elevated plasma lactate concentrations before cannulation (39.0 and 20.0 mmol/l). ECLS was associated with a significantly lower ICU mortality rate than that expected from the Simplified Acute Physiology Score II (91.9%) and lower than the maximum Sequential Organ Failure Assessment score (>90%). Emergency ECLS is feasible in medical ICU and should be considered as a resuscitative tool for selected patients suffering from refractory cardiac arrest.

Predicting United States Medical Licensure Examination Step 2 clinical knowledge scores from previous academic indicators

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Monteiro KA

2017-06-01

Full Text Available Kristina A Monteiro, Paul George, Richard Dollase, Luba Dumenco Office of Medical Education, The Warren Alpert Medical School of Brown University, Providence, RI, USA Abstract: The use of multiple academic indicators to identify students at risk of experiencing difficulty completing licensure requirements provides an opportunity to increase support services prior to high-stakes licensure examinations, including the United States Medical Licensure Examination (USMLE Step 2 clinical knowledge (CK. Step 2 CK is becoming increasingly important in decision-making by residency directors because of increasing undergraduate medical enrollment and limited available residency vacancies. We created and validated a regression equation to predict students’ Step 2 CK scores from previous academic indicators to identify students at risk, with sufficient time to intervene with additional support services as necessary. Data from three cohorts of students (N=218 with preclinical mean course exam score, National Board of Medical Examination subject examinations, and USMLE Step 1 and Step 2 CK between 2011 and 2013 were used in analyses. The authors created models capable of predicting Step 2 CK scores from academic indicators to identify at-risk students. In model 1, preclinical mean course exam score and Step 1 score accounted for 56% of the variance in Step 2 CK score. The second series of models included mean preclinical course exam score, Step 1 score, and scores on three NBME subject exams, and accounted for 67%–69% of the variance in Step 2 CK score. The authors validated the findings on the most recent cohort of graduating students (N=89 and predicted Step 2 CK score within a mean of four points (SD=8. The authors suggest using the first model as a needs assessment to gauge the level of future support required after completion of preclinical course requirements, and rescreening after three of six clerkships to identify students who might benefit from

Bar Code Medication Administration Technology: Characterization of High-Alert Medication Triggers and Clinician Workarounds.

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Miller, Daniel F; Fortier, Christopher R; Garrison, Kelli L

2011-02-01

Bar code medication administration (BCMA) technology is gaining acceptance for its ability to prevent medication administration errors. However, studies suggest that improper use of BCMA technology can yield unsatisfactory error prevention and introduction of new potential medication errors. To evaluate the incidence of high-alert medication BCMA triggers and alert types and discuss the type of nursing and pharmacy workarounds occurring with the use of BCMA technology and the electronic medication administration record (eMAR). Medication scanning and override reports from January 1, 2008, through November 30, 2008, for all adult medical/surgical units were retrospectively evaluated for high-alert medication system triggers, alert types, and override reason documentation. An observational study of nursing workarounds on an adult medicine step-down unit was performed and an analysis of potential pharmacy workarounds affecting BCMA and the eMAR was also conducted. Seventeen percent of scanned medications triggered an error alert of which 55% were for high-alert medications. Insulin aspart, NPH insulin, hydromorphone, potassium chloride, and morphine were the top 5 high-alert medications that generated alert messages. Clinician override reasons for alerts were documented in only 23% of administrations. Observational studies assessing for nursing workarounds revealed a median of 3 clinician workarounds per administration. Specific nursing workarounds included a failure to scan medications/patient armband and scanning the bar code once the dosage has been removed from the unit-dose packaging. Analysis of pharmacy order entry process workarounds revealed the potential for missed doses, duplicate doses, and doses being scheduled at the wrong time. BCMA has the potential to prevent high-alert medication errors by alerting clinicians through alert messages. Nursing and pharmacy workarounds can limit the recognition of optimal safety outcomes and therefore workflow processes

EAST AFRICAN MEDICAL JOURNAL

African Journals Online (AJOL)

2003-11-11

Nov 11, 2003 ... East African Medical Journal Vol. ... Lecturer/Consultant Surgeon, Paediatric Surgery Unit, Department of Surgery, College of Medical Sciences, University of Calabar, .... mind and the results obtained were however satisfying.

Medical advice and diabetes self-management reported by Mexican-American, Black- and White-non-Hispanic adults across the United States

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Vaccaro Joan A

2012-03-01

Full Text Available Abstract Background Diabetes has reached epidemic proportions in the United States, particularly among minorities, and if improperly managed can lead to medical complications and death. Healthcare providers play vital roles in communicating standards of care, which include guidance on diabetes self-management. The background of the client may play a role in the patient-provider communication process. The aim of this study was to determine the association between medical advice and diabetes self care management behaviors for a nationally representative sample of adults with diabetes. Moreover, we sought to establish whether or not race/ethnicity was a modifier for reported medical advice received and diabetes self-management behaviors. Methods We analyzed data from 654 adults aged 21 years and over with diagnosed diabetes [130 Mexican-Americans; 224 Black non-Hispanics; and, 300 White non-Hispanics] and an additional 161 with 'undiagnosed diabetes' [N = 815(171 MA, 281 BNH and 364 WNH] who participated in the National Health and Nutrition Examination Survey (NHANES 2007-2008. Logistic regression models were used to evaluate whether medical advice to engage in particular self-management behaviors (reduce fat or calories, increase physical activity or exercise, and control or lose weight predicted actually engaging in the particular behavior and whether the impact of medical advice on engaging in the behavior differed by race/ethnicity. Additional analyses examined whether these relationships were maintained when other factors potentially related to engaging in diabetes self management such as participants' diabetes education, sociodemographics and physical characteristics were controlled. Sample weights were used to account for the complex sample design. Results Although medical advice to the patient is considered a standard of care for diabetes, approximately one-third of the sample reported not receiving dietary, weight management, or physical

Burden of medically attended influenza infection and cases averted by vaccination — United States, 2013/14 through 2015/16 influenza seasons

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Jackson, Michael L.; Phillips, C. Hallie; Benoit, Joyce; Jackson, Lisa A.; Gaglani, Manjusha; Murthy, Kempapura; McLean, Huong Q.; Belongia, Edward A.; Malosh, Ryan; Zimmerman, Richard; Flannery, Brendan

2018-01-01

Background In addition to preventing hospitalizations and deaths due to influenza, influenza vaccination programs can reduce the burden of outpatient visits for influenza. We estimated the incidence of medically-attended influenza at three geographically diverse sites in the United States, and the cases averted by vaccination, for the 2013/14 through 2015/16 influenza seasons. Methods We defined surveillance populations at three sites from the United States Influenza Vaccine Effectiveness Network. Among these populations, we identified outpatient visits laboratory-confirmed influenza via active surveillance, and identified all outpatient visits for acute respiratory illness from healthcare databases. We extrapolated the total number of outpatient visits for influenza from the proportion of surveillance visits with a positive influenza test. We combined estimates of incidence, vaccine coverage, and vaccine effectiveness to estimate outpatient visits averted by vaccination. Results Across the three sites and seasons, incidence of medically attended influenza ranged from 14 to 54 per 1,000 population. Incidence was highest in children aged 6 months to 9 years (33 to 70 per 1,000) and lowest in adults aged 18-49 years (21 to 27 per 1,000). Cases averted ranged from 9 per 1,000 vaccinees (Washington, 2014/15) to 28 per 1,000 (Wisconsin, 2013/14). Discussion Seasonal influenza epidemics cause a considerable burden of outpatient medical visits. The United States influenza vaccination program has caused meaningful reductions in outpatient visits for influenza, even in years when the vaccine is not well-matched to the dominant circulating influenza strain. PMID:29249545

A Pilot Project Demonstrating that Combat Medics Can Safely Administer Parenteral Medications in the Emergency Department.

Science.gov (United States)

Schauer, Steven G; Cunningham, Cord W; Fisher, Andrew D; DeLorenzo, Robert A

2017-12-01

Introduction Select units in the military have improved combat medic training by integrating their functions into routine clinical care activities with measurable improvements in battlefield care. This level of integration is currently limited to special operations units. It is unknown if regular Army units and combat medics can emulate these successes. The goal of this project was to determine whether US Army combat medics can be integrated into routine emergency department (ED) clinical care, specifically medication administration. Project Design This was a quality assurance project that monitored training of combat medics to administer parenteral medications and to ensure patient safety. Combat medics were provided training that included direct supervision during medication administration. Once proficiency was demonstrated, combat medics would prepare the medications under direct supervision, followed by indirect supervision during administration. As part of the quality assurance and safety processes, combat medics were required to document all medication administrations, supervising provider, and unexpected adverse events. Additional quality assurance follow-up occurred via complete chart review by the project lead. Data During the project period, the combat medics administered the following medications: ketamine (n=13), morphine (n=8), ketorolac (n=7), fentanyl (n=5), ondansetron (n=4), and other (n=6). No adverse events or patient safety events were reported by the combat medics or discovered during the quality assurance process. In this limited case series, combat medics safely administered parenteral medications under indirect provider supervision. Future research is needed to further develop this training model for both the military and civilian setting. Schauer SG , Cunningham C W, Fisher AD , DeLorenzo RA . A pilot project demonstrating that combat medics can safely administer parenteral medications in the emergency department. Prehosp Disaster Med. 2017;32(6):679-681.

Potentially inappropriate medication related to weakness in older acute medical patients

DEFF Research Database (Denmark)

Jensen, Line Due; Andersen, Ove; Hallin, Marianne

2014-01-01

: Patients aged ≥65 years admitted to the acute medical unit during the period October to December 2011 were included. Patients were interviewed at admission and at a follow-up visit 30 days after discharge. Data included information about medications, social status, functional status, cognitive status.......94), cognition (p = 0.10), pain (p = 0.46), or visual acuity (p = 0.55). CONCLUSIONS: Use of PIMs was very common among older people admitted to an acute medical unit. The use of PIMs is associated with low functional status, low handgrip strength, and reduced health-related quality of life.......: The prevalence of PIMs and the association with PIMs and functional status handgrip strength, HRQOL, comorbidities, social demographic data and vision. RESULTS: Seventy-one patients (55 % men) with a median age of 78.7 years participated. The median number of medications was eight per person. Eighty percent were...

Patient safety culture at neonatal intensive care units: perspectives of the nursing and medical team 1

Science.gov (United States)

Tomazoni, Andréia; Rocha, Patrícia Kuerten; de Souza, Sabrina; Anders, Jane Cristina; de Malfussi, Hamilton Filipe Correia

2014-01-01

OBJECTIVE: to verify the assessment of the patient safety culture according to the function and length of experience of the nursing and medical teams at Neonatal Intensive Care Units. METHOD: quantitative survey undertaken at four Neonatal Intensive Care Units in Florianópolis, Brazil. The sample totaled 141 subjects. The data were collected between February and April 2013 through the application of the Hospital Survey on Patient Safety Culture. For analysis, the Kruskal-Wallis and Chi-Square tests and Cronbach's Alpha coefficient were used. Approval for the research project was obtained from the Ethics Committee, CAAE: 05274612.7.0000.0121. RESULTS: differences in the number of positive answers to the Hospital Survey on Patient Safety Culture, the safety grade and the number of reported events were found according to the professional characteristics. A significant association was found between a shorter Length of work at the hospital and Length of work at the unit and a larger number of positive answers; longer length of experience in the profession represented higher grades and less reported events. The physicians and nursing technicians assessed the patient safety culture more positively. Cronbach's alpha demonstrated the reliability of the instrument. CONCLUSION: the differences found reveal a possible relation between the assessment of the safety culture and the subjects' professional characteristics at the Neonatal Intensive Care Units. PMID:25493670

The Accreditation Council for Graduate Medical Education resident duty hour new standards: history, changes, and impact on staffing of intensive care units.

Science.gov (United States)

Pastores, Stephen M; O'Connor, Michael F; Kleinpell, Ruth M; Napolitano, Lena; Ward, Nicholas; Bailey, Heatherlee; Mollenkopf, Fred P; Coopersmith, Craig M

2011-11-01

The Accreditation Council for Graduate Medical Education recently released new standards for supervision and duty hours for residency programs. These new standards, which will affect over 100,000 residents, take effect in July 2011. In response to these new guidelines, the Society of Critical Care Medicine convened a task force to develop a white paper on the impact of changes in resident duty hours on the critical care workforce and staffing of intensive care units. A multidisciplinary group of professionals with expertise in critical care education and clinical practice. Relevant medical literature was accessed through a systematic MEDLINE search and by requesting references from all task force members. Material published by the Accreditation Council for Graduate Medical Education and other specialty organizations was also reviewed. Collaboratively and iteratively, the task force corresponded by electronic mail and held several conference calls to finalize this report. The new rules mandate that all first-year residents work no more than 16 hrs continuously, preserving the 80-hr limit on the resident workweek and 10-hr period between duty periods. More senior trainees may work a maximum of 24 hrs continuously, with an additional 4 hrs permitted for handoffs. Strategic napping is strongly suggested for trainees working longer shifts. Compliance with the new Accreditation Council for Graduate Medical Education duty-hour standards will compel workflow restructuring in intensive care units, which depend on residents to provide a substantial portion of care. Potential solutions include expanded utilization of nurse practitioners and physician assistants, telemedicine, offering critical care training positions to emergency medicine residents, and partnerships with hospitalists. Additional research will be necessary to evaluate the impact of the new standards on patient safety, continuity of care, resident learning, and staffing in the intensive care unit.

Use of a medication quantification scale for comparison of pain medication usage in patients with complex regional pain syndrome (CRPS).

Science.gov (United States)

Gallizzi, Michael A; Khazai, Ravand S; Gagnon, Christine M; Bruehl, Stephen; Harden, R Norman

2015-03-01

To correlate the amount and types of pain medications prescribed to CRPS patients, using the Medication Quantification Scale, and patients' subjective pain levels. An international, multisite, retrospective review. University medical centers in the United States, Israel, Germany, and the Netherlands. A total of 89 subjects were enrolled from four different countries: 27 from the United States, 20 Germany, 18 Netherlands, and 24 Israel. The main outcome measures used were the Medication Quantification Scale III and numerical analog pain scale. There was no statistically significant correlation noted between the medication quantification scale and the visual analog scale for any site except for a moderate positive correlation at German sites. The medication quantification scale mean differences between the United States and Germany, the Netherlands, and Israel were 9.793 (P CRPS patients and would be useful in further prospective studies of pain medication prescription practices in the CRPS population worldwide. Wiley Periodicals, Inc.

A patient with autism and severe depression: medical and ethical challenges for an adolescent medicine unit.

Science.gov (United States)

Skinner, S Rachel; Ng, Cindy; McDonald, Ann; Walters, Tamara

2005-10-17

An adolescent with autism and intellectual disability presented with severe depression related to menstruation. Because of the complex medical, psychiatric and ethical issues involved, her care was coordinated by a hospital-based adolescent medicine unit. After trials of other therapies over an extended period and interdisciplinary and intersectoral case conferencing, it was decided that hysterectomy was the most appropriate management. This case highlights the complexity of adolescent health care in a tertiary hospital, the importance of intersectoral cooperation between hospital and community, and the integral role of interdisciplinary care of adolescent patients with chronic conditions.

Neutron flux in a periodical slab geometry (1960); Flux neutronique dans un milieu multiplicateur perturbe par la presence de lames planes (1960)

Energy Technology Data Exchange (ETDEWEB)

Lamare, J de; Mathelot, P; Cadhilac, M [Commissariat a l' Energie Atomique, Saclay (France).Centre d' Etudes Nucleaires

1960-07-01

In the present report, we explain an original method to perform exact calculations of neutron flux in either of two geometries: a slab surrounded by an infinite multiplying medium or a periodical, one dimensional array of two different media. (author) [French] La methode exposee dans ce rapport permet de calculer exactement la distribution du flux dans un milieu multiplicateur infini dont l'uniformite est perturbee par l'interposition d'une lame plane de nature differente, ou dont l'heterogeneite est de caractere periodique et unidimensionnel. (auteur)

Identifying medication errors in the neonatal intensive care unit and ...

African Journals Online (AJOL)

Background. Paediatric patients are particularly prone to medication errors as they are classified as the most fragile population in a hospital setting. Paediatric medication errors in the South African healthcare setting are comparatively understudied. Objectives. To determine the incidence of medication errors in neonatal ...

Designing and evaluating an automated system for real-time medication administration error detection in a neonatal intensive care unit.

Science.gov (United States)

Ni, Yizhao; Lingren, Todd; Hall, Eric S; Leonard, Matthew; Melton, Kristin; Kirkendall, Eric S

2018-05-01

Timely identification of medication administration errors (MAEs) promises great benefits for mitigating medication errors and associated harm. Despite previous efforts utilizing computerized methods to monitor medication errors, sustaining effective and accurate detection of MAEs remains challenging. In this study, we developed a real-time MAE detection system and evaluated its performance prior to system integration into institutional workflows. Our prospective observational study included automated MAE detection of 10 high-risk medications and fluids for patients admitted to the neonatal intensive care unit at Cincinnati Children's Hospital Medical Center during a 4-month period. The automated system extracted real-time medication use information from the institutional electronic health records and identified MAEs using logic-based rules and natural language processing techniques. The MAE summary was delivered via a real-time messaging platform to promote reduction of patient exposure to potential harm. System performance was validated using a physician-generated gold standard of MAE events, and results were compared with those of current practice (incident reporting and trigger tools). Physicians identified 116 MAEs from 10 104 medication administrations during the study period. Compared to current practice, the sensitivity with automated MAE detection was improved significantly from 4.3% to 85.3% (P = .009), with a positive predictive value of 78.0%. Furthermore, the system showed potential to reduce patient exposure to harm, from 256 min to 35 min (P patient exposure to potential harm following MAE events.

Examining Informal Learning using Mobile Devices in the Healthcare Workplace / Examen de l’apprentissage informel par l’utilisation d’appareils mobiles dans le milieu des soins de santé

Directory of Open Access Journals (Sweden)

Dorothy (Willy Fahlman

2013-12-01

Full Text Available The study of workplace learning and informal learning are not new to adult education and pedagogy. However, the use of mobile devices as learning tools for informal learning in the workplace is an understudied area. Using theories on informal learning and constructivism as a framework, this paper explores informal learning of registered nurses using mobile devices to meet their learning needs for continuing professional education, professional development, and continuing competence within the challenging healthcare workplace. In this mixed methods study, participants used their devices for self-directed informal learning with non-collaborative strategies/processes for evidence-based support, new procedures/treatments, professional development, patient/client teaching, and maintaining competency. Positive perceptions were articulated. Minimal differences were associated to the nurses’ age. However, workplace-related influences were relevant to the informal learning experiences with the mobile devices. L'étude de l'apprentissage en milieu de travail et de l’apprentissage informel n’est pas nouvelle dans le domaine de l'éducation des adultes et de la pédagogie. Cependant, l'utilisation d'appareils mobiles comme outils pour l'apprentissage informel en milieu de travail est un domaine peu étudié. En utilisant comme cadre d’analyse des théories de l'apprentissage informel et le constructivisme, cet article examine l'apprentissage informel des infirmières utilisant des appareils mobiles pour répondre à leurs besoins d'apprentissage en contexte de formation professionnelle continue, de perfectionnement professionnel et de maintien de leurs compétences dans le milieu difficile de la santé. Dans cette étude à méthodologies mixtes, les participants ont utilisé leurs appareils pour un apprentissage autodirigé informel à l’aide de stratégies et de processus non collaboratifs permettant un appui sur des données factuelles, pour

[Complexity of care and organizational effectiveness: a survey among medical care units in nine Lombardy region hospitals].

Science.gov (United States)

Pasquali, Sara; Capitoni, Enrica; Tiraboschi, Giuseppina; Alborghetti, Adriana; De Luca, Giuseppe; Di Mauro, Stefania

2017-01-01

Eleven medical care units of nine Lombardy Region hospitals organized by levels of care model or by the traditional departmental model have been analyzed, in order to evaluate if methods for complexity of patient-care evaluation represent an index factor of nursing organizational effectiveness. Survey with nine Nurses in managerial position was conducted between Nov. 2013-Jan. 2014. The following factors have been described: context and nursing care model, staffing, complexity evaluation, patient satisfaction, staff well-being. Data were processed through Microsoft Excel. Among Units analysed ,all Units in levels of care and one organized by the departmental model systematically evaluate nursing complexity. Registered Nurses (RN) and Health Care Assistants (HCA) are on average numerically higher in Units that measure complexity (0.55/ 0.49 RN, 0.38/0.23 HCA - ratio per bed). Adopted measures in relation to changes in complexity are:rewarding systems, supporting interventions, such as moving personnel within different Units or additional required working hours; reduction in number of beds is adopted when no other solution is available. Patient satisfaction is evaluated through Customer Satisfaction questionnaires. Turnover, stress and rate of absenteeism data are not available in all Units. Complexity evaluation through appropriate methods is carried out in all hospitals organized in levels of care with personalized nursing care models, though complexity is detected with different methods. No significant differences in applied managerial strategies are present. Patient's satisfaction is evaluated everywhere. Data on staffing wellbeing is scarcely available. Coordinated regional actions are recommended in order to gather comparable data for research, improve decision making and effectiveness of Nursing care.

The occurrence of adverse events potentially attributable to nursing care in medical units: cross sectional record review.

Science.gov (United States)

D'Amour, Danielle; Dubois, Carl-Ardy; Tchouaket, Eric; Clarke, Sean; Blais, Régis

2014-06-01

Ensuring the safety of hospitalized patients remains a major challenge for healthcare systems, and nursing services are at the center of hospital care. Yet our knowledge about safety of nursing care is quite limited. In fact, most earlier studies examined one, or at most two, indicators, thus presenting an incomplete picture of safety at an institutional or broader level. Furthermore, methodologies have differed from one study to another, making benchmarking difficult. The aim of this study was to describe the frequencies of six adverse events widely considered in the literature to be nursing-sensitive outcomes and to estimate the degree to which these events could be attributed to nursing care. Cross-sectional review of charts of 2699 patients hospitalized on 22 medical units in 11 hospitals in Quebec, Canada. The events included: pressure sores, falls, medication administration errors, pneumonias, urinary infections, and inappropriate use of restraints. Experienced nurse reviewers abstracted patients' charts based on a grid developed for the study. Patient-level risk for at least one of these six adverse events was 15.3%, ranging from 9% to 28% across units. Of the 412 patients who experienced an event, 30% experienced two or more, for a total of 568 events. The risk of experiencing an adverse event with consequences was 6.2%, with a unit-level range from 3.2% to 13.5%. Abstractors concluded that 76.8% of the events were attributable to nursing care. While the measurement approach adopted here has limitations stemming from reliance on review of documentation, it provided a practical means of assessing several nursing-sensitive adverse events simultaneously. Given that patient safety issues are so complex, tracking their prevalence and impact is important, as is finding means of evaluating progress in reducing them. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

The contribution of a clinical pharmacist to the improvement of medication at a geriatric hospital unit in Norway.

Directory of Open Access Journals (Sweden)

Veggeland T

2008-03-01

Full Text Available The aim of the study was to use a clinical pharmacist in order to improve the medication of patients in a geriatric hospital unit. The hospital had no experience of using a clinical pharmacist before.Methods: A clinical pharmacist participated in the therapeutic team for 27 days during a 4-year period. Drug-related problems were recorded prospectively and discussed before and at the ward round. The results of the physician’s decisions on the current day about potential changes in medication proposed by the pharmacist were continuously recorded.Results: The pharmacist evaluated the medication of 250 patients. At least one drug- related problem was found in 188 (75% of the patients. For these patients, the physician made 606 decisions concerning potential changes in the medication (3.2 per patient. Thirty percent (184/606 of the decisions were connected to further measurements and to the follow-up of laboratory results, mainly (82%, 151/184 for cardiovascular drugs. Forty-two percent (255/606 of the decisions resulted in the discontinuation of drugs, dosage reduction or a decision to revise the assessment at a later stage during hospitalisation. Medicines with anticholinergic adverse effects were to a great extent withdrawn. Twenty-one percent (129/606 of the decisions were made on drugs with an addiction potential: hypnotics, anxiolytics, as well as analgesics containing tramadol and codeine. The result was often (71%, 91/129 dosage reduction, a change from fixed medication to medication on demand or to discontinuation. Conclusion: Even with a modest participation of once a month, the evaluation of a patient’s medication by a clinical pharmacist led to improved changes and the follow-up of the medication of the elderly.

Prevalence of GMC performance assessments in the United Kingdom: a retrospective cohort analysis by country of medical qualification.

Science.gov (United States)

Mehdizadeh, L; Potts, H W W; Sturrock, A; Dacre, J

2017-04-04

The demographics of doctors working in the UK are changing. The United Kingdom (UK) has voted to leave the European Union (EU) and there is heightened political discourse around the world about the impact of migration on healthcare services. Previous work suggests that foreign trained doctors perform worse than UK graduates in postgraduate medical examinations. We analysed the prevalence by country of primary medical qualification of doctors who were required to take an assessment by the General Medical Council (GMC) because of performance concerns. This was a retrospective cohort analysis of data routinely collected by the GMC. We compared doctors who had a GMC performance assessment between 1996 and 2013 with the medical register in the same period. The outcome measures were numbers experiencing performance assessments by country or region of medical qualification. The rate of performance assessment varied significantly by place of medical qualification and by year; χ 2 (17) = 188, p Economic Area (EEA), were more likely to have a performance assessment than UK trained doctors, with the exception of South African trained doctors. The rate of performance assessment varies significantly by place of medical qualification. This is the first study to explore the risk of performance assessment by individual places of medical qualification. While concern has largely focused on the competence of non-EEA, International Medical Graduates, we discuss implications for how to ensure European trained doctors are fit to practise before their medical licence in the UK is granted. Further research is needed to investigate whether these country effects hold true when controlling for factors like doctors' sex, age, length of time working in the UK, and English language skills. This will allow evidence-based decisions to be made around the regulatory environment the UK should adopt once it leaves the EU. Patients should be reassured that the vast majority of all doctors

Medication prescribing advice and drug utilization: a review from the United Kingdom.

Science.gov (United States)

Law, J; Thompson, A

1996-01-01

General Medical Practitioners (GPs) in the United Kingdom are usually the first point of contact with the National Health Service (NHS) for patients. They provide the majority of ambulatory care for their practice population and act as 'gatekeepers' for referral onwards to other services. This article investigates the influence of the purchasing authority prescribing advisors (PAs), including pharmacists and GPs on the prescribing habits in Salford, England, an inner city area in the North of England, close to the city of Manchester. The PAs became known as the prescribing CIA, and used the strategy of Control, progressing to Influence and Autonomy, to develop a mature partnership between the GPs, PAs and other health care professionals. Information collated from prescribing (PACT) data, by the Prescription Pricing Authority, was used to make comparisons between different practices within an area. Savings made by making rational changes in prescribing, were used to enhance practice development for the benefit of patient care.

Pre-Medical Preparation in Microbiology among Applicants and Matriculants in Osteopathic Medical School in the United States.

Science.gov (United States)

Ramos, Raddy L; Guercio, Erik; Martinez, Luis R

2017-01-01

It is recognized that medical school curricula contain significant microbiology-related content as part of the training of future physicians who will be responsible stewards of antimicrobials. Surprisingly, osteopathic and allopathic medical schools do not require pre-medical microbiology coursework, and the extent to which medical students have completed microbiology coursework remains poorly understood. In this report, we show that fewer than 3% of applicants and matriculants to osteopathic medical school (OMS) have completed an undergraduate major or minor in microbiology, and fewer than 17% of applicants and matriculants to OMS have completed one or more microbiology-related courses. These data demonstrate limited pre-medical microbiology-related knowledge among osteopathic medical students, which may be associated with an increase in perceived stress when learning this content or during clinical rotations as well as a potential lack of interest in pursuing a career in infectious diseases.

What Are Medical Students in the United States Learning About Radiation Oncology? Results of a Multi-Institutional Survey

International Nuclear Information System (INIS)

Zaorsky, Nicholas G.; Shaikh, Talha; Handorf, Elizabeth; Eastwick, Gary; Hesney, Adam; Scher, Eli D.; Jones, Ryan T.; Showalter, Timothy N.; Avkshtol, Vladimir; Rice, Stephanie R.; Horwitz, Eric M.; Meyer, Joshua E.

2016-01-01

Purpose: The purposes of this study were to assess the exposure that medical students (MSs) have to radiation oncology (RO) during the course of their medical school career, as evidenced by 2 time points in current medical training (ie, first vs fourth year; MS1s and MS4s, respectively) and to assess the knowledge of MS1s, MS4s, and primary care physicians (PCPs) about the appropriateness of RT in cancer management in comparison with RO attendings. Methods: We developed and beta tested an electronic survey divided into 3 parts: RO job descriptions, appropriateness of RT, and toxicities of RT. The surveys were distributed to 7 medical schools in the United States. A concordance of >90% (either yes or no) among RO attendings in an answer was necessary to determine the correct answer and to compare with other subgroups using a χ"2 test (P 1 of 5 respondents. Multiple nontoxicities of RT (eg, emitting low-level radiation from the treatment site) were incorrectly identified as toxicities by >1 of 5 respondents. MS4s/PCPs with an RO rotation in medical school had improved scores in all prompts. Conclusions: Although MS knowledge of general RT principles improves from the first to the fourth year, a large knowledge gap still exists between MSs, current PCPs, and ROs. Some basic misconceptions of RT persist among a minority of MSs and PCPs. We recommend implementing formal education in RO fundamentals during the core curriculum of medical school.

Electronic medical history designed by a multidisciplinary unit mastology; Historia clinica electronica disenada por una unidad de mastologia multidisciplinaria

Energy Technology Data Exchange (ETDEWEB)

Camejo, N.; Castillo, C.; Vaca, N.; Camargo, B.; Artagaveytia, N.; Acuna, S.; Milans, S.; Lavina, G.; Carzoglio, J.; Jacobo, O.; Pressa, C.; Delgado, L. [Servicio de Oncologia, Hospital de Clinicas, Montevideo (Uruguay)

2012-11-15

Full text: Objective: To facilitate the collection, organization and analysis of data from patients Unit assisted in Mastology by producing an electronic health record. Materials and Methods: We evaluated forms provided by medical oncologists, radio therapists, radiologists, pathologists, and plastic surgeons mastologists collect data interrogation, physical examination, complementary examinations, diagnoses, anatomy pathological evolution and treatment instituted and generating the system was computerized {sup U}nit Mastology - Electronic Health Record ( UMAHCE){sup .} Results: The story was designed in modules that collect data on instances arising diagnostic, treatment and monitoring of patients. Each module is represented by an icon that changes color to enter data, allowing the objectify doctor if they are or not the data for that module. The system can attach images recorded by breast exam photos, photos of study, imaging (mammography, CT, MRI) in the same way that the surgeon to enter the protocol surgical or anatomical pathologist enter a pathological report of a study untimely or after definitive surgery. The system can generate an automatic report of the input data that can be printed and placed in the patient's medical history. It also can generate the e mail alerts doctors on pathological results were entered into regarding the diagnosis or treatment breast cancer (eg, mammography B I-Rads 4 or 5, report positive cytologic puncture malignancy, H R and Her status). Conclusions: We developed an electronic medical record that allows different doctors involved in the management of breast disease can be accessed through the web regardless of where they are ( pathology laboratory, room radiology reports, clinic, operation theater), both for information about a patient to enter data the same in relation to their specialty. Moreover, homogenize manages the type and quality of the data and therefore can improve the care and research activities as well as

Parents' experiences with neonatal home care following initial care in the neonatal intensive care unit: a phenomenological hermeneutical interview study.

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Dellenmark-Blom, Michaela; Wigert, Helena

2014-03-01

A descriptive study of parents' experiences with neonatal home care following initial care in the neonatal intensive care unit. As survival rates improve among premature and critically ill infants with an increased risk of morbidity, parents' responsibilities for neonatal care grow in scope and degree under the banner of family-centred care. Concurrent with medical advances, new questions arise about the role of parents and the experience of being provided neonatal care at home. An interview study with a phenomenological hermeneutic approach. Parents from a Swedish neonatal (n = 22) home care setting were extensively interviewed within one year of discharge. Data were collected during 2011-2012. The main theme of the findings is that parents experience neonatal home care as an inner emotional journey, from having a child to being a parent. This finding derives from three themes: the parents' experience of leaving the hospital milieu in favour of establishing independent parenthood, maturing as a parent and processing experiences during the period of neonatal intensive care. This study suggests that neonatal home care is experienced as a care structure adjusted to incorporate parents' needs following discharge from a neonatal intensive care unit. Neonatal home care appears to bridge the gap between hospital and home, supporting the family's adaptation to life in the home setting. Parents become empowered to be primary caregivers, having nurse consultants serving the needs of the whole family. Neonatal home care may therefore be understood as the implementation of family-centred care during the transition from NICU to home. © 2013 John Wiley & Sons Ltd.

Units of Instruction. Health Occupations Education. Volume I. [Teacher's Guide].

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East Texas State Univ., Commerce. Occupational Curriculum Lab.

Ten units on health occupations are presented in this teacher's guide. The units are the following: recording vital signs; job application and interview; grooming and personal hygiene; health careers; medical careers; medical ethics; medical terminology and abbreviations; medical asepsis; basic patient care (e.g., measuring and recording fluid…

Defining the Medical Intensive Care Unit in the Words of Patients and Their Family Members: A Freelisting Analysis.

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Auriemma, Catherine L; Lyon, Sarah M; Strelec, Lauren E; Kent, Saida; Barg, Frances K; Halpern, Scott D

2015-07-01

No validated conceptual framework exists for understanding the outcomes of patient- and family-centered care in critical care. To explore the meaning of intensive care unit among patients and their families by using freelisting. The phrase intensive care unit was used to prompt freelisting among intensive care unit patients and patients' family members. Freelisting is an anthropological technique in which individuals define a domain by listing all words that come to mind in response to a topic. Salience scores, derived from the frequency with which a word was mentioned, the order in which it was mentioned, and the length of each list, were calculated and analyzed. Among the 45 participants, many words were salient to both patients and patients' family members. Words salient solely for patients included consciousness, getting better, noisy, and personal care. Words salient solely for family members included sadness, busy, professional, and hope. The words suffering, busy, and team were salient solely for family members of patients who lived, whereas sadness, professionals, and hope were salient solely for family members of patients who died. The words caring and death were salient for both groups. Intensive care unit patients and their families define intensive care unit by using words to describe sickness, caring, medical staff, emotional states, and physical qualities of the unit. The results validate the importance of these topics among patients and their families in the intensive care unit and illustrate the usefulness of freelisting in critical care research. ©2015 American Association of Critical-Care Nurses.

Medical cautery units as a permanent and non-invasive method of marking lizards

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Anna Ekner

2011-12-01

Full Text Available The identification of previously captured individuals is essential for a wide variety of ecological and behavioural studies. A lot of different methods are used for marking lizards, however they have many drawbacks. In presented study we used heat-branding method, using pen-like medical cautery units, previously employed to successfully mark other lizard species and snakes. The technique is permanent, readable and harmless for lizards, as well quick and easy. In 2009 we marked 111 individuals of sand lizard, Lacerta agilis. Next year we caught 88 lizards, 17 of them were re-captured. Among these re-captured lizards, five were caught after 26.8 (± 16.3 days (means in the same year and 12 after 308.8 (± 64.3 days (means in the next year. Recaptured individuals were still unambiguously recognisable.

How we established a new undergraduate firm on a Medical Admissions Unit.

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Nazir, Tahir; Wallis, Simon; Higham, Jackie; Newton, Kate; Pugh, Mark; Woywodt, Alexander

2014-11-01

Medical Admission Units (MAUs) were introduced in the UK in the 1980s primarily driven by a governance and service improvement agenda. In the UK this has led to the development of Acute Medicine as a specialty in its own right, together with a strong role of this specialty in postgraduate teaching. In contrast, the role of MAUs, if any, in undergraduate medical education is currently unclear. Prompted by an expansion of our undergraduate student numbers, our aim was to establish a Year 3 undergraduate firm on a 33-bedded MAU in a large academic teaching hospital in the National Health Service (NHS). Despite initial scepticism from clinicians, managers, and educators, the new firm placement on MAU became an instant success and continues to attract excellent feedback from our Year 3 undergraduate students. Students enjoy the bedside teaching with a high percentage of consultant-delivered teaching and also liked the involvement of Foundation Doctors. Here, we report our experience on how to make such a firm work, based on student feedback and the tutors' experience. We provide an overview and a step-by-step guide of how to construct a successful new undergraduate firm on a busy MAU. We also discuss opportunities and challenges and discuss the relevant literature. We conclude that undergraduate teaching is feasible and rewarding in an extremely busy MAU setting. We note that identifying enthusiastic educators within the MAU team, utilisation of peripheral learning opportunities, structured timetables and induction, and a robust framework for quality assurance are all crucial to success.

Unit cost of medical services at different hospitals in India.

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Susmita Chatterjee

Full Text Available Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010-11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital to Rs. 2,213 (private hospital (USD 1 = INR 52. The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country's hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising

Unit Cost of Medical Services at Different Hospitals in India

Science.gov (United States)

Chatterjee, Susmita; Levin, Carol; Laxminarayan, Ramanan

2013-01-01

Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates

Professionalism among multicultural medical students in the United Arab Emirates.

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Abdulrahman, Mahera; Alsalehi, Shahd; Husain, Zahra S M; Nair, Satish C; Carrick, Frederick Robert

2017-01-01

Moral competencies and ethical practices of medical professionals are among the desired outcomes of academic training. Unfortunately, academic dishonesty and misconduct are reported from medical colleges across the world. This study investigates the level of academic dishonesty/misconduct among multicultural medical students. The aim of this study is to investigate the level of academic dishonesty/misconduct among multicultural medical students. Validated and customized version of Dundee Polyprofessionalism Inventory-1 detailing lapses of professionalism in undergraduate health professions education was used to determine the perceived prevalence and self-reported lapses of academic integrity in this study. This study shows that the majority (458/554, 83%) of medical students have admitted to acts of academic dishonesty mentioned in the questionnaire. Approximately 42% (231/554) of the students have given proxy for attendance and 71% of them considered this as an offense. Similarly, 12% (66/554) have copied from the record books of others, and 86% (477/554) have considered it unethical. In addition, 5% (28/554) of the students revealed forging a teacher's signature in their record or logbooks, with 16% (91/554) of them reporting that they have seen others forge signatures. This is the first multi-center, multi-cultural and multi-ethnic study involving a large number of participants that addresses academic professionalism among medical students in the Middle East. Certainly, the paucity of data limits definitive conclusions about the best approach to prevent academic misconduct in the UAE medical schools. Yet, the results of our study are anticipated not only to benefit the UAE but also to find application in the Arab world, with similar medical school programs, values, culture and tradition.

Impact of boarding pediatric psychiatric patients on a medical ward.

Science.gov (United States)

Claudius, Ilene; Donofrio, J Joelle; Lam, Chun Nok; Santillanes, Genevieve

2014-05-01

Psychiatric disorders account for an increasing number of pediatric hospitalizations. Due to lack of psychiatric beds, patients on involuntary psychiatric holds may be admitted to medical units. Our objectives were to evaluate the rate of admission of psychiatric patients to a medical unit, psychiatric care provided, and estimated cost of care. The study involved retrospective chart review of all patients on involuntary psychiatric holds presenting to 1 pediatric emergency department from July 2009 to December 2010. We determined the rate of admission to a medical unit, the rate of counseling or psychiatric medication administration, and the estimated cost of nonmedical admissions (boarding) of patients on the medical unit. A total of 555 (50.1%) of 1108 patients on involuntary psychiatric holds were admitted to the pediatric medical unit. The majority (523 [94.2%]) were admitted for boarding because no psychiatric bed was available. Thirty-two (6.1%) patients admitted for isolated psychiatric reasons had counseling documented, and 105 (20.1%) received psychiatric medications. Patients admitted to an affiliated psychiatric hospital were significantly more likely to receive counseling and medications. Psychiatric patients were boarded in medical beds for 1169 days at an estimated cost of $2 232 790 or $4269 per patient over the 18-month period. We found high admission rates of patients on involuntary psychiatric holds to a pediatric medical unit with little psychiatric treatment in 1 hospital. Further research in other centers is required to determine the extent of the issue. Future studies of longer term outcomes (including readmission rates and assessments of functioning) are needed.

Current disparities in the prices of medical materials between Japan and the United States: further investigation of cardiovascular medical devices.

Science.gov (United States)

Yasunaga, Hideo; Ide, Hiroo; Imamura, Tomoaki

2007-02-01

Prices of medical devices in Japan were previously reported to be 2 to 4 times higher than those in the United States in 1996 and 1997. However, such data are out of date. We previously compared the market prices in early 2005 between Japan and the US for 16 items in 10 categories of medical materials, and showed that price differences still existed for all these items. However, the number of items investigated was small for each category, and generalization of the results might have been limited. The present study conducted a further investigation into price information for multiple items for each category, focusing on 5 cardiovascular devices. The US market price information was obtained from interviews of a healthcare provider network and 2 different group-purchasing organizations. We could obtain price information on 19 items in 5 categories. We substituted the Japanese reimbursement prices for the Japanese market prices. The price ratio (Japanese reimbursement price / US market price)was 2.0-3.5 for coronary stents, 5.9-6.8 for percutaneous transluminal coronary angioplasty catheters, 2.2-3.5 for pacemakers, 1.6-2.5 for mechanical valves, and 3.4-4.7 for oxygenators. The price disparities for cardiovascular devices between Japan and the US were reconfirmed. Japan's healthcare system should establish group-purchasing organizations, promote centers of clinical excellence, and abolish regulation of parallel imports and protectionism under the Japanese Pharmaceutical Affairs Law.

A renewed Medication Adherence Alliance call to action: harnessing momentum to address medication nonadherence in the United States.

Science.gov (United States)

Zullig, Leah L; Granger, Bradi B; Bosworth, Hayden B

2016-01-01

Nonadherence to prescription medications is a common and costly problem with multiple contributing factors, spanning the dimensions of individual behavior change, psychology, medicine, and health policy, among others. Addressing the problem of medication nonadherence requires strategic input from key experts in a number of fields. The Medication Adherence Alliance is a group of key experts, predominately from the US, in the field of medication nonadherence. Members include representatives from consumer advocacy groups, community health providers, nonprofit groups, the academic community, decision-making government officials, and industry. In 2015, the Medication Adherence Alliance convened to review the current landscape of medication adherence. The group then established three working groups that will develop recommendations for shifting toward solutions-oriented science. From the perspective of the Medication Adherence Alliance, the objective of this commentary is to describe changes in the US landscape of medication adherence, framing the evolving field in the context of a recent think tank meeting of experts in the field of medication adherence.

Barriers to discharge in an acute care medical teaching unit: a qualitative analysis of health providers’ perceptions

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Okoniewska B

2015-02-01

Full Text Available Barbara Okoniewska,1 Maria Jose Santana,1 Horacio Groshaus,2 Svetlana Stajkovic,3 Jennifer Cowles,4 David Chakrovorty,5 William A Ghali1 1Department of Community Health Sciences, W21C Research and Innovation Centre, Institute of Public Health, 2Department of Internal Medicine, University of Calgary, 3Community Based Practice, 4Foothills Medical Centre, 5Department of Quality and Healthcare Improvement, Alberta Health Services, Calgary, AB, Canada Background: The complex process of discharging patients from acute care to community care requires a multifaceted interaction between all health care providers and patients. Poor communication in a patient’s discharge can result in post hospital adverse events, readmission, and mortality. Because of the gravity of these problems, discharge planning has been emphasized as a potential solution. The purpose of this paper is to identify communication barriers to effective discharge planning in an acute care unit of a tertiary care center and to suggest solutions to these barriers. Methods: Health care providers provided comments to a single open-ended question: “What are the communication barriers between the different health care providers that limit an effective discharge of patients from Unit 36?” We conducted qualitative thematic analysis by identifying themes related to communication barriers affecting a successful discharge process. Results: Three broad themes related to barriers to the discharge process were identified: communication, lack of role clarity and lack of resources. We also identified two themes for opportunities for improvement, ie, structure and function of the medical team and need for leadership. Conclusion: While it was evident that poor communication was an overarching barrier identified by health care providers, other themes emerged. In an effort to increase inter-team communication, “bullet rounds”, a condensed form of discharge rounds, were introduced to the medical

Barriers to Exercise in Younger and Older Non-Exercising Adult Women: A Cross Sectional Study in London, United Kingdom

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Ansari, Walid El; Lovell, Geoff

2009-01-01

A survey of 100 women in the south of London, United Kingdom (UK) compared exercise barrier intensities between non-exercising younger (20–27 years) and older (28–35 years) adult women; and examined childcare duties as perceived barriers to exercise. Perceived barriers to exercise were examined using an Exercise Benefits/Barriers Scale (EBBS) comprising four subscales (exercise milieu; time expenditure; physical exertion; family discouragement). Participants’ number of children was also noted. Non-exercising older women reported significantly higher total exercise barriers, as well as across three barrier subscales: exercise milieu, time expenditure, and family discouragement. For both age groups, significant correlation existed between number of children and women’s total exercise barrier scores. Number of children explained ≈25% and ≈30% of the variance of younger and older women’s total barrier scores respectively. For both women groups, the strongest correlation between exercise barrier and number of children was for the time expenditure subscale. Broad grouping of 20–35 year old non-exercising women does not reflect a homogenous sample. Age categories employing narrower age brackets are recommended. Issues surrounding family responsibilities e.g. childcare duties may be shared between these groups and require further research and policy attention. PMID:19440527

Barriers to Exercise in Younger and Older Non-Exercising Adult Women: A Cross Sectional Study in London, United Kingdom

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Geoff Lovell

2009-04-01

Full Text Available A survey of 100 women in the south of London, United Kingdom (UK compared exercise barrier intensities between non-exercising younger (20-27 years and older (28-35 years adult women; and examined childcare duties as perceived barriers to exercise. Perceived barriers to exercise were examined using an Exercise Benefits/Barriers Scale (EBBS comprising four subscales (exercise milieu; time expenditure; physical exertion; family discouragement. Participants’ number of children was also noted. Non-exercising older women reported significantly higher total exercise barriers, as well as across three barrier subscales: exercise milieu, time expenditure, and family discouragement. For both age groups, significant correlation existed between number of children and women’s total exercise barrier scores. Number of children explained »25% and »30% of the variance of younger and older women’s total barrier scores respectively. For both women groups, the strongest correlation between exercise barrier and number of children was for the time expenditure subscale. Broad grouping of 20-35 year old non-exercising women does not reflect a homogenous sample. Age categories employing narrower age brackets are recommended. Issues surrounding family responsibilities e.g. childcare duties may be shared between these groups and require further research and policy attention.

A renewed Medication Adherence Alliance call to action: harnessing momentum to address medication nonadherence in the United States

Directory of Open Access Journals (Sweden)

Zullig LL

2016-07-01

Full Text Available Leah L Zullig,1,2 Bradi B Granger,3 Hayden B Bosworth,1–4 On behalf of the Medication Adherence Alliance 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 2Division of General Internal Medicine, Department of Medicine, Duke University, 3Duke Heart Center Nursing Research Program, School of Nursing, Duke University, 4Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA The problem: Nonadherence to prescription medications is a common and costly problem with multiple contributing factors, spanning the dimensions of individual behavior change, psychology, medicine, and health policy, among others. Addressing the problem of medication nonadherence requires strategic input from key experts in a number of fields.Meeting of experts: The Medication Adherence Alliance is a group of key experts, predominately from the US, in the field of medication nonadherence. Members include representatives from consumer advocacy groups, community health providers, nonprofit groups, the academic community, decision-making government officials, and industry. In 2015, the Medication Adherence Alliance convened to review the current landscape of medication adherence. The group then established three working groups that will develop recommendations for shifting toward solutions-oriented science.Commentary of expert opinion: From the perspective of the Medication Adherence Alliance, the objective of this commentary is to describe changes in the US landscape of medication adherence, framing the evolving field in the context of a recent think tank meeting of experts in the field of medication adherence. Keywords: medication adherence, health planning recommendations, chronic disease

Ionizing radiations: medical and industrial applications

International Nuclear Information System (INIS)

Vidal, H.

1994-01-01

Medical diagnosis with X-rays is the best known use of ionizing radiations on account of its wide diffusion (about 57 500 units in France). Other medical applications of artificial radionuclides involving a smaller number of installations are also well known, i.e. gamma teletherapy (167 units), brachytherapy (119 units) or therapy using unsealed sources (257 units). The industrial uses of ionising radiation, the diversity of which is very large, are generally less well known. The use of X- and gamma rays for non-destructive testing or food preservation and the use of tracers have some notoriety, but few people know that radioactive sources are involved in the measurement of parameters controlling industrial processes. The number of persons authorized to hold, use and/or sell artificial radionuclides amounts to about 4 800, all applications included. Approximately 650 of them are involved in therapy and 500 in medical research. The aim of this paper, which is not exhaustive, is to review a few typical applications of radionuclides both in the medical and industrial fields. It also supplies data both on the number of people authorized to use each technique and the radionuclides involved. (author). 10 tabs

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

DEFF Research Database (Denmark)

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

2017-01-01

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

Nurses\\' perception of caring behaviors in intensive care units in hospitals of Lorestan University of Medical Sciences, Iran

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Asadi SE

2014-11-01

Full Text Available Background and Objective: Caring is the core of nursing however, different individules have different perceptions of it. Continuous assessment and measurement of caring behaviors results in the identification of their problems. The careful planning of interventions and problem solving will improve care. The aim of this study was to identify nurses' perception of caring behaviors in the intensive care units. Materials and Method: In this descriptive-analytic study, 140 nurses were selected from intensive care units of hospitals affiliated to Lorestan University of Medical Sciences, Iran, using the census method in 2012. The data collection tool was the Caring Behaviors Inventory for Elders (CBI-E. This questionnaire consisted of two parts including demographic information and 28 items related to care. Face and content validity of the Persian version of the questionnaire were provided by professionals, and after deletion of 4 items a 24-item questionnaire was provided. Cronbach's alpha coefficient was calculated to assess reliability (&alpha = 0.71. Data were analyzed using SPSS software version 18 and descriptive-analytic statistics (Kruskal-Wallis test and Mann-Whitney test. Results: Based on the findings, nurses paid more attention to the physical–technical aspects (95.71 ± 12.76 of care in comparison to its psychosocial aspects (75.41 ± 27.91. Nurses had the highest score in care behavior of "timely performance of medical procedures and medication administration". Conclusion: Since nurses paid more attention to the technical aspects of care than its psychosocial aspects, by providing nurses with a correct perception of care, patients can be provided with needs-based care. This will increase patient satisfaction with nursing care, and indirectly result in the positive attitude of patients and society toward the nursing profession and its services. Moreover, nursing education officials can use these results to assist nurses in meeting

Challenges and Opportunities for the Use of Medications to Treat Opioid Addiction in the United States and Other Nations of the World.

Science.gov (United States)

Parrino, Mark W; Maremmani, Angelo Giovanni Icro; Samuels, Paul N; Maremmani, Icro

2015-01-01

There has been a well documented increase in the use and abuse of prescription opioids and heroin in the United States and other parts of the world. There has also been an increasing focus to increase access to the use of medications (methadone, buprenorphine, Naltrexone/Vivitrol) for opioid addicted individuals under legal supervision. As policymakers engage in strategic initiatives to better prevent and effectively treat chronic opioid addiction, both in the United States and other countries, there are a number of unintended consequences, complicating how best to increase access to effective treatment.

Tracking the Implementation of Electronic Medical Records in Dubai, United Arab Emirates, Using an Adoption Benchmarking Tool.

Science.gov (United States)

El-Hassan, Osama; Sharif, Amer; Al Redha, Mohammad; Blair, Iain

2017-01-01

In the United Arab Emirates (UAE), health services have developed greatly in the past 40 years. To ensure they continue to meet the needs of the population, innovation and change are required including investment in a strong e-Health infrastructure with a single transferrable electronic patient record. In this paper, using the Emirate of Dubai as a case study, we report on the Middle East Electronic Medical Record Adoption Model (EMRAM). Between 2011-2016, the number of participating hospitals has increased from 23 to 33. Currently, while 20/33 of hospitals are at Stage 2 or less, 10/33 have reached Stage 5. Also Dubai's median EMRAM score in 2016 (2.5) was higher than the scores reported from Australia (2.2), New Zealand (2.3), Malaysia (0.06), the Philippines (0.06) and Thailand (0.5). EMRAM has allowed the tracking of the progress being made by healthcare facilities in Dubai towards upgrading their information technology infrastructure and the introduction of electronic medical records.

Unit-of-Use Versus Traditional Bulk Packaging

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Tiffany So

2012-01-01

Full Text Available Background: The choice between unit-of-use versus traditional bulk packaging in the US has long been a continuous debate for drug manufacturers and pharmacies in order to have the most efficient and safest practices. Understanding the benefits of using unit-of-use packaging over bulk packaging by US drug manufacturers in terms of workflow efficiency, economical costs and medication safety in the pharmacy is sometimes challenging.Methods: A time-saving study comparing the time saved using unit-of-use packaging versus bulk packaging, was examined. Prices between unit-of-use versus bulk packages were compared by using the Red Book: Pharmacy’s Fundamental Reference. Other articles were reviewed on the topics of counterfeiting, safe labeling, and implementation of unit-of-use packaging. Lastly, a cost-saving study was reviewed showing how medication adherence, due to improved packaging, could be cost-effective for patients.Results: When examining time, costs, medication adherence, and counterfeiting arguments, unit-of-use packaging proved to be beneficial for patients in all these terms.

Unit-of-Use Versus Traditional Bulk Packaging

Directory of Open Access Journals (Sweden)

Tiffany So

2012-01-01

Full Text Available Background: The choice between unit-of-use versus traditional bulk packaging in the US has long been a continuous debate for drug manufacturers and pharmacies in order to have the most efficient and safest practices. Understanding the benefits of using unit-of-use packaging over bulk packaging by US drug manufacturers in terms of workflow efficiency, economical costs and medication safety in the pharmacy is sometimes challenging. Methods: A time-saving study comparing the time saved using unit-of-use packaging versus bulk packaging, was examined. Prices between unit-of-use versus bulk packages were compared by using the Red Book: Pharmacy's Fundamental Reference. Other articles were reviewed on the topics of counterfeiting, safe labeling, and implementation of unit-of-use packaging. Lastly, a cost-saving study was reviewed showing how medication adherence, due to improved packaging, could be cost-effective for patients. Results: When examining time, costs, medication adherence, and counterfeiting arguments, unit-of-use packaging proved to be beneficial for patients in all these terms.   Type: Student Project

Study of uranium (VI) in carbonate solution by potentiometric titrations and ion-exchange; Etude des solutions d'uranium (VI) en milieu carbonate par titrages potentiometriques et echange d'ions

Energy Technology Data Exchange (ETDEWEB)

Billon, A [Commissariat a l' Energie Atomique, 92 - Fontenay-aux-Roses (France). Centre d' Etudes Nucleaires

1968-04-01

The present work is devoted to the fixation of uranium (VI) on the conventional anion-exchange resin Dowex 2 X 8 in carbonate and hydrogen-carbonate media. Both media were successfully used for the recuperation of uranium (VI) from very dilute solutions. Equilibrium constant of the exchange [UO{sub 2}(CO{sub 3}){sub 3}{sup 4+}]{sub S} + 2 [CO{sub 3}{sup 2-}]{sub R} {r_reversible} [UO{sub 2}(CO{sub 3}){sub 3}{sup 4-}]{sub R} + 2[CO{sub 3}{sup 2-}]{sub S} is determined for carbonate concentration range 0.1 M to 0.6 M from partition curves. A markedly increase in the relative fixation of uranium results with: - increasing free carbonate concentration of the solution, - decreasing uranium concentration. A study in the same conditions of the fixation of molybdenum has made it possible to separate the latter from uranium by elution, the carbonate concentration being molar. It is suggested a possibility of separation on a larger scale, based upon molybdenum displacement by uranium in hydrogen-carbonate medium. (author) [French] Le present travail precise la fixation de l'uranium (VI) sur la resine echangeuse d'anions Dowex 2 X 8, en milieu carbonate et hydrogeno-carbonate. Nous en avons deduit que ces deux milieux sont egalement favorables a la recuperation de l'uranium a partir de solutions tres diluees. La constante d'equilibre de la reaction d'echange [UO{sub 2}(CO{sub 3}){sub 3}{sup 4+}]{sub S} + 2 [CO{sub 3}{sup 2-}]{sub R} {r_reversible} [UO{sub 2}(CO{sub 3}){sub 3}{sup 4-}]{sub R} + 2[CO{sub 3}{sup 2-}]{sub S} a ete determinee pour le milieu carbonate 0.1 M a 0.6 M, a partir deb courbes de partage. La fixation relative de l'uranium augmente considerablement lorsque: - la concentration du carbonate libre (respectivement hydrogenocarbonate) diminue, - la concentration de l'uranium en solution diminue. Le comportement du molybdene a ete etudie en vue de la separation uranium-molybdene. L'ion fixe sur la resine est l'ion molybdate MoO{sub 4}{sup 2-}. La separation est

Evaluating the Frequency of Errors in Preparation and Administration of Intravenous Medications in the Intensive Care Unit of Shahid-Sadoughi Hospital in Yazd

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SeyedMojtaba Sohrevardi

2015-10-01

Full Text Available Background: In most Iranian hospitals, the nurses in the wards prepare intravenous (IV drugs and unfortunately pharmacists are not involved in this process. The severity of the patients in Intensive Care Unit (ICU heightens the risk of errors. More over the frequency of using IV drugs in this unit is high, so we decided to determine the frequency and types of errors, which occur in the preparation and administration of commonly, used IV medications in an ICU.Method: A prospective cross sectional study was performed from November 2013 to August 2014, in the intensive care unit in Shahid-Sadoughi hospital in Yazd. Medication errors occurred in the process of preparation and administration of IV drugs, were recorded by a pharmacy student and were evaluated by direct observation, according to the method established by Barker and McConnell.Results: A total number of 843 intravenous doses were evaluated. The most common type of error (34.26% was the injection of IV doses faster than the recommended rate followed by preparation (15.69%, administration (9.23% and compatibility with doctor’s order (6.24%. Amikacin was the most common drug involved in errors (41.67%. Most of errors were occurred at afternoon (8 p.m, 28.36%.Conclusion: According to our study the rate of errors in preparation and administration of IV drugs was high in this ICU. Employing more nurses, using developed medical instruments and clinical pharmacists can help to decrease these errors and improve the quality of patient care.

Accounting for medical communication: parents' perceptions of communicative roles and responsibilities in the pediatric intensive care unit.

Science.gov (United States)

Gordon, Cynthia; Barton, Ellen; Meert, Kathleen L; Eggly, Susan; Pollacks, Murray; Zimmerman, Jerry; Anand, K J S; Carcillo, Joseph; Newth, Christopher J L; Dean, J Michael; Willson, Douglas F; Nicholson, Carol

2009-01-01

Through discourse analysis of transcribed interviews conducted over the phone with parents whose child died in the Pediatric Intensive Care Unit (PICU) (n = 51), this study uncovers parents' perceptions of clinicians' and their own communicative roles and responsibilities in the context of team-based care. We examine parents' descriptions and narratives of communicative experiences they had with PICU clinicians, focusing on how parents use accounts to evaluate the communicative behaviors they report (n = 47). Findings indicate that parental perceptions of communicative responsibilities are more nuanced than assumed in previous research: Parents identified their own responsibilities as participating as part of the team of care, gathering information, interacting with appropriate affect, and working to understand complex and uncertain medical information. Complementarily, parents identified clinician responsibilities as communicating professionally, providing medical information clearly, managing parents' hope responsibly, and communicating with appropriate affect. Through the accounts they provide, parents evaluate both parental and clinician role-responsibilities as fulfilled and unfulfilled. Clinicians' management of prognostic uncertainty and parents' struggles to understand that uncertainty emerged as key, complementary themes with practical implications for incorporating parents into the PICU care team. The study also highlights insights retrospective interview data bring to the examination of medical communication.

Residency training in the United States: What foreign medical ...

African Journals Online (AJOL)

FMGs) planning to pursue post-graduate residency training in the United States of America (USA). While the number of residency training positions is shrinking, and the number of United States graduates has steadily declined over the past ...

Ecology and sampling techniques of an understudied subterranean habitat: the Milieu Souterrain Superficiel (MSS).

Science.gov (United States)

Mammola, Stefano; Giachino, Pier Mauro; Piano, Elena; Jones, Alexandra; Barberis, Marcel; Badino, Giovanni; Isaia, Marco

2016-12-01

The term Milieu Souterrain Superficiel (MSS) has been used since the early 1980s in subterranean biology to categorize an array of different hypogean habitats. In general terms, a MSS habitat represents the underground network of empty air-filled voids and cracks developing within multiple layers of rock fragments. Its origins can be diverse and is generally covered by topsoil. The MSS habitat is often connected both with the deep hypogean domain-caves and deep rock cracks-and the superficial soil horizon. A MSS is usually characterized by peculiar microclimatic conditions, and it can harbor specialized hypogean, endogean, and surface-dwelling species. In light of the many interpretations given by different authors, we reviewed 235 papers regarding the MSS in order to provide a state-of-the-art description of these habitats and facilitate their study. We have briefly described the different types of MSS mentioned in the scientific literature (alluvial, bedrock, colluvial, volcanic, and other types) and synthesized the advances in the study of the physical and ecological factors affecting this habitat-i.e., microclimate, energy flows, animal communities, and trophic interactions. We finally described and reviewed the available sampling methods used to investigate MSS fauna.

[Learning from the experiences of an arbitration unit for medical liability questions].

Science.gov (United States)

Scheppokat, K D

2005-03-01

While other countries', e.g. the United States', experience with alternative dispute resolution (ADR) in medical malpractice has been disappointing, German physicians have instituted extrajudicial claims resolution as an alternative to civil litigation: Established by the Arztekammern (corporate bodies of professional self-governance) in the mid-1970s, the Schlichtungsstellen (SchlSt--claims resolution panels) offer patients and doctors, on a voluntary basis, proceedings directed toward achieving a settlement. The number of cases submitted to these panels has been constantly growing since. In 90% of cases decided upon by the panel, civil litigation was avoided. Doctors can, as exemplified by the operation of the SchlSt, tackle difficult and complex problems and solve them--without being funded or directed by outside agencies. What can be learnt from being, as a physician member, associated with a SchlSt for several years? (1) Physicians--as Eddy has pointed out--must make decisions about complex problems under difficult conditions on the basis of inadequate information. Expert testimony suffers from similar uncertainties. Decisions on individual cases cannot be improved by external and necessarily generalized ruling (disease management programs, other directives). (2) Errors and adverse events in medical care have to be accepted as principally unavoidable. Most claims heard by the panel have to do with operations and--in the non-surgical specialties--with invasive procedures. Medical tasks of high complexity, as many operative and invasive procedures indeed are, seem to have an inherent accident-proneness. Therefore decisions as to operations and invasive procedures should be weighed with utmost care. More is not always better (3) 25% of the patients filing claims with the SchlSt complain of deficient doctor-patient-communication. Failure of doctors and staff to communicate adequately with the patients and with their professional contacts plays an important role as

Bariatric Endocrinology: Principles of Medical Practice

Science.gov (United States)

Gonzalez-Campoy, J. Michael; Richardson, Bruce; Gonzalez-Cameron, David; Ebrahim, Ayesha; Strobel, Pamela; Martinez, Tiphani; Blaha, Beth; Ransom, Maria; Quinonez-Weislow, Jessica; Pierson, Andrea; Gonzalez Ahumada, Miguel

2014-01-01

Obesity, is a chronic, biological, preventable, and treatable disease. The accumulation of fat mass causes physical changes (adiposity), metabolic and hormonal changes due to adipose tissue dysfunction (adiposopathy), and psychological changes. Bariatric endocrinology was conceived from the need to address the neuro-endocrinological derangements that are associated with adiposopathy, and from the need to broaden the scope of the management of its complications. In addition to the well-established metabolic complications of overweight and obesity, adiposopathy leads to hyperinsulinemia, hyperleptinemia, hypoadiponectinemia, dysregulation of gut peptides including GLP-1 and ghrelin, the development of an inflammatory milieu, and the strong risk of vascular disease. Therapy for adiposopathy hinges on effectively lowering the ratio of orexigenic to anorexigenic signals reaching the the hypothalamus and other relevant brain regions, favoring a lower caloric intake. Adiposopathy, overweight and obesity should be treated indefinitely with the specific aims to reduce fat mass for the adiposity complications, and to normalize adipose tissue function for the adiposopathic complications. This paper defines the principles of medical practice in bariatric endocrinology—the treatment of overweight and obesity as means to treat adiposopathy and its accompanying metabolic and hormonal derangements. PMID:24899894

Over-imaging in uncomplicated low back pain: a 12-month audit of a general medical unit.

Science.gov (United States)

Rego, M H; Nagiah, S

2016-12-01

Low back pain is frequently encountered in hospitals and is a leading cause of disability, often involving costly imaging that exposes a patient to radiation. A retrospective 12-month audit at a South Australian tertiary hospital aimed to evaluate the frequency, modality and appropriateness of imaging in patients with low back pain. Results showed that the general medical unit was unnecessarily ordering imaging in 40% of patients who exhibited no indications warranting such a procedure. A standardised protocol is required to preventing clinicians from requesting imaging solely for the purposes of self-reassurance, patient reassurance or fear of litigation. © 2016 Royal Australasian College of Physicians.

The Impact of Bar Code Medication Administration Technology on Reported Medication Errors

Science.gov (United States)

Holecek, Andrea

2011-01-01

The use of bar-code medication administration technology is on the rise in acute care facilities in the United States. The technology is purported to decrease medication errors that occur at the point of administration. How significantly this technology affects actual rate and severity of error is unknown. This descriptive, longitudinal research…

Defected red blood cell membranes and direct correlation with the uraemic milieu: the connection with the decreased red blood cell lifespan observed in haemodialysis patients

International Nuclear Information System (INIS)

Stamopoulos, D; Manios, E; Gogola, V; Grapsa, E; Bakirtzi, N

2012-01-01

Together with impaired production of erythropoietin and iron deficiency, the decreased lifespan of red blood cells (RBCs) is a main factor contributing to the chronic anaemia observed in haemodialysis (HD) patients. Atomic force microscopy is employed in this work to thoroughly survey the membrane of intact RBCs (iRBCs) of HD patients in comparison to those of healthy donors, aiming to obtain direct information on the structural status of RBCs that can be related to their decreased lifespan. We observed that the iRBC membrane of the HD patients is overpopulated with extended circular defects, termed ‘orifices’, that have typical dimension ranging between 0.2 and 1.0 μm. The ‘orifice’ index—that is, the mean population of ‘orifices’ per top membrane surface—exhibits a pronounced relative increase of order 54 ± 12% for the HD patients as compared to healthy donors. Interestingly, for the HD patients, the ‘orifice’ index, which relates to the structural status of the RBC membrane, correlates strongly with urea concentration, which is a basic index of the uraemic milieu. Thus, these results indicate that the uraemic milieu downgrades the structural status of the RBC membrane, possibly triggering biochemical processes that result in their premature elimination from the circulation. This process could decrease the lifespan of RBCs, as observed in HD patients. (paper)

Valuation of medical resource units collected in health economic studies.

Science.gov (United States)

Copley-Merriman, C; Lair, T J

1994-01-01

This paper reviews the issues that are critical for the valuation of medical resources in the context of health economic studies. There are several points to consider when undertaking the valuation of medical resources. The perspective of the analysis should be established before determining the valuation process. Future costs should be discounted to present values, and time and effort spent in assigning a monetary value to a medical resource should be proportional to its importance in the analysis. Prices vary considerably based on location of the service and the severity of the illness episode. Because of the wide variability in pricing data, sensitivity analysis is an important component of validation of study results. A variety of data sources have been applied to the valuation of medical resources. Several types of data are reviewed in this paper, including claims data, national survey data, administrative data, and marketing research data. Valuation of medical resources collected in clinical trials is complex because of the lack of standardization of the data sources. A national pricing data source for health economic valuation would greatly facilitate study analysis and make comparisons between results more meaningful.

The Self-Perception and Usage of Medical Apps amongst Medical Students in the United States: A Cross-Sectional Survey

Directory of Open Access Journals (Sweden)

Cara Quant

2016-01-01

Full Text Available Background. Mobile medical software applications (apps are used for clinical decision-making at the point of care. Objectives. To determine (1 the usage, reliability, and popularity of mobile medical apps and (2 medical students’ perceptions of app usage effect on the quality of patient-provider interaction in healthcare settings. Methods. An anonymous web-based survey was distributed to medical students. Frequency of use, type of app used, and perceptions of reliability were assessed via univariate analysis. Results. Seven hundred thirty-one medical students responded, equating to a response rate of 29%. The majority (90% of participants thought that medical apps enhance clinical knowledge, and 61% said that medical apps are as reliable as textbooks. While students thought that medical apps save time, improve the care of their patients, and improve diagnostic accuracy, 53% of participants believed that mobile device use in front of colleagues and patients makes one appear less competent. Conclusion. While medical students believe in the utility and reliability of medical apps, they were hesitant to use them out of fear of appearing less engaged. Higher levels of training correlated with a greater degree of comfort when using medical apps in front of patients.

Supporting medical education research quality: the Association of American Medical Colleges' Medical Education Research Certificate program.

Science.gov (United States)

Gruppen, Larry D; Yoder, Ernie; Frye, Ann; Perkowski, Linda C; Mavis, Brian

2011-01-01

The quality of the medical education research (MER) reported in the literature has been frequently criticized. Numerous reasons have been provided for these shortcomings, including the level of research training and experience of many medical school faculty. The faculty development required to improve MER can take various forms. This article describes the Medical Education Research Certificate (MERC) program, a national faculty development program that focuses exclusively on MER. Sponsored by the Association of American Medical Colleges and led by a committee of established medical education researchers from across the United States, the MERC program is built on a set of 11 interactive workshops offered at various times and places across the United States. MERC participants can customize the program by selecting six workshops from this set to fulfill requirements for certification. This article describes the history, operations, current organization, and evaluation of the program. Key elements of the program's success include alignment of program content and focus with needs identified by prospective users, flexibility in program organization and logistics to fit participant schedules, an emphasis on practical application of MER principles in the context of the participants' activities and interests, consistency in program content and format to ensure standards of quality, and a sustainable financial model. The relationship between the national MERC program and local faculty development initiatives is also described. The success of the MERC program suggests that it may be a possible model for nationally disseminated faculty development programs in other domains.

The Study of Life Change Unit as Stressor Agents among Tehran University of Medical Sciences Hospitals' Employees

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Hossein Dargahi

2010-08-01

Full Text Available Life crises as stressor agents can disrupt the best stress management regime. Different life crises have different impacts. A standard scale to rate change and its related stress impact has been developed commonly referred to as LCU (Life Change Unit Rating. This allocates a number of Life Crisis Units or Life Change Units (LCUs to different event and then evaluates them and takes action accordingly. This idea behind this approach of is to rundown the LCU table, totaling the LCUs for life crisis that have occurred in the previous one year. A Cross - sectional, descriptive and analytical study was conducted among 900 Tehran University of Medical Sciences (TUMS Employees by a Holms and Rahe LCU questionnaire at 15 hospitals. The respondents were asked to determine their demographic information, list of stress symptoms which suffered from these diseases in the previous one year and finally, responded to 45 Life Change Unit as stressful life events and the value of each in "stress units" which occurred in the previous one year. The results showed that there is significant correlation between the employees LCU rating by sex, educational degree and size of hospital. Also we found that there are significant correlations between the employees stress symptoms with their LCU rating. Totally, 40% of the employees have less than 150 LCU rating (normal range and 60% of them have 150-300 or more than 300 LCU rating (abnormal range. In conclusion most of TUMS hospitals' employees who had stress symptoms have more LCU rating. One third of these employees are not in danger of suffering the illness effect, while two third of them are in danger.

Effect of PACS/CR on cost of care and length of stay in a medical intensive care unit

Science.gov (United States)

Langlotz, Curtis P.; Kundel, Harold L.; Brikman, Inna; Pratt, Hugh M.; Redfern, Regina O.; Horii, Steven C.; Schwartz, J. Sanford

1996-05-01

Our purpose was to determine the economic effects associated with the introduction of PACS and computed radiology (CR) in a medical intensive care unit (MICU). Clinical and financial data were collected over a period of 6 months, both before and after the introduction of PACS/CR in our medical intensive care unit. Administrative claims data resulting from the MICU stay of each patient enrolled in our study were transferred online to our research database from the administrative databases of our hospital and its affiliated clinical practices. These data included all charge entries, sociodemographic data, admissions/discharge/transfer chronologies, ICD9 diagnostic and procedure codes, and diagnostic related groups. APACHE III scores and other case mix adjusters were computed from the diagnostic codes, and from the contemporaneous medical record. Departmental charge to cost ratios and the Medicare Resource-Based Relative Value Scale fee schedule were used to estimate costs from hospital and professional charges. Data were analyzed using both the patient and the exam as the unit of analysis. Univariate analyses by patient show that patients enrolled during the PACS periods were similar to those enrolled during the Film periods in age, sex, APACHE III score, and other measures of case mix. No significant differences in unadjusted median length of stay between the two Film and two PACS periods were detected. Likewise, no significant differences in unadjusted total hospital and professional costs were found between the Film and PACS periods. In our univariate analyses by exam, we focused on the subgroup of exams that had triggered primary clinical actions in any period. Those action-triggering exams were divided into two groups according to whether the referring clinician elected to obtain imaging results from the workstation or from the usual channels. Patients whose imaging results were obtain from the workstation had significantly lower professional costs in the 7 days

Gifts and influence: Conflict of interest policies and prescribing of psychotropic medications in the United States.

Science.gov (United States)

King, Marissa; Bearman, Peter S

2017-01-01

The pharmaceutical industry spends roughly 15 billion dollars annually on detailing - providing gifts, information, samples, trips, honoraria and other inducements - to physicians in order to encourage them to prescribe their drugs. In response, several states in the United States adopted policies that restrict detailing. Some states banned gifts from pharmaceutical companies to doctors, other states simply required physicians to disclose the gifts they receive, while most states allowed unrestricted detailing. We exploit this geographic variation to examine the relationship between gift regulation and the diffusion of four newly marketed medications. Using a dataset that captures 189 million psychotropic prescriptions written between 2005 and 2009, we find that uptake of new costly medications was significantly lower in states with marketing regulation than in areas that allowed unrestricted pharmaceutical marketing. In states with gift bans, we observed reductions in market shares ranging from 39% to 83%. Policies banning or restricting gifts were associated with the largest reductions in uptake. Disclosure policies were associated with a significantly smaller reduction in prescribing than gift bans and gift restrictions. In states that ban gift-giving, peer influence substituted for pharmaceutical detailing when a relatively beneficial drug came to market and provided a less biased channel for physicians to learn about new medications. Our work suggests that policies banning or limiting gifts from pharmaceutical representatives to doctors are likely to be more effective than disclosure policies alone. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Current Status of Medical Marijuana in the United States

OpenAIRE

McKenna, Gerald J

2014-01-01

Medical marijuana is currently a controversial issue in medicine. There are strong pro and con opinions but relatively little scientific data on which to base medical decisions. The unfortunate scheduling of marijuana in class I has limited research and only serves to fuel the controversy.

QUANTITIES AND UNITS IN MEDICAL SCIENCE - A PLEA FOR STANDARDIZATION

NARCIS (Netherlands)

ZIJLSTRA, WG

1993-01-01

The paper puts forward the idea that a relative lack of interest in the quantitative aspects of pathophysiological processes has made medical practice as well as medical research vulnerable to misconceptions carried into the field by technical innovations. More attention to these matters may not

Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?

Directory of Open Access Journals (Sweden)

Ekerstad N

2016-12-01

Full Text Available Niklas Ekerstad,1,2 Björn W Karlson,3 Synneve Dahlin Ivanoff,4 Sten Landahl,5 David Andersson,6 Emelie Heintz,7 Magnus Husberg,2 Jenny Alwin2 1Department of Cardiology, NU (NÄL-Uddevalla Hospital Group, Trollhattan, 2Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, 3Department of Molecular and Clinical Medicine, Institute of Medicine, 4Centre for Ageing and Health, AGECAP, Department of Health and Rehabilitation, 5Department of Geriatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 6Division of Economics, Department of Management and Engineering, Linköping University, Linköping, 7Health Outcomes and Economic Evaluation Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden Objective: The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA unit is superior to the care in a conventional acute medical care unit. Design: This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting: This study was conducted in a large county hospital in western Sweden. Participants: The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206 or control group (n=202. Mean age of the patients was 85.7 years, and 56% were female. Intervention: This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements: The primary outcome was the change in health-related quality of life (HRQoL 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3. Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. Results: After adjustment by

Medical Practice Makes Perfect

Science.gov (United States)

1998-01-01

Cedaron Medical Inc., was founded in 1990 as a result of a NASA SBIR (Small Business Innovative Research) grant from Johnson Space Center to develop a Hand Testing and Exercise Unit for use in space. From that research came Dexter, a comprehensive workstation that creates a paperless environment for medical data management.

Effects of learning climate and registered nurse staffing on medication errors.

Science.gov (United States)

Chang, YunKyung; Mark, Barbara

2011-01-01

Despite increasing recognition of the significance of learning from errors, little is known about how learning climate contributes to error reduction. The purpose of this study was to investigate whether learning climate moderates the relationship between error-producing conditions and medication errors. A cross-sectional descriptive study was done using data from 279 nursing units in 146 randomly selected hospitals in the United States. Error-producing conditions included work environment factors (work dynamics and nurse mix), team factors (communication with physicians and nurses' expertise), personal factors (nurses' education and experience), patient factors (age, health status, and previous hospitalization), and medication-related support services. Poisson models with random effects were used with the nursing unit as the unit of analysis. A significant negative relationship was found between learning climate and medication errors. It also moderated the relationship between nurse mix and medication errors: When learning climate was negative, having more registered nurses was associated with fewer medication errors. However, no relationship was found between nurse mix and medication errors at either positive or average levels of learning climate. Learning climate did not moderate the relationship between work dynamics and medication errors. The way nurse mix affects medication errors depends on the level of learning climate. Nursing units with fewer registered nurses and frequent medication errors should examine their learning climate. Future research should be focused on the role of learning climate as related to the relationships between nurse mix and medication errors.

Medical research at the Albert Schweitzer Hospital.

Science.gov (United States)

Issifou, Saadou; Adegnika, Ayola A; Lell, Bertrand

2010-03-01

Built in 1981, the Medical Research Unit is located at the campus of the Albert Schweitzer Hospital. The main scientific activities of this research unit lie on clinical research focusing on antimalarial drugs and vaccines, and basic studies on pathogenesis of infectious diseases. Since 2002 the Medical Research Unit has experience in organising and hosting high quality training in clinical research in collaboration with the Vienna School of Clinical Research and other partners. For the future, this unit is involved as a key partner in the Central African Network on Tuberculosis, HIV/AIDS and Malaria (CANTAM) consortium playing a central role for the excellence in clinical research in Central Africa.

U.S. Army Medical Department Journal, April-June 2008

Science.gov (United States)

2008-06-01

IGR), against dengue vector mosquitoes. In the Peruvian Amazon community at Iquitos, Stancil42 (Naval Medical Research Center Detachment, Peru ...Research Unit- Kenya, Nairobi; Naval Medical Research Center Detachment, Lima, Peru ; Naval Medical Research Unit-2, Jakarta, Indonesia; and the Naval...These projects have revealed that sand flies often emerge from the soil beneath tents and camps. In an effort to prevent sand flies breeding in rodent

Handling of TRIGA spent fuel at the Medical University of Hanover and its return to the United States

International Nuclear Information System (INIS)

Hampel, Gabriele; Harke, Heinrich; Kelm, Wieland; Klaus, Uwe

2008-01-01

The Medical University of Hannover (MHH) was taking part in the US Department of Energy's (DOE) 'Research Reactor Spent Fuel Acceptance Program' to return its 76 spent TRIGA fuel elements to the United States in the middle of 1999. The fuel elements have been moved to the Idaho National Engineering and Environmental Laboratory (INEEL) in Idaho. This paper describes the technical facilities for handling the fuel elements at the MHH and the various steps in removing the fuel elements from the reactor, transferring them to the transport cask and shipping them to the INEEL. (authors)

Intrafollicular Endocrine Milieu After Addition of hCG to Recombinant FSH During Controlled Ovarian Stimulation for In Vitro Fertilization

DEFF Research Database (Denmark)

Thuesen, L L; Andersen, A Nyboe; Loft, A

2014-01-01

CONTEXT: The role of human chorionic gonadotropin (hCG) supplementation on the intrafollicular steroid milieu has been studied. OBJECTIVE: The objective of the study was to assess the impact on steroid levels in follicular fluids (FFs) after different doses of hCG supplementation to recombinant FSH...... protocol with recombinant FSH 150 IU/d and randomized from stimulation day 1 to supplementation with hCG: D0, 0 IU/d; D50, 50 IU/d; D100, 100 IU/d; and D150, 150 IU/d. MAIN OUTCOME MEASURE: Intrafollicular hormone concentrations in relation to treatment groups, follicular sizes, and embryo quality were...... measured. RESULTS: In large follicles, hCG supplementation induced a nearly 3-fold increase of estradiol (nanomoles per liter) [D0: 1496; D50: 3138; D100: 4338; D150: 4009 (P

CLINICAL AND HORMONAL MILIEU OF 9 PATIENTS WITH PRIMARY GROWTH HORMONE INSENSITIVITY SYNDROME AND THEIR RESPONSE TO IGF-I GENERATION TEST

Directory of Open Access Journals (Sweden)

M. Razzaghy-Azar

2006-05-01

Full Text Available Primary growth hormone insensitivity syndrome (GHIS is a rare entity which can be due to defects in growth hormone (GH receptor that is called type 1 Laron syndrome (T1LS or post receptor defects (type 2 Laron syndrome . The aim of study was determining the clinical and hormonal milieu of the patients with primary GHIS and their response to IGF-I (insulin like growth factor-I generation test (IGT. GH, IGF-I, IGF-II, IGF binding protein 1 and 3 (BP-1 and BP-3, GH binding protein (GHBP and anti-GH antibody were detected by ELISA and RIA methods. IGF-I and BP-3 were measured before and after IGT. Nine patients (8 males, 1 female (mean age ± SD, 6.4 ± 5 years with severe short stature and high GH level were studied. Height SDS was - 8.5 ± 2.6. In 7 patients GHBP was zero, IGF-I and BP-3 were low and did not increase after IGT, so they had T1LS. Two brothers did not show the hormonal milieu of GH receptor defect, and were called non Laron syndrome (NLS. Birth weight in patients with T1LS and NLS was 3.65 ± 0.2 Kg and 1.65 ± 0.2 Kg, respectively (P = 0.001. All of the patients had typical clinical feature of GH-deficiency, but nasal bridge depression and microphallus were not seen in NLS. GH treatment of NLS, normalized their growth velocity, but without catch up growth. In conclusion IGT can differentiate Laron syndrome from other types of short stature. GH and IGF-I of fetus have no role in intrauterine growth.

Insurance Companies Adapting to Trends by Adopting Medical Tourism.

Science.gov (United States)

Paul, David P; Barker, Tyler; Watts, Angela L; Messinger, Ashley; Coustasse, Alberto

Health care costs in the United States are rising every year, and patients are seeking new ways to control their expenditures and save money. Going abroad to receive health care is a cheaper alternative than receiving the same or similar care at home. Insurance companies are beginning to realize the benefits of medical tourism for both themselves and their beneficiaries and have therefore started to introduce medical tourism plans for their clients as an option for their beneficiaries. This research study explores the benefits and risks of medical tourism and examines the US insurance market's reaction to the trend of increasing medical tourism. The US medical tourism industry mirrors that of the United Kingdom in recent years, with more patients seeking care abroad than in the United States. Insurance companies have introduced new plans providing the option of traveling abroad to countries such as India and Costa Rica. Medical tourism is gaining popularity with US residents, and insurance companies are recognizing this trend.

First Nations People: Addressing the Relationships between Under-Enrollment in Medical Education, STEM Education, and Health in the United States

Directory of Open Access Journals (Sweden)

Dharam Persaud-Sharma

2018-02-01

Full Text Available In the United States of America, an analysis of enrollment statistics to institutions of higher education, those pursuing Science, Technology, Engineering, and Mathematics (STEM fields, as well as those pursuing medical education show a paralleled ethnic stratification. Based upon such stratification, Native Americans consistently rank amongst the lowest demographic groups to enroll in and pursue higher education, STEM or medical education. A perturbed history of the First Nations people in the establishment of the United States of America laid the foundation for a multitude of factors contributing to current trends in health, living, and academic pursuits amongst First Nation’s people. This paper aims to explore the factors underlying the lack of Native American enrollment in higher education, careers in STEM and medicine. An investigation was conducted following a broad literature review relevant to the topic, and articles were critically appraised using the Search, Appraisal, Synthesis of Analysis (SALSA framework as well as the Standards for Reporting Qualitative Research (SRQR. Findings from such studies indicate that the Native American communities face a unique set of social circumstances rooted in a historical context, with several unmet basic needs of living required for integration, access, and pursuit of higher education.

Spreading a medication administration intervention organizationwide in six hospitals.

Science.gov (United States)

Kliger, Julie; Singer, Sara; Hoffman, Frank; O'Neil, Edward

2012-02-01

Six hospitals from the San Francisco Bay Area participated in a 12-month quality improvement project conducted by the Integrated Nurse Leadership Program (INLP). A quality improvement intervention that focused on improving medication administration accuracy was spread from two pilot units to all inpatient units in the hospitals. INLP developed a 12-month curriculum, presented in a combination of off-site training sessions and hospital-based training and consultant-led meetings, to teach clinicians the key skills needed to drive organizationwide change. Each hospital established a nurse-led project team, as well as unit teams to address six safety processes designed to improve medication administration accuracy: compare medication to the medication administration record; keep medication labeled throughout; check two patient identifications; explain drug to patient (if applicable); chart immediately after administration; and protect process from distractions and interruptions. From baseline until one year after project completion, the six hospitals improved their medication accuracy rates, on average, from 83.4% to 98.0% in the spread units. The spread units also improved safety processes overall from 83.1% to 97.2%. During the same time, the initial pilot units also continued to improve accuracy from 94.0% to 96.8% and safety processes overall from 95.3% to 97.2%. With thoughtful planning, engaging those doing the work early and focusing on the "human side of change" along with technical knowledge of improvement methodologies, organizations can spread initiatives enterprisewide. This program required significant training of frontline workers in problem-solving skills, leading change, team management, data tracking, and communication.

Automated drug dispensing system reduces medication errors in an intensive care setting.

Science.gov (United States)

Chapuis, Claire; Roustit, Matthieu; Bal, Gaëlle; Schwebel, Carole; Pansu, Pascal; David-Tchouda, Sandra; Foroni, Luc; Calop, Jean; Timsit, Jean-François; Allenet, Benoît; Bosson, Jean-Luc; Bedouch, Pierrick

2010-12-01

We aimed to assess the impact of an automated dispensing system on the incidence of medication errors related to picking, preparation, and administration of drugs in a medical intensive care unit. We also evaluated the clinical significance of such errors and user satisfaction. Preintervention and postintervention study involving a control and an intervention medical intensive care unit. Two medical intensive care units in the same department of a 2,000-bed university hospital. Adult medical intensive care patients. After a 2-month observation period, we implemented an automated dispensing system in one of the units (study unit) chosen randomly, with the other unit being the control. The overall error rate was expressed as a percentage of total opportunities for error. The severity of errors was classified according to National Coordinating Council for Medication Error Reporting and Prevention categories by an expert committee. User satisfaction was assessed through self-administered questionnaires completed by nurses. A total of 1,476 medications for 115 patients were observed. After automated dispensing system implementation, we observed a reduced percentage of total opportunities for error in the study compared to the control unit (13.5% and 18.6%, respectively; perror (20.4% and 13.5%; perror showed a significant impact of the automated dispensing system in reducing preparation errors (perrors caused no harm (National Coordinating Council for Medication Error Reporting and Prevention category C). The automated dispensing system did not reduce errors causing harm. Finally, the mean for working conditions improved from 1.0±0.8 to 2.5±0.8 on the four-point Likert scale. The implementation of an automated dispensing system reduced overall medication errors related to picking, preparation, and administration of drugs in the intensive care unit. Furthermore, most nurses favored the new drug dispensation organization.

Medical marijuana: a public health perspective

OpenAIRE

Ushang Desai; Paras Patel

2013-01-01

Over the few years medical marijuana is growing in the United States. Because of the medical marijuana legislators able to legalized recreational marijuana in the two states in the US. Marijuana has several potential benefits that help in certain disease. The delivery of marijuana is also important because smoking marijuana has severe side effects. Physicians also play important role in medical marijuana, physicians also divided on the use of medical marijuana. Their attitude towards medical ...

Medication adherence among adult patients on hemodialysis

Directory of Open Access Journals (Sweden)

Abdulmalik M Alkatheri

2014-01-01

Full Text Available Medication adherence was assessed in 89 patients on hemodialysis (HD at the King Abdul Aziz Medical City using an Arabic version of the Morisky Medication Adherence Scale (MASS-8. The results of the study revealed that 31.46% and 40.45% of the participants showed low and medium adherence, respectively, while 28.09% showed high medication adherence. Accordingly, 71.91% of the patients visiting the dialysis unit were considered medication non-adherent. While being of older age (P = 0.012, being married (P = 0.012 increased the level of adherence, being of medium level of education (P = 0.024 decreased adherence levels. On the other hand, gender, presence of a care-giver, number of members in the household and employment status seems to have no effect on the level of medication adherence. These results call upon the practitioners in HD units to develop intervention programs that can increase the level of medication adherence.

Comparative analysis of acetic and citric acid on internal milieu of broiler chickens

Directory of Open Access Journals (Sweden)

Marcela Capcarova

2014-02-01

Full Text Available Normal 0 21 false false false CS JA X-NONE The aim of the present study was to analyse the effect of two organic acids (acetic and citric acid inclusion on serum parameters and the level of antioxidant status of broiler chickens. Some organic acidifiers reduce the growth of many intestinal bacteria, reduce intestinal colonisation and reduce infectious processes, decrease inflammatory processes at the intestinal mucosa, increase villus height and function of secretion, digestion and absorption of nutrients. Broiler chickens hybrid Ross 308 (n=180 were divided into 3 groups: one control (C and two experimental groups (E1, E2. Experimental animals received acetic and citric acid per os in water in single dose 0.25% for 42 days. After 42 days of feeding blood samples were collected (n=10 in each group. Significant decrease of serum triglycerides in citric acid group when compared with the control group was recorded. Acetic acid administration resulted in increased sodium level. Significant increase of albumin content in both experimental groups and increase of bilirubin content in citric group was recorded. Acids administration had no significant effect on other serum and antioxidant parameters. Acetic and citric acid had no harmful influenced on internal milieu of broiler chickens. The research on the field of organic acid will be worthy of further investigation.

Abraham Flexner of Kentucky, his report, Medical Education in the United States and Canada, and the historical questions raised by the report.

Science.gov (United States)

Halperin, Edward C; Perman, Jay A; Wilson, Emery A

2010-02-01

One hundred years ago, the time was right and the need was critical for medical education reform. Medical education had become a commercial enterprise with proprietary schools of variable quality, lectures delivered in crowded classrooms, and often no laboratory instruction or patient contact. Progress in science, technology, and the quality of medical care, along with political will and philanthropic support, contributed to the circumstances under which Abraham Flexner produced his report. Flexner was dismayed by the quality of many of the medical schools he visited in preparing the report. Many of the recommendations in Medical Education in the United States and Canada are still relevant, especially those concerning the physician as a practitioner whose purpose is more societal and preventive than individual and curative. Flexner helped establish standards for prerequisite education, framed medical school admission criteria, aided in the design of a curriculum introduced by the basic and followed by the clinical sciences, stipulated the resources necessary for medical education, and emphasized medical school affiliation with both a university and a strong clinical system. He proposed integration of basic and clinical sciences leading to contextual learning, active rather than passive learning, and the importance of philanthropy. Flexner's report poses several questions for the historian: How were his views on African American medical education shaped by his post-Civil War upbringing in Louisville? Was the report original or derivative? Why did it have such a large impact? This article describes Flexner's early life and the report's methodology and considers several of the historical questions.

Potentially inappropriate medication prescribed to elderly outpatients at a general medicine unit

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Christine Grützmann Faustino

2011-03-01

Full Text Available Objective: To establish the prevalence of potentially inappropriate medications prescribed for elderly patients, to identify the most commonly involved drugs, and to investigate whether age, sex and number of medications were related with the prescription of these drugs. Methods: Prescriptions for 1,800 elderly patients (≥ 60 years were gathered from a database. These prescriptions were written by general physicians at a tertiary level university hospital in the city of Sao Paulo, Brazil, from February to May 2008. Only one prescription per patient was considered. The prescriptions were classified according to sex and age (60-69, 70-79 and ≥ 80. The Beers criteria (2003 version were used to evaluate potentially inappropriate medications. Results: Most of the sample comprised women (66.6% with a mean age of 71.3 years. The mean prevalence of potentially inappropriate medication prescriptions was 37.6%. The 60-69 age group presented the highest prevalence (49.9%. The most frequently prescribed potentially inappropriate medications to women were carisoprodol, amitriptyline, and fluoxetine; amitriptyline, carisoprodol, fluoxetine and clonidine were prescribed more often to men. The female sex (p<0.001; OR=2.0 and number of medications prescribed (p<0.001 were associated with prescription of potentially inappropriate medications. The chance of having a prescription of these drugs was lower among patients aged over 80 years (OR=0.7. The mean number of prescribed medications for both sexes and all age groups was 7.1. The mean number of medications per patient was higher among females (p<0.001; this result was not age-dependent (p=0.285. Conclusion: The prevalence of potentially inappropriate medications was similar to previously reported values in the literature and was correlated with the female sex. The chance of having a potentially inappropriate medication prescription was lower among patients aged over 80 years. The chance of having a

Frequency of Cannabis Use and Medical Cannabis Use Among Persons Living With HIV in the United States: Findings From a Nationally Representative Sample.

Science.gov (United States)

Pacek, Lauren R; Towe, Sheri L; Hobkirk, Andrea L; Nash, Denis; Goodwin, Renee D

2018-04-01

Little is known about cannabis use frequency, medical cannabis use, or correlates of use among persons living with HIV (PLWH) in United States nationally representative samples. Data came from 626 PLWH from the 2005-2015 National Survey on Drug Use and Health. Logistic regression identified characteristics associated with frequency of cannabis use. Chi-squares identified characteristics associated with medial cannabis use. Non-daily and daily cannabis use was reported by 26.9% and 8.0%. Greater perceived risk of cannabis use was negatively associated with daily and non-daily use. Younger age, substance use, and binge drinking were positively associated with non-daily cannabis use. Smoking and depression were associated with non-daily and daily use. One-quarter reported medical cannabis use. Medical users were more likely to be White, married, and nondrinkers. Cannabis use was common among PLWH. Findings help to differentiate between cannabis users based on frequency of use and medical versus recreational use.

How students experience and navigate transitions in undergraduate medical education: an application of Bourdieu's theoretical model.

Science.gov (United States)

Balmer, Dorene F; Richards, Boyd F; Varpio, Lara

2015-10-01

Using Bourdieu's theoretical model as a lens for analysis, we sought to understand how students experience the undergraduate medical education (UME) milieu, focusing on how they navigate transitions from the preclinical phase, to the major clinical year (MCY), and to the preparation for residency phase. Twenty-two medical students participated in this longitudinal case study. Students had similar preclinical and post-MCY experiences but different MCY experiences (rotational vs. longitudinal tracks). We interviewed students every 6 months in the preclinical phase, mid-way through MCY, and 7-8 months before graduation (101 total interviews). We inductively created codes, iteratively revised codes to best-fit the data, and thematically clustered codes into Bourdieu-informed categories: field (social structures), capital (resources) and habitus (dispositions). We found that students acclimated to shifts in the UME field as they moved through medical school: from medical school itself to the health system and back. To successfully navigate transitions, students learned to secure capital as medical knowledge and social connections in the preclinical and preparation for residency phases, and as reputable patient care and being noticed in the clinical phase. To obtain capital, and be well-positioned for the next phase of training, students consistently relied on dispositions of initiative and flexibility. In summary, students experience the complex context of medical school through a series of transitions. Efforts to improve UME would be well-served by greater awareness of the social structures (field) that students encounter, the resources to which they afford value (capital), and the dispositions which aid acquisition of these resources (habitus).

Medication Errors in an Internal Intensive Care Unit of a Large Teaching Hospital: A Direct Observation Study

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Saadat Delfani

2012-06-01

Full Text Available Medication errors account for about 78% of serious medical errors in intensive care unit (ICU. So far no study has been performed in Iran to evaluate all type of possible medication errors in ICU. Therefore the objective of this study was to reveal the frequency, type and consequences of all type of errors in an ICU of a large teaching hospital. The prospective observational study was conducted in an 11 bed internal ICU of a university hospital in Shiraz. In each shift all processes that were performed on one selected patient was observed and recorded by a trained pharmacist. Observer would intervene only if medication error would cause substantial harm. The data was evaluated and then were entered in a form that was designed for this purpose. The study continued for 38 shifts. During this period, a total of 442 errors per 5785 opportunities for errors (7.6% occurred. Of those, there were 9.8% administration errors, 6.8% prescribing errors, 3.3% transcription errors and, 2.3% dispensing errors. Totally 45 interventions were made, 40% of interventions result in the correction of errors. The most common causes of errors were observed to be: rule violations, slip and memory lapses and lack of drug knowledge. According to our results, the rate of errors is alarming and requires implementation of a serious solution. Since our system lacks a well-organize detection and reporting mechanism, there is no means for preventing errors in the first place. Hence, as the first step we must implement a system where errors are routinely detected and reported.

Study of uranium (VI) in carbonate solution by potentiometric titrations and ion-exchange; Etude des solutions d'uranium (VI) en milieu carbonate par titrages potentiometriques et echange d'ions

Energy Technology Data Exchange (ETDEWEB)

Billon, A. [Commissariat a l' Energie Atomique, 92 - Fontenay-aux-Roses (France). Centre d' Etudes Nucleaires

1968-04-01

The present work is devoted to the fixation of uranium (VI) on the conventional anion-exchange resin Dowex 2 X 8 in carbonate and hydrogen-carbonate media. Both media were successfully used for the recuperation of uranium (VI) from very dilute solutions. Equilibrium constant of the exchange [UO{sub 2}(CO{sub 3}){sub 3}{sup 4+}]{sub S} + 2 [CO{sub 3}{sup 2-}]{sub R} {r_reversible} [UO{sub 2}(CO{sub 3}){sub 3}{sup 4-}]{sub R} + 2[CO{sub 3}{sup 2-}]{sub S} is determined for carbonate concentration range 0.1 M to 0.6 M from partition curves. A markedly increase in the relative fixation of uranium results with: - increasing free carbonate concentration of the solution, - decreasing uranium concentration. A study in the same conditions of the fixation of molybdenum has made it possible to separate the latter from uranium by elution, the carbonate concentration being molar. It is suggested a possibility of separation on a larger scale, based upon molybdenum displacement by uranium in hydrogen-carbonate medium. (author) [French] Le present travail precise la fixation de l'uranium (VI) sur la resine echangeuse d'anions Dowex 2 X 8, en milieu carbonate et hydrogeno-carbonate. Nous en avons deduit que ces deux milieux sont egalement favorables a la recuperation de l'uranium a partir de solutions tres diluees. La constante d'equilibre de la reaction d'echange [UO{sub 2}(CO{sub 3}){sub 3}{sup 4+}]{sub S} + 2 [CO{sub 3}{sup 2-}]{sub R} {r_reversible} [UO{sub 2}(CO{sub 3}){sub 3}{sup 4-}]{sub R} + 2[CO{sub 3}{sup 2-}]{sub S} a ete determinee pour le milieu carbonate 0.1 M a 0.6 M, a partir deb courbes de partage. La fixation relative de l'uranium augmente considerablement lorsque: - la concentration du carbonate libre (respectivement hydrogenocarbonate) diminue, - la concentration de l'uranium en solution diminue. Le comportement du molybdene a ete etudie en vue de la separation uranium-molybdene. L'ion fixe sur la resine est l

Iatrogenic medication errors in a paediatric intensive care unit in ...

African Journals Online (AJOL)

Errors most frequently encountered included failure to calculate rates of infusion and the conversion of mL to mEq or mL to mg for potassium, phenobarbitone and digoxin. Of the 117 children admitted, 111 (94.9%) were exposed to at least one medication error. Two or more medication errors occurred in 34.1% of cases.

Treatment of Young People With Antipsychotic Medications in the United States.

Science.gov (United States)

Olfson, Mark; King, Marissa; Schoenbaum, Michael

2015-09-01

Despite concerns about rising treatment of young people with antipsychotic medications, little is known about trends and patterns of their use in the United States. To describe antipsychotic prescription patterns among young people in the United States, focusing on age and sex. A retrospective descriptive analysis of antipsychotic prescriptions among patients aged 1 to 24 years was performed with data from calendar years 2006 (n = 765,829), 2008 (n = 858,216), and 2010 (n = 851,874), including a subset from calendar year 2009 with service claims data (n = 53,896). Data were retrieved from the IMS LifeLink LRx Longitudinal Prescription database, which includes approximately 60% of all retail pharmacies in the United States. Denominators were adjusted to generalize estimates to the US population. The percentage of young people filling 1 or more antipsychotic prescriptions during the study year by sex and age group (younger children, 1-6 years; older children, 7-12 years; adolescents, 13-18 years; and young adults, 19-24 years) was calculated. Among young people with antipsychotic use, percentages with specific clinical psychiatric diagnoses and 1 or more antipsychotic prescriptions from a psychiatrist and from a child and adolescent psychiatrist were also determined. The percentages of young people using antipsychotics in 2006 and 2010, respectively, were 0.14% and 0.11% for younger children, 0.85% and 0.80% for older children, 1.10% and 1.19% for adolescents, and 0.69% and 0.84% for young adults. In 2010, males were more likely than females to use antipsychotics, especially during childhood and adolescence: 0.16% vs 0.06% for younger children, 1.20% vs 0.44% for older children, 1.42% vs 0.95% for adolescents, and 0.88% vs 0.81% for young adults. Among young people treated with antipsychotics in 2010, receiving a prescription from a psychiatrist was less common among younger children (57.9%) than among other age groups (range, 70.4%-77.9%). Approximately 29.3% of

Race, ethnicity, and medical student well-being in the United States.

Science.gov (United States)

Dyrbye, Liselotte N; Thomas, Matthew R; Eacker, Anne; Harper, William; Massie, F Stanford; Power, David V; Huschka, Mashele; Novotny, Paul J; Sloan, Jeff A; Shanafelt, Tait D

2007-10-22

Little is known about the training experience of minority medical students. We explore differences in the prevalence of burnout, depressive symptoms, and quality of life (QOL) among minority and nonminority medical students as well as the role race/ethnicity plays in students' experiences. Medical students (N = 3080) at 5 medical schools were surveyed in 2006 using validated instruments to assess burnout, depression, and QOL. Students were also asked about the impact of race/ethnicity on their training experience. The response rate was 55%. Nearly half of students reported burnout (47%) and depressive symptoms (49%). Mental QOL scores were lower among students than among the age-matched general population (43.1 vs 47.2; P race/ethnicity had adversely affected their medical school experience (11% vs 2%; P race does contribute to the distress minority students do experience. Additional studies are needed to define the causes of these perceptions and to improve the learning climate for all students.

Sjögren syndrome and neuromyelitis optica spectrum disorder co-exist in a common autoimmune milieu

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Diogo C. Carvalho

2014-06-01

Full Text Available The relationship between Sjögren’s syndrome (SS and neuromyelitis optica spectrum disorder (NMOSD is not completely understood. We report two patients with both conditions and review 47 other previously reported cases meeting currently accepted diagnostic criteria, from 17 articles extracted from PubMed. Out of 44 patients whose gender was informed, 42 were females. Mean age at onset of neurological manifestation was 36.2 years (10-74. Serum anti-AQP4-IgG was positive in 32 patients, borderline in 1, and negative in 4. Our Case 1 was seronegative for AQP4-IgG and had no non-organ-specific autoantibodies other than anti-SSB antibodies. Our Case 2 had serum anti-AQP4, anti-SSA/SSB, anti-thyreoglobulin and anti-acethylcholine-receptor antibodies, as well as clinical hypothyreoidism, but no evidence of myasthenia gravis. Our Cases and others, as previously reported in literature, with similar heterogeneous autoimmune response to aquaporin-4, suggest that SS and NMO co-exist in a common autoimmune milieu which is not dependent on aquaporin-4 autoimmunity.

Investigation and management of gastro-oesophageal reflux in United Kingdom neonatal intensive care units.

Science.gov (United States)

Rossor, Thomas; Andradi, Gwendolyn; Bhat, Ravindra; Greenough, Anne

2018-01-01

In 2004, wide variation in the investigation and management of gastro-oesophageal reflux (GOR) of infants on UK major neonatal units was demonstrated. Our aim was to resurvey neonatal practitioners to determine current practice and whether it was now evidence based. A questionnaire was sent to all 207 UK neonatal units. Responses were obtained from 84% of units. The most frequent 'investigation' was a trial of therapy (83% of units); pH studies were used in 38%, upper GI contrast studies in 19% and multichannel intraluminal impedance (MII)/pH studies in 5%. Only six units suggested a threshold for an abnormal pH study and two units for an abnormal MII study. Infants were commenced on antireflux medication without investigation always in 32% of units, often in 29%, occasionally in 19% and only never in 1%. Gaviscon was used as first line treatment in 60% of units, and other medications included ranitidine in 53%, thickening agents in 27%, proton pump inhibitors in 23%, domperidone in 22% and erythromycin in 6%. There remains a wide variation in diagnostic and treatment strategies for infants with suspected GOR on neonatal intensive care units, emphasising the need for randomised trials to determine appropriate GOR management. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

State-level medical and absenteeism cost of asthma in the United States.

Science.gov (United States)

Nurmagambetov, Tursynbek; Khavjou, Olga; Murphy, Louise; Orenstein, Diane

2017-05-01

For medically treated asthma, we estimated prevalence, medical and absenteeism costs, and projected medical costs from 2015 to 2020 for the entire population and separately for children in the 50 US states and District of Columbia (DC) using the most recently available data. We used multiple data sources, including the Medical Expenditure Panel Survey, U.S. Census Bureau, Kaiser Family Foundation, Medical Statistical Information System, and Current Population Survey. We used a two-part regression model to estimate annual medical costs of asthma and a negative binomial model to estimate annual school and work days missed due to asthma. Per capita medical costs of asthma ranged from $1,860 (Mississippi) to $2,514 (Michigan). Total medical costs of asthma ranged from $60.7 million (Wyoming) to $3.4 billion (California). Medicaid costs ranged from $4.1 million (Wyoming) to $566.8 million (California), Medicare from $5.9 million (DC) to $446.6 million (California), and costs paid by private insurers ranged from $27.2 million (DC) to $1.4 billion (California). Total annual school and work days lost due to asthma ranged from 22.4 thousand (Wyoming) to 1.5 million days (California) and absenteeism costs ranged from $4.4 million (Wyoming) to $345 million (California). Projected increase in medical costs from 2015 to 2020 ranged from 9% (DC) to 34% (Arizona). Medical and absenteeism costs of asthma represent a significant economic burden for states and these costs are expected to rise. Our study results emphasize the urgency for strategies to strengthen state level efforts to prevent and control asthma attacks.

International adaptation: psychosocial and parenting experiences of caregivers who travel to the United States to obtain acute medical care for their seriously ill child.

Science.gov (United States)

Margolis, Rachel; Ludi, Erica; Pao, Maryland; Wiener, Lori

2013-01-01

Despite the increasing trend of travel for medical purposes, little is known about the experience of parents and other caregivers who come to the United States specifically to obtain medical treatment for their seriously ill child. In this exploratory, descriptive qualitative study, we used a semi-structured narrative guide to conduct in-depth interviews with 22 Spanish- or English-speaking caregivers about the challenges encountered and adaptation required when entering a new medical and cultural environment. Caregivers identified the language barrier and transnational parenting as challenges while reporting hospital staff and their own families as major sources of support. Using the results of the study as a guide, clinical and program implications are provided and recommendations for social work practice discussed.

Patient satisfaction with treatment in first-episode psychosis

DEFF Research Database (Denmark)

Haahr, Ulrik Helt; Simonsen, Erik; Røssberg, Jan Ivar

2012-01-01

Purpose: To examine first-episode psychotic patients' satisfaction with elements of a comprehensive 2-year treatment program. Subjects and method: The TIPS (Early Treatment and Intervention in Psychosis) project provided a 2-year treatment program consisting of milieu therapy (inpatient), individ......Purpose: To examine first-episode psychotic patients' satisfaction with elements of a comprehensive 2-year treatment program. Subjects and method: The TIPS (Early Treatment and Intervention in Psychosis) project provided a 2-year treatment program consisting of milieu therapy (inpatient......), individual psychotherapy, family intervention and medication. Of 140 patients at baseline, 112 were included at 2-year follow-up. Eighty-four participants were interviewed using a questionnaire eliciting levels of satisfaction with different treatment elements at two of the four sites. Results: Participants...... and non-participants did not differ on demographic or clinical data at baseline. Of those participating, 75% were satisfied with treatment in general. Individual and milieu therapy received higher rating than medication or family intervention. No predictors of general satisfaction with treatment were...

The Text of the Instrument connected with the Agency's Assistance to the United Arab Republic in Establishing a Project for Training and Medical Applications

Energy Technology Data Exchange (ETDEWEB)

NONE

1967-06-09

The text of the Agreement between the Agency and the Government of the United Arab Republic in connection with the Agency's assistance to that Government in establishing a project for training and medical applications of atomic energy is reproduced in this document for the information of all Members.

The Text of the Instrument connected with the Agency's Assistance to the United Arab Republic in Establishing a Project for Training and Medical Applications

International Nuclear Information System (INIS)

1967-01-01

The text of the Agreement between the Agency and the Government of the United Arab Republic in connection with the Agency's assistance to that Government in establishing a project for training and medical applications of atomic energy is reproduced in this document for the information of all Members

Correlation of United States Medical Licensing Examination and Internal Medicine In-Training Examination performance.

Science.gov (United States)

Perez, Jose A; Greer, Sharon

2009-12-01

The Internal Medicine In-Training Examination (ITE) is administered during residency training in the United States as a self-assessment and program assessment tool. Performance on this exam correlates with outcome on the American Board of Internal Medicine Certifying examination. Internal Medicine Program Directors use the United States Medical Licensing Examination (USMLE) to make decisions in recruitment of potential applicants. This study was done to determine a correlation of USMLE Steps 1, 2 and 3 results with ITE scores in each level of Internal Medicine training. A retrospective review of all residents graduating from an Internal Medicine program from 1999 to 2006 was done. Subjects included had data for all USMLE Steps and ITE during all years of training. Thirty-one subjects were included in the study. Correlations of USMLE Steps 1, 2 and 3 were done with ITE scores (percent correct) in each year of training. Pearson's correlation coefficient (r) was determined for each pairing and a t test to determine statistical significance of the correlation was done. Statistical significance was defined as P value ITE percent correct in PGY I, II and III were 0.46, 0.55 and 0.51 respectively. Corresponding r values for USMLE Step 2 and ITE percent correct were 0.79, 0.70 and 0.72; for USMLE Step 3 these values were 0.51, 0.37 and 0.51 respectively for each training year. USMLE scores are correlated with ITE scores. This correlation was strongest for USMLE Step 2.

The Study of Life Change Unit as Stressor Agents among Tehran University of Medical Sciences Hospitals' Employees

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Hossein Dargahi

2010-07-01

Full Text Available "nLife crises as stressor agents can disrupt the best stress management regime. Different life crises have different impacts. A standard scale to rate change and its related stress impact has been developed commonly referred to as LCU (Life Change Unit Rating. This allocates a number of Life Crisis Units or Life Change Units (LCUs to different event and then evaluates them and takes action accordingly. This idea behind this approach of is to rundown the LCU table, totaling the LCUs for life crisis that have occurred in the previous one year. A Cross - sectional, descriptive and analytical study was conducted among 900 Tehran University of Medical Sciences (TUMS Employees by a Holms and Rahe LCU questionnaire at 15 hospitals. The respondents were asked to determine their demographic information, list of stress symptoms which suffered from these diseases in the previous one year and finally, responded to 45 Life Change Unit as stressful life events and the value of each in "stress units" which occurred in the previous one year. The results showed that there is significant correlation between the employees LCU rating by sex, educational degree and size of hospital. Also we found that there are significant correlations between the employees stress symptoms with their LCU rating. Totally, 40% of the employees have less than 150 LCU rating (normal range and 60% of them have 150-300 or more than 300 LCU rating (abnormal range. In conclusion most of TUMS hospitals' employees who had stress symptoms have more LCU rating. One third of these employees are not in danger of suffering the illness effect, while two third of them are in danger.

What Are Medical Students in the United States Learning About Radiation Oncology? Results of a Multi-Institutional Survey

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Zaorsky, Nicholas G., E-mail: nicholaszaorsky@gmail.com [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Shaikh, Talha; Handorf, Elizabeth [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Eastwick, Gary [Temple University School of Medicine, Philadelphia, Pennsylvania (United States); Hesney, Adam [Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Scher, Eli D. [Rowan University School of Osteopathic Medicine, Stratford, New Jersey (United States); Jones, Ryan T.; Showalter, Timothy N. [Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia (United States); Avkshtol, Vladimir [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); University of Toledo College of Medicine, Toledo, Ohio (United States); Rice, Stephanie R. [University of Wisconsin School of Medicine, Madison, Wisconsin (United States); Horwitz, Eric M.; Meyer, Joshua E. [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States)

2016-02-01

Purpose: The purposes of this study were to assess the exposure that medical students (MSs) have to radiation oncology (RO) during the course of their medical school career, as evidenced by 2 time points in current medical training (ie, first vs fourth year; MS1s and MS4s, respectively) and to assess the knowledge of MS1s, MS4s, and primary care physicians (PCPs) about the appropriateness of RT in cancer management in comparison with RO attendings. Methods: We developed and beta tested an electronic survey divided into 3 parts: RO job descriptions, appropriateness of RT, and toxicities of RT. The surveys were distributed to 7 medical schools in the United States. A concordance of >90% (either yes or no) among RO attendings in an answer was necessary to determine the correct answer and to compare with other subgroups using a χ{sup 2} test (P<.05 was significant). Results: The overall response rate for ROs, MS1s, MS4s, and PCPs was 26%; n (22 + 315 + 404 + 43)/3004. RT misconceptions decreased with increasing level of training. More than 1 of 10 MSs did not believe that RT alone could cure cancer. Emergent oncologic conditions for RT (eg, spinal cord compression, superior vena cava syndrome) could not be identified by >1 of 5 respondents. Multiple nontoxicities of RT (eg, emitting low-level radiation from the treatment site) were incorrectly identified as toxicities by >1 of 5 respondents. MS4s/PCPs with an RO rotation in medical school had improved scores in all prompts. Conclusions: Although MS knowledge of general RT principles improves from the first to the fourth year, a large knowledge gap still exists between MSs, current PCPs, and ROs. Some basic misconceptions of RT persist among a minority of MSs and PCPs. We recommend implementing formal education in RO fundamentals during the core curriculum of medical school.

Race differences in obesity and its relationship to the sex hormone milieu.

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Perry, Arlette C; Martin, Lorena

2014-09-01

A sexual dimorphism exists in which increased abdominal and visceral adipose tissue (VAT) - found in women and marked by low sex hormone binding globulin (SHBG) and high bioavailable testosterone (BT) - is related to the metabolic risk profile. In men, increased BT is related to decreased abdominal obesity and a decrease in the metabolic risk profile. In women, race differences have been found in androgenic sex steroids including SHBG and BT as well as central fat distribution, creating inherently greater metabolic risk for certain populations. Estrogen and estrogen receptor isoforms play a role in fat deposition and distribution and may influence the changes that occur during the menopausal transition. Androgenic sex steroids serve a mediating role, influencing VAT accumulation and its associated metabolic risk factors while VAT also serves a mediating role influencing the androgenic sex steroid-metabolic risk relationship in women. Furthermore, androgenic sex steroids and VAT may independently contribute to the variance in several metabolic variables associated with cardiovascular disease, type 2 diabetes, and their antecedent conditions such as the metabolic syndrome. Race has been shown to modify the relationship between androgenic sex steroids and metabolic variables associated with risk for diabetes in Black and White women. Further research is warranted to examine the mechanisms involved in race differences. Total adiposity and central fat distribution in accordance with changes in the hormone and metabolic milieu influence breast cancer risk, which varies by race and menopausal status. These findings have broader implications for the study of health promotion/disease prevention in women.

National Characteristics of Emergency Medical Services Responses for Older Adults in the United States.

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Duong, Hieu V; Herrera, Lauren Nicholas; Moore, Justin Xavier; Donnelly, John; Jacobson, Karen E; Carlson, Jestin N; Mann, N Clay; Wang, Henry E

2018-01-01

Older adults, those aged 65 and older, frequently require emergency care. However, only limited national data describe the Emergency Medical Services (EMS) care provided to older adults. We sought to determine the characteristics of EMS care provided to older adults in the United States. We used data from the 2014 National Emergency Medical Services Information System (NEMSIS), encompassing EMS response data from 46 States and territories. We excluded EMS responses for children older adults as age ≥65 years. We compared patient demographics (age, sex, race, primary payer), response characteristics (dispatch time, location type, time intervals), and clinical course (clinical impression, injury, procedures, medications) between older and younger adult EMS emergency 9-1-1 responses. During the study period there were 20,212,245 EMS emergency responses. Among the 16,116,219 adult EMS responses, there were 6,569,064 (40.76%) older and 9,547,155 (59.24%) younger adults. Older EMS patients were more likely to be white and the EMS incident to be located in healthcare facilities (clinic, hospital, nursing home). Compared with younger patients, older EMS patients were more likely to present with syncope (5.68% vs. 3.40%; OR 1.71; CI: 1.71-1.72), cardiac arrest/rhythm disturbance (3.27% vs. 1.69%; OR 1.97; CI: 1.96-1.98), stroke (2.18% vs. 0.74%; OR 2.99; CI: 2.96-3.02) and shock (0.77% vs. 0.38%; OR 2.02; CI: 2.00-2.04). Common EMS interventions performed on older persons included intravenous access (32.02%), 12-lead ECG (14.37%), CPR (0.87%), and intubation (2.00%). The most common EMS drugs administered to older persons included epinephrine, atropine, furosemide, amiodarone, and albuterol or ipratropium. One of every three U.S. EMS emergency responses involves older adults. EMS personnel must be prepared to care for the older patient.

Does a specialist unit improve outcomes for hospitalized patients with Parkinson's disease?

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Skelly, Rob; Brown, Lisa; Fakis, Apostolos; Kimber, Lindsey; Downes, Charlotte; Lindop, Fiona; Johnson, Clare; Bartliff, Caroline; Bajaj, Nin

2014-01-01

Objective Suboptimal management of Parkinson's disease (PD) medication in hospital may lead to avoidable complications. We introduced an in-patient PD unit for those admitted urgently with general medical problems. We explored the effect of the unit on medication management, length of stay and patient experience. Methods We conducted a single-center prospective feasibility study. The unit's core features were defined following consultation with patients and professionals: specially trained staff, ready availability of PD drugs, guidelines, and care led by a geriatrician with specialty PD training. Mandatory staff training comprised four 1 h sessions: PD symptoms; medications; therapy; communication and swallowing. Most medication was prescribed using an electronic Prescribing and Administration system (iSOFT) which provided accurate data on time of administration. We compared patient outcomes before and after introduction of the unit. Results The general ward care (n = 20) and the Specialist Parkinson's Unit care (n = 24) groups had similar baseline characteristics. On the specialist unit: less Parkinson's medication was omitted (13% vs 20%, p < 0.001); of the medication that was given, more was given on time (64% vs 50%, p < 0.001); median length of stay was shorter (9 days vs 13 days, p = 0.043) and patients' experience of care was better (p = 0.01). Discussion If replicated and generalizable to other hospitals, reductions in length of stay would lead to significant cost savings. The apparent improved outcomes with Parkinson's unit care merit further investigation. We hope to test the hypothesis that specialized units are cost-effective and improve patient care using a randomized controlled trial design. PMID:25264022

10 CFR 35.690 - Training for use of remote afterloader units, teletherapy units, and gamma stereotactic...

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2010-01-01

... radiation safety, radionuclide handling, treatment planning, quality assurance, and clinical use of... medical unit that includes— (i) 200 hours of classroom and laboratory training in the following areas— (A... administrative controls to prevent a medical event involving the use of byproduct material; (D) Implementing...

Medical Marijuana: More Questions than Answers

OpenAIRE

Hill, Kevin P.

2014-01-01

With 23 states and the District of Columbia having enacted medical marijuana laws as of August 2014, it is important that psychiatrists be able to address questions about medical marijuana from patients, families, and other health care professionals. The author discusses the limited medical literature on synthetic cannabinoids and medical marijuana. The synthetic cannabinoids dronabinol and nabilone are approved by the United States Food and Drug Administration for nausea and vomiting associa...

L'hybridation dans les populations naturelles de salmonidés dans le Sud-Ouest de l'Europe et en milieu expérimental

OpenAIRE

BEALL E.; MORAN P.; PENDAS A.; IZQUIERDO J.; GARCIA VAZQUEZ E.; GLISE S.; VIGNES J. C.; BARRIERE L.

1997-01-01

L'hybridation interspécifique entre le saumon atlantique et la truite commune dans la nature a été mise en évidence dans différents pays d'Europe et au Canada. Une étude a été entreprise pour examiner son incidence dans des populations de salmonidés de certaines rivières des Asturies (nord de l'Espagne) et du sud-ouest de la France. Elle a été complétée par des expériences en milieu contrôlé pour déterminer les causes et les conditions de la disparition des barrières comportementales permetta...

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

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

2017-06-21

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

A progressive three-phase innovation to medical education in the United States.

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Pfeifer, Cory M

2018-12-01

The practice of medicine has changed greatly over the past 100 years, yet the structure of undergraduate medical education has evolved very little. Many schools have modified their curricula to incorporate problem-based learning and organ systems-based curricula, but few schools have adequately addressed rising tuition costs. Undergraduate medical education has become cost-prohibitive for students interested in primary care. In the meanwhile, the concept of a separate dedicated intern year is outdated and mired in waste despite remaining a requirement for several hospital-based and surgical specialties. Described here is an innovative approach to medical education which reduces tuition costs and maximizes efficiency, based on principals already employed by several schools. This integrated curriculum, first suggested by the author in 2010, keeps the current USMLE system in place, exposes medical students to patient care earlier, expands and incorporates the 'intern' year into a four-year medical training program, provides more time for students to decide on a specialty, and allows residency programs to acquire fully-licensed practitioners with greater clinical experience than the status quo. MCAT: Medical college admission test; USMLE: US medical licensing examination.

Medical professionalism in China and the United States: a transcultural interpretation.

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Nie, Jing-Bao; Smith, Kirk L; Cong, Yali; Hu, Linying; Tucker, Joseph D

2015-01-01

As in other societies, medical professionalism in the Peoples' Republic of China has been rapidly evolving. One of the major events in this process was the endorsement in 2005 of the document, "Medical Professionalism in the New Millennium: A Physician Charter," by the Chinese Medical Doctor Association (hereafter, the Charter)(1). More recently, a national survey, the first on such a large scale, was conducted on Chinese physicians' attitudes toward the fundamental principles and core commitments put forward in the Charter. Based on empirical findings from that study and comparing them to the published results of a similar American survey, the authors offer an in-depth interpretation of significant cross-cultural differences and important transcultural commonalities. The broader historical, socio-economic, and ethical issues relating to salient Chinese cultural practices such as family consent, familism (the custom of deferring decisions to family members), and the withholding of medical information, as well as controversial topics such as not respecting patients' autonomy, are examined. The Chinese Survey found that Chinese physicians supported the principles of the Charter in general. Here we argue that Chinese culture and traditional medical ethics are broadly compatible with the moral commitments demanded by modern medical professionalism. Methodologically and theoretically-recognizing the problems inherent in the hoary but still popular habit of dichotomizing cultures and in relativism-a transcultural approach is adopted that gives greater (due) weight to the internal moral diversity present within every culture, the common ground shared by different cultures, and the primacy of morality. Genuine cross-cultural dialogue, including a constructive Chinese-American dialogue in the area of medical professionalism, is not only possible, but necessary. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

Dementia Special Care Units in Residential Care Communities: United States, 2010

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... on Vital and Health Statistics Annual Reports Health Survey Research Methods Conference Reports from the National Medical Care Utilization ... dementia special care units, or in a more traditional setting where these residents are integrated with residents ...

The economic burden of nurse-sensitive adverse events in 22 medical-surgical units: retrospective and matching analysis.

Science.gov (United States)

Tchouaket, Eric; Dubois, Carl-Ardy; D'Amour, Danielle

2017-07-01

The aim of this study was to assess the economic burden of nurse-sensitive adverse events in 22 acute-care units in Quebec by estimating excess hospital-related costs and calculating resulting additional hospital days. Recent changes in the worldwide economic and financial contexts have made the cost of patient safety a topical issue. Yet, our knowledge about the economic burden of safety of nursing care is quite limited in Canada in general and Quebec in particular. Retrospective analysis of charts of 2699 patients hospitalized between July 2008 - August 2009 for at least 2 days of 30-day periods in 22 medical-surgical units in 11 hospitals in Quebec. Data were collected from September 2009 to August 2010. Nurse-sensitive adverse events analysed were pressure ulcers, falls, medication administration errors, pneumonia and urinary tract infections. Descriptive statistics identified numbers of cases for each nurse-sensitive adverse event. A literature analysis was used to estimate excess median hospital-related costs of treatments with these nurse-sensitive adverse events. Costs were calculated in 2014 Canadian dollars. Additional hospital days were estimated by comparing lengths of stay of patients with nurse-sensitive adverse events with those of similar patients without nurse-sensitive adverse events. This study found that five adverse events considered nurse-sensitive caused nearly 1300 additional hospital days for 166 patients and generated more than Canadian dollars 600,000 in excess treatment costs. The results present the financial consequences of the nurse-sensitive adverse events. Government should invest in prevention and in improvements to care quality and patient safety. Managers need to strengthen safety processes in their facilities and nurses should take greater precautions. © 2017 John Wiley & Sons Ltd.

Introspection by a Medical Teacher on the Present Status of Medical Education in Libya

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Sheriff DS

2009-01-01

Full Text Available To The Editor: I had the privilege of teaching in Garyounis Medical University and then Al Arab Medical University at Benghazi during its golden period from 1980 to 1990. During that period the university had eminent teachers of great caliber from India, United States of America and the United Kingdom. Around 150 to 200 students were admitted to the course. The medium of instruction was English. The student attendance was compulsory for the practical as well as lecture classes. There were no private centres of instruction. The students were very interested in their education and had shown great interest in learning. Under the tutelage of eminent teachers the students completed their medical training and proudly occupy great positions in leading hospitals and teaching institutions in Libya and all around the globe. It is a proud moment for any teacher to cherish and witness such great achievements accomplished by the students whom he/she has taught. However, it gives me no pleasure to see the standard of the medical education in Libya slipping despite the massive expansion in the number of medical schools resulting in putting enormous pressure on the scarce resources. At present, Libya has 25000 students in nine medical schools [1], compared to just 9000 practicing doctors, and a total population of around 6 million [2]. In this article I would like to propose some practical measures that may help in reviving medical education in Libya.

Neonatologists can impede or support parents' participation in decision-making during medical rounds in neonatal intensive care units.

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Axelin, Anna; Outinen, Jyri; Lainema, Kirsi; Lehtonen, Liisa; Franck, Linda S

2018-05-03

We explored the dynamics of neonatologist-parent communication and decision-making during medical rounds in a level three neonatal intensive care unit. This was a qualitative study, with an ethnographic approach, that was conducted at Turku University Hospital, Finland, from 2013-2014. We recruited eight mothers and seven couples, their 11 singletons and four sets of twins and two neonatologists and observed and video recorded 15 medical rounds. The infants were born at 23+5 to 40+1 weeks and the parents were aged 24-47. The neonatologists and parents were interviewed separately after the rounds. Four patterns of interaction emerged. The collaborative pattern was most consistent, with the ideal of shared decision-making, as the parents' preferences were genuinely and visibly integrated into the treatment decisions. In the neonatologist-led interactional pattern, the decision-making process was only somewhat inclusive of the parents' observations and preferences. The remaining two patterns, emergency and disconnected, were characterised by a paternalistic decision-making model where the parents' observations and preferences had minimal to no influence on the communication or decision-making. The neonatologists played a central role in facilitating parental participation and their interaction during medical rounds were characterised by the level of parent participation in decision-making. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

The effect of race on postsurgical ambulatory medical follow-up among United States Veterans.

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Schonberger, Robert B; Dai, Feng; Brandt, Cynthia; Burg, Matthew M

2017-08-01

To investigate the association between self-identified black or African American race and the presence of ambulatory internal medicine follow-up in the year after surgery. Our hypothesis was that among US Veterans who presented for surgery, black or African American race would be associated with a decreased likelihood to receive ambulatory internal medicine follow-up in the year after surgery. Retrospective observational. All US Veterans Affairs hospitals. A total of 236,200 Veterans undergoing surgery between 2006 and 2011 who were discharged within 10 days of surgery and survived the full 1-year exposure period. None. Attendance at an internal medicine follow-up appointment within 1 year after surgery. After controlling for year of surgery, age, age ≥65 years, sex, Hispanic ethnicity, and number of inpatient days, black or African American patients were 11% more likely to lack internal medicine follow-up after surgery (adjusted odds ratio, 1.11; 95% confidence interval, 1.06-1.16). When accounting for geographic region, this difference remained significant at the Bonferoni-corrected P < .007 level only in the Midwest United States where black or African American patients were 28% more likely to lack medical follow-up in the year after surgery (odds ratio, 1.28; 95% confidence interval, 1.16-1.42; P < .0001). The disparity in ambulatory medical follow-up following surgery among black or African American vs nonblack or non-African American Veterans in the Midwest region deserves further study and may lead to important quality improvement initiatives aimed specifically at this population. Copyright © 2016 Elsevier Inc. All rights reserved.

Short-Range Temporal Interactions in Sleep; Hippocampal Spike Avalanches Support a Large Milieu of Sequential Activity Including Replay.

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J Matthew Mahoney

Full Text Available Hippocampal neural systems consolidate multiple complex behaviors into memory. However, the temporal structure of neural firing supporting complex memory consolidation is unknown. Replay of hippocampal place cells during sleep supports the view that a simple repetitive behavior modifies sleep firing dynamics, but does not explain how multiple episodes could be integrated into associative networks for recollection during future cognition. Here we decode sequential firing structure within spike avalanches of all pyramidal cells recorded in sleeping rats after running in a circular track. We find that short sequences that combine into multiple long sequences capture the majority of the sequential structure during sleep, including replay of hippocampal place cells. The ensemble, however, is not optimized for maximally producing the behavior-enriched episode. Thus behavioral programming of sequential correlations occurs at the level of short-range interactions, not whole behavioral sequences and these short sequences are assembled into a large and complex milieu that could support complex memory consolidation.

Medical Articles in Eighteenth Century American Magazines

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Coggins, Clemency Chase

1965-01-01

Formal medical publication began in the United States with The Medical Repository in 1797. Between 1741, the date of the first American magazine, and 1797 medical articles were included in general magazines. This study deals with ten representative magazines and reviews their general content. The varying content of the medical articles is analyzed into broad categories, and several important physicians, contributors to the magazines, are discussed. The Medical Repository is treated as a culmination of eighteenth century medical publication. PMID:14306031

Patient need at the heart of workforce planning: the use of supply and demand analysis in a large teaching hospital's acute medical unit.

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Le Jeune, I R; Simmonds, M J R; Poole, L

2012-08-01

Timely medical assessment is integral to the safety and quality of healthcare delivery in acute medicine. Medical staff are an expensive resource. This study aimed to develop a modelling system that facilitated efficient workforce planning according to patient need on the acute medical unit. A realistic 24-hour 'supply' of junior doctors was calculated by adjusting the theoretical numbers on the rota for leave allowances, natural breaks and other ward duties by a combination of direct observation of working practice and junior doctor interviews. 'Demand' was analysed using detailed admission data. Supply and demand were then integrated with data from a survey of the time spent on the process of clerking and assessment of medical admissions. A robust modelling system that predicted the number of unclerked patients was developed. The utility of the model was assessed by demonstrating the impact of a regulation-compliant redesign of the rota using existing staff and by predicting the most efficient use of an additional shift. This simple modelling system has the potential to enhance quality of care and efficiency by linking workforce planning to patient need.

The American Medical Association's Section on Surgery: The Beginnings of the Organization, Professionalization, and Specialization of Surgery in the United States.

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Rutkow, Ira

2017-01-01

To explore the founding of the American Medical Association's Section on Surgery in 1859 and how it represented, on a national basis, the beginnings of organized surgery and the formal start of the professionalization and specialization of surgery in the United States. The broad social process of organization, professionalization, and specialization that began for various disciplines in America in the mid-19th century was a reaction to emerging economic, political, and scientific influences including industrialization, urbanization, and technology. For surgeons or, at least, those men who performed surgical operations, the efforts toward group organization provided a means to promote their skills and restrict competition. An analysis of the published literature, and unpublished documents relating to the creation of the American Medical Association's Section on Surgery. During the 1850s and through the 1870s, a time when surgery was still not considered a separate branch of medicine, the organization of the American Medical Association's Section on Surgery provided the much needed encouragement to surgeons in their quest for professional and specialty recognition. The establishment of the American Medical Association's Section on Surgery in 1859 helped shape the nationwide future of the craft, in particular, surgery's rise as a specialty and profession.

[The "return of the repressed": the role of sexuality in the reception of psychoanalysis in Chilean medical circles, 1910-1940].

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Honorato, Mariano Ruperthuz

2015-12-01

This article discusses the reception of psychoanalysis in Chilean medical circles from the decade of 1910 onwards. The findings make it possible to reconstruct how Freudianism was initially rejected by the incipient local psychiatric milieu, accusing it of being pansexualist. In the 1930s, this situation changed, and a reassessment of psychoanalysis was made at a local level, describing it precisely as a branch of knowledge specialized in sexuality. The highlighting of the "sublimation" mechanism, esteemed for its ability to transmute the danger of the "id" into culturally accepted products, is a milestone that marked this "return of the repressed" of the sexual factor of psychoanalysis in Chile. The possible social, political and economic variables that influenced this phenomenon are duly discussed.

Discharge against Medical Advice at Neonatal Intensive Care Unit in Gujarat, India.

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Devpura, Bhanu; Bhadesia, Pranav; Nimbalkar, Somashekhar; Desai, Sandeep; Phatak, Ajay

2016-01-01

Objective . We explored reasons for discharged against medical advice (DAMA) of neonates from a neonatal intensive care unit (NICU) through in-depth interviews of the parents/guardians. Methods . Of 456 babies admitted to NICU during April 2014 to March 2015, 116 babies were DAMA. Parents of randomly selected 50 babies of these 116, residing within 50 kilometers, were approached for in-depth interviews at their homes. Audio recordings were done and manually transcribed, analyzed in detail to explore common threads leading to DAMA. Basic demographic information of the newborns was retrieved from hospital records. Results . The prevalence of DAMA was 25.4%. Of 50 parents approached, 41 in-depth interviews were completed. Nonaffordability (38.6%), no improvement (14.6%), poor prognosis (12%), and inappropriate behavior of the patient relation office personnel (10.6%) were major factors contributing to DAMA. Parents of 6.6% neonates wanted guarantee of survival and 5.3% parents reported poor behavior of nurses. No gender bias was observed related to DAMA. One-third of neonates (34.1%) were DAMA on first day of admission. Conclusions . The issue of DAMA needs attention. Besides nonaffordability and clinical characteristics of the baby, communication (breaking bad news, counseling, etc.) and lack of adequate infrastructure for relatives emerged as modifiable factors leading to DAMA.

EXPERIENCE IN DEVELOPMENT MEDICAL KITS FOR MEDICAL SERVICES OF THE RUSSIAN FEDERATION ARMED FORCES

Directory of Open Access Journals (Sweden)

E. O. Rodionov

2016-01-01

new models of complete-standard issue equipment of the Armed Forces Medical Service, which provides healthcare to a necessary extent and speed of deployment and mobility of medical units formations and military units in the field.

Medical and Safety Reforms in Boxing

Science.gov (United States)

Jordan, Barry D.

1988-01-01

The continued existence of boxing as an accepted sport in civilized society has been long debated. The position of the American Medical Association (AMA) has evolved from promoting increased safety and medical reform to recommending total abolition of both amateur and professional boxing. In response to the AMA opposition to boxing, the boxing community has attempted to increase the safeguards in amateur and professional boxing. The United States of America Amateur Boxing Federation, which is the national regulatory agency for all amateur boxing in the United States, has taken several actions to prevent the occurrence of acute brain injury and is currently conducting epidemiologic studies to assess the long-term neuropsychologic consequences of amateur boxing. In professional boxing, state regulatory agencies such as the New York State Athletic Commission have introduced several medical interventions to prevent and reduce neurologic injury. The lack of a national regulatory agency to govern professional boxing has stimulated the formation of the Association of Boxing Commissions and potential legislation for the federal regulation of professional boxing by a federally chartered organization called the United States Boxing Commission. The AMA's opposition to boxing and the medical and safety reforms implemented by the proponents of boxing are discussed. PMID:3385788

Shuttle Kit Freezer Refrigeration Unit Conceptual Design

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Copeland, R. J.

1975-01-01

The refrigerated food/medical sample storage compartment as a kit to the space shuttle orbiter is examined. To maintain the -10 F in the freezer kit, an active refrigeration unit is required, and an air cooled Stirling Cycle refrigerator was selected. The freezer kit contains two subsystems, the refrigeration unit, and the storage volume. The freezer must provide two basic capabilities in one unit. One requirement is to store 215 lbs of food which is consumed in a 30-day period by 7 people. The other requirement is to store 128.3 lbs of medical samples consisting of both urine and feces. The unit can be mounted on the lower deck of the shuttle cabin, and will occupy four standard payload module compartments on the forward bulkhead. The freezer contains four storage compartments.

24 CFR 291.530 - Eligible firefighter/emergency medical technicians.

Science.gov (United States)

2010-04-01

... medical technicians. 291.530 Section 291.530 Housing and Urban Development Regulations Relating to Housing... medical technicians. A person qualifies as a firefighter/emergency medical technician for the purposes of... technician by a fire department or emergency medical services responder unit of the federal government, a...

Perspective: private schools of the Caribbean: outsourcing medical education.

Science.gov (United States)

Eckhert, N Lynn

2010-04-01

Twenty-five percent of the U.S. physician workforce is made up of international medical graduates (IMGs), a growing proportion of whom (27% in 2005) are U.S. citizens. Most IMGs graduate from "offshore medical schools" (OMSs), for-profit institutions primarily located in the Caribbean region and established to train U.S. students who will return home to practice medicine. Following the recent call for a larger physician workforce, OMSs rapidly increased in number. Unlike U.S. schools, which must be accredited by the Liaison Committee on Medical Education, OMSs are recognized by their home countries and may not be subject to a rigorous accreditation process. Although gaps in specific data exist, a closer look at OMSs reveals that most enroll three groups of students per year, and many educate students initially at "offshore campuses" and later at clinical sites in the United States. Students from some OMSs are eligible for the U.S. Federal Family Education Loan Program. The lack of uniform data on OMSs is problematic for state medical boards, which struggle to assess the quality of the medical education offered at any one school and which, in some cases, disapprove a school. With the United States' continued reliance on IMGs to meet its health needs, the public and the profession will be best served by knowing more about medical education outside of the United States. Review of medical education in OMSs whose graduates will become part of U.S. health care delivery is timely as the United States reforms its health-care-delivery system.

Teaching psychosomatic (biopsychosocial) medicine in United States medical schools: survey findings.

Science.gov (United States)

Waldstein, S R; Neumann, S A; Drossman, D A; Novack, D H

2001-01-01

A survey of US medical schools regarding the incorporation of psychosomatic (biopsychosocial) medicine topics into medical school curriculum was conducted. The perceived importance and success of this curriculum, barriers to teaching psychosomatic medicine, and curricular needs were also assessed. From August 1997 to August 1999, representatives of US medical schools were contacted to complete a survey instrument either by telephone interview or by written questionnaire. Survey responses were received from 54 of the 118 US medical schools contacted (46%). Responses were obtained from representatives of both public (57%) and private (43%) institutions. Only 20% of respondents indicated that their schools used the term "psychosomatic medicine"; the terms "behavioral medicine" (63%) and "biopsychosocial medicine" (41%) were used more frequently. Coverage of various health habits (eg, substance use and exercise) ranged from 52% to 96%. The conceptualization and/or measurement of psychosocial factors (eg, stress and social support) was taught by 80% to 93% of schools. Teaching about the role of psychosocial factors in specific disease states or syndromes ranged from 33% (renal disease) to 83% (cardiovascular disease). Coverage of treatment-related issues ranged from 44% (relaxation/biofeedback) to 98% (doctor-patient communication). Topics in psychosomatic medicine were estimated to comprise approximately 10% (median response) of the medical school curriculum. On a scale of 1 (lowest) to 10 (highest), ratings of the relative importance of this curriculum averaged 7 (SD = 2.5; range = 2-10). Student response to the curriculum varied from positive to mixed to negative. Perceived barriers to teaching psychosomatic medicine included limited resources (eg, time, money, and faculty), student and faculty resistance, and a lack of continuity among courses. Sixty-three percent of respondents expressed an interest in receiving information about further incorporation of topics in

Hands in medicine: understanding the impact of competency-based education on the formation of medical students' identities in the United States.

Science.gov (United States)

Gonsalves, Catherine; Zaidi, Zareen

2016-01-01

There have been critiques that competency training, which defines the roles of a physician by simple, discrete tasks or measurable competencies, can cause students to compartmentalize and focus mainly on being assessed without understanding how the interconnected competencies help shape their role as future physicians. Losing the meaning and interaction of competencies can result in a focus on 'doing the work of a physician' rather than identity formation and 'being a physician.' This study aims to understand how competency-based education impacts the development of a medical student's identity. Three ceramic models representing three core competencies 'medical knowledge,' 'patient care,' and 'professionalism' were used as sensitizing objects, while medical students reflected on the impact of competency-based education on identity formation. Qualitative analysis was used to identify common themes. Students across all four years of medical school related to the 'professionalism' competency domain (50%). They reflected that 'being an empathetic physician' was the most important competency. Overall, students agreed that competency-based education played a significant role in the formation of their identity. Some students reflected on having difficulty in visualizing the interconnectedness between competencies, while others did not. Students reported that the assessment structure deemphasized 'professionalism' as a competency. Students perceive 'professionalism' as a competency that impacts their identity formation in the social role of 'being a doctor,' albeit a competency they are less likely to be assessed on. High-stakes exams, including the United States Medical Licensing Exam clinical skills exam, promote this perception.

Performance evaluation of medical records departments by analytical hierarchy process (AHP) approach in the selected hospitals in Isfahan : medical records dep. & AHP.

Science.gov (United States)

Ajami, Sima; Ketabi, Saeedeh

2012-06-01

Medical Records Department (MRD) is an important unit for evaluating and planning of care services. The goal of this study is evaluating the performance of the Medical Records Departments (MRDs) of the selected hospitals in Isfahan, Iran by using Analytical Hierarchy Process (AHP). This was an analytic of cross-sectional study that was done in spring 2008 in Isfahan, Iran. The statistical population consisted of MRDs of Alzahra, Kashani and Khorshid Hospitals in Isfahan. Data were collected by forms and through brainstorm technique. To analyze and perform AHP, Expert Choice software was used by researchers. Results were showed archiving unit has received the largest importance weight with respect to information management. However, on customer aspect admission unit has received the largest weight. Ordering weights of Medical Records Departments' Alzahra, Kashani and Khorshid Hospitals in Isfahan were with 0.394, 0.342 and 0.264 respectively. It is useful for managers to allocate and prioritize resources according to AHP technique for ranking at the Medical Records Departments.

Medical Examination of Aliens--Revisions to Medical Screening Process. Final rule.

Science.gov (United States)

2016-01-26

The Centers for Disease Control and Prevention (CDC), within the Department of Health and Human Services (HHS), is issuing this final rule (FR) to amend its regulations governing medical examinations that aliens must undergo before they may be admitted to the United States. Based on public comment received, HHS/CDC did not make changes from the NPRM published on June 23, 2015. Accordingly, this FR will: Revise the definition of communicable disease of public health significance by removing chancroid, granuloma inguinale, and lymphogranuloma venereum as inadmissible health-related conditions for aliens seeking admission to the United States; update the notification of the health-related grounds of inadmissibility to include proof of vaccinations to align with existing requirements established by the Immigration and Nationality Act (INA); revise the definitions and evaluation criteria for mental disorders, drug abuse and drug addiction; clarify and revise the evaluation requirements for tuberculosis; clarify and revise the process for the HHS/CDC-appointed medical review board that convenes to reexamine the determination of a Class A medical condition based on an appeal; and update the titles and designations of federal agencies within the text of the regulation.

[The influence of the advertising in the medication use in a group of elderly attended in a primary health care unit in Aracaju (Sergipe, Brasil)].

Science.gov (United States)

de Lyra, Divaldo Pereira; Neves, Aline Souza; Cerqueira, Karine Santos; Marcellini, Paulo Sergio; Marques, Tatiane Cristina; de Barros, José Augusto Cabral

2010-11-01

The growth of the Brazilian elderly people has led to a trend to an increase in the medication use. The inadequate use of drugs can be induced by some factors, like advertisement, with the risk of damaging the user's health. The objective of the study was to evaluate the advertisement influence in medication use in a group of elderly patients in a primary health care unit in Aracaju, Sergipe, Brazil. 230 elderly aging over 60 years with both genders had been interviewed from April to June of 2007. The majority of the interviewees (73%) has at least a chronic health condition and 73.9% consumed regularly at least one medication. 17.8% of the sample informed to use medication motivated by publicity influence; 2.2% had considered that the medication never cause damages and 6.5% believed that always it makes well. In this study, correlations have been made and demonstrated that those who presented a higher level of consumption influenced by advertising also think that drugs used are always beneficial and vice versa (p= 0.04). The data showed that part of elderly suffered influence of advertisement to medication use, and are not conscious of risks involved.

Frequency and causes of discharges against medical advice from hospital cardiac care units of East Azerbaijan, Iran

Directory of Open Access Journals (Sweden)

Saber Azami-Aghdash

2016-05-01

Full Text Available Introduction: Discharges against medical advice (DAMA is a common problem of hospitals that could lead increasing the complications and readmission. For this, the aim of this study is to investigate the frequency and effective factors of DAMA in patients with cardiovascular disease in hospital cardiac care units (CCU of East Azerbaijan, Iran. Methods: This cross-sectional study was performed, in 2013, in Tabriz University of Medical Sciences, Iran. Required information was extracted using valid and reliable forms of medical records of 2000 patients admitted to 20 CCU in 17 hospitals of East Azerbaijan, by two trained interviewers. Data analysis was performed using descriptive statistics (frequency, mean, percentage, etc., chi-square test, and linear regression model using the SPSS software. The tests were considered a statistically significant level of 0.05%. Results: The results showed that 272 patients (13.6% were DAMA from the hospital. The frequency of DAMA was in men more than women. The most frequency of discharge has occurred in the range of 40-80 years old. Results of linear regression showed that there was a significant correlation between DAMA and type of insurance, history of myocardial infarction (MI, comorbid disease, cause of hospitalization, location of hospital, and staying < 48 hours (P < 0.050. Conclusion: In this study, the rate of DAMA was relatively high compared with similar studies and it is considered as a concern problem that should study the reasons and its effective factors and plan effective interventions to reduce them.

Sleep and sedation in the pediatric intensive care unit.

Science.gov (United States)

Carno, Margaret-Ann; Connolly, Heidi V

2005-09-01

Sleep is an important and necessary function of the human body. Somatic growth and cellular repair occur during sleep. Critically ill children have disturbed sleep while in the pediatric intensive care unit related both to the illness itself and to light, noise, and caregiver activities disrupting an environment conducive to sleep. Medications administered in the pediatric intensive care unit can also disrupt sleep. This article reviews what is known about sleep in the pediatric intensive care unit and the effects of common sedation medications on sleep.

Medical researchers unite for study on cancer intervention

Directory of Open Access Journals (Sweden)

Editorial Office

2016-08-01

Full Text Available We introduce Drs. Antoine Snijders and Jian-Hua Mao, whose article is published in this issue of AMOR and discuss their views on cancer genetics, targeted therapy, and personalized medicine.Having worked together in numerous joint investigations that have yielded significant results, Dr. Snijders and Dr. Mao would most definitely agree that two heads are better than one. “Researchers these days need to have the ability to collaborate across many different disciplines,” said the duo in an exclusive interview with AMOR. Dr. Snijders and Dr. Mao, both with PhDs in cancer genetics and genomics, are currently based at the Biological Systems and Engineering Division of Lawrence Berkeley National Laboratory, California, which is a member of the national laboratory system supported by the U.S Department of Energy through its Office of Science. The Berkeley Lab is well known for producing excellent scholars, as thirteen Nobel Prize winners are affiliated with the Lab and seventy of its scientists are members of the National Academy of Sciences (NAS, one of the highest honors for a scientist in the United States. Dr. Snijders, a Dutch who has conducted his research at Berkeley Lab for the past eight years, did his Masters in Science (Medical Biology at the Vrije Universiteit Amsterdam, Netherlands – an institute with a strong focus on scientific research and is home to five Spinoza Prize (a.k.a. the “Dutch Nobel” winners. Dr. Snijders’s PhD (cum laude in cancer and molecular biology was awarded by University Utrecht in Netherlands, but his research work was carried out at the University of California San Francisco. Subsequently, he continued his postdoctoral research in molecular cytogenetics at the same institution. A prolific author of 114 publications (with 3,851 citations according to ResearchGate, Dr. Snijders – who also volunteers with California’s Contra Costa County Search and Rescue team for missing persons – has interests in

Efficacy of an expanded ventilator bundle for the reduction of ventilator-associated pneumonia in the medical intensive care unit.

Science.gov (United States)

Blamoun, John; Alfakir, Maria; Rella, Marie E; Wojcik, Janice M; Solis, Roberto A; Anees Khan, M; DeBari, Vincent A

2009-03-01

The ventilator bundle (VB) includes a group of clinical maneuvers (head-of-bed elevation, "sedation vacation," deep vein thrombosis prophylaxis, and peptic ulcer disease prophylaxis) to improve outcomes in patients undergoing mechanical ventilation. We modified the standard VB in our medical intensive care unit to include a group of respiratory therapist-driven protocols and, postimplementation, observed a statistically significant (P = .0006) reduction in ventilator-associated pneumonia (VAP), from a median of 14.1 cases/10(3) ventilator-days (interquartile range [IQR] = 12.1 to 20.6) to 0 cases/10(3) ventilator-days (IQR = 0 to 1.1).

Sexual and gender minority identity disclosure during undergraduate medical education: "in the closet" in medical school.

Science.gov (United States)

Mansh, Matthew; White, William; Gee-Tong, Lea; Lunn, Mitchell R; Obedin-Maliver, Juno; Stewart, Leslie; Goldsmith, Elizabeth; Brenman, Stephanie; Tran, Eric; Wells, Maggie; Fetterman, David; Garcia, Gabriel

2015-05-01

To assess identity disclosure among sexual and gender minority (SGM) students pursuing undergraduate medical training in the United States and Canada. From 2009 to 2010, a survey was made available to all medical students enrolled in the 176 MD- and DO-granting medical schools in the United States and Canada. Respondents were asked about their sexual and gender identity, whether they were "out" (i.e., had publicly disclosed their identity), and, if they were not, their reasons for concealing their identity. The authors used a mixed-methods approach and analyzed quantitative and qualitative survey data. Of 5,812 completed responses (of 101,473 eligible respondents; response rate 5.7%), 920 (15.8%) students from 152 (of 176; 86.4%) institutions identified as SGMs. Of the 912 sexual minorities, 269 (29.5%) concealed their sexual identity in medical school. Factors associated with sexual identity concealment included sexual minority identity other than lesbian or gay, male gender, East Asian race, and medical school enrollment in the South or Central regions of North America. The most common reasons for concealing one's sexual identity were "nobody's business" (165/269; 61.3%), fear of discrimination in medical school (117/269; 43.5%), and social or cultural norms (110/269; 40.9%). Of the 35 gender minorities, 21 (60.0%) concealed their gender identity, citing fear of discrimination in medical school (9/21; 42.9%) and lack of support (9/21; 42.9%). SGM students continue to conceal their identity during undergraduate medical training. Medical institutions should adopt targeted policies and programs to better support these individuals.

Use of simulation-based education to improve resident learning and patient care in the medical intensive care unit: a randomized trial.

Science.gov (United States)

Schroedl, Clara J; Corbridge, Thomas C; Cohen, Elaine R; Fakhran, Sherene S; Schimmel, Daniel; McGaghie, William C; Wayne, Diane B

2012-04-01

The purpose of this study is to determine the effect of simulation-based education on the knowledge and skills of internal medicine residents in the medical intensive care unit (MICU). From January 2009 to January 2010, 60 first-year residents at a tertiary care teaching hospital were randomized by month of rotation to an intervention group (simulator-trained, n = 26) and a control group (traditionally trained, n = 34). Simulator-trained residents completed 4 hours of simulation-based education before their medical intensive care unit (MICU) rotation. Topics included circulatory shock, respiratory failure, and mechanical ventilation. After their rotation, residents completed a standardized bedside skills assessment using a 14-item checklist regarding respiratory mechanics, ventilator settings, and circulatory parameters. Performance of simulator-trained and traditionally trained residents was compared using a 2-tailed independent-samples t test. Simulator-trained residents scored significantly higher on the bedside skills assessment compared with traditionally trained residents (82.5% ± 10.6% vs 74.8% ± 14.1%, P = .027). Simulator-trained residents were highly satisfied with the simulation curriculum. Simulation-based education significantly improved resident knowledge and skill in the MICU. Knowledge acquired in the simulated environment was transferred to improved bedside skills caring for MICU patients. Simulation-based education is a valuable adjunct to standard clinical training for residents in the MICU. Copyright © 2012 Elsevier Inc. All rights reserved.

The anthrax letters: a medical detective story

National Research Council Canada - National Science Library

Cole, Leonard A

2003-01-01

.... Library of Congress Cataloging-in-Publication Data Cole, Leonard A., 1933The anthrax letters : a medical detective story / Leonard A. Cole. p. cm. Includes bibliographical references and index. ISBN 0-309-08881-X - ISBN 0-309-52584-5 (PDF) 1. Bioterrorism- United States. 2. Anthrax- United States. 3. Postal service- United States. 4. Victims of...

Radically Reducing Radiation Exposure during Routine Medical Imaging

Science.gov (United States)

Exposure to radiation from medical imaging in the United States has increased dramatically. NCI and several partner organizations sponsored a 2011 summit to promote efforts to reduce radiation exposure from medical imaging.

The effect of physician staffing model on patient outcomes in a medical progressive care unit.

Science.gov (United States)

Yoo, E J; Damaghi, N; Shakespeare, W G; Sherman, M S

2016-04-01

Although evidence supports the impact of intensivist physician staffing in improving intensive care unit (ICU) outcomes, the optimal coverage for progressive care units (PCU) is unknown. We sought to determine how physician staffing models influence outcomes for intermediate care patients. We conducted a retrospective observational comparison of patients admitted to the medical PCU of an academic hospital during 12-month periods of high-intensity and low-intensity staffing. A total of 318 PCU patients were eligible for inclusion (143 high-intensity and 175 low-intensity). We found that low-intensity patients were more often stepped up from the emergency department and floor, whereas high-intensity patients were ICU transfers (61% vs 42%, P = .001). However, Mortality Probability Model scoring was similar between the 2 groups. In adjusted analysis, there was no association between intensity of staffing and hospital mortality (odds ratio, 0.84; 95% confidence interval, 0.36-1.99; P = .69) or PCU mortality (odds ratio, 0.96; 95% confidence interval, 0.38-2.45; P = .69). There was also no difference in subsequent ICU admission rates or in PCU length of stay. We found no evidence that high-intensity intensivist physician staffing improves outcomes for intermediate care patients. In a strained critical care system, our study raises questions about the role of the intensivist in the graded care options between intensive and conventional ward care. Copyright © 2015 Elsevier Inc. All rights reserved.

The role of the medical physic on radiologic, hemodynamic and surgery unit at Hospital das Clinicas de Porto Alegre, Rio Grande do Sul State, Brazil

International Nuclear Information System (INIS)

Bacelar, A.; Furtado, A.P.A.; Krebs, E.M.; Oliveira, S.S.; Lima, A.A.; Jacques, L.C.; Silveira, C.S.

1996-01-01

The activities executed by the medical physic in the radiologic, hemodynamic and surgery unit are presented. Topics such as organization of a radiologic protection project and a quality assurance program, monthly information of the individual doses, sanitary inspection and training of the professionals involved are emphasized. The methodology and results are briefly presented

Annual Medical Expenditure and Productivity Loss Among Colorectal, Female Breast, and Prostate Cancer Survivors in the United States.

Science.gov (United States)

Zheng, Zhiyuan; Yabroff, K Robin; Guy, Gery P; Han, Xuesong; Li, Chunyu; Banegas, Matthew P; Ekwueme, Donatus U; Jemal, Ahmedin

2016-05-01

There are limited nationally representative estimates of the annual economic burden among survivors of the three most prevalent cancers (colorectal, female breast, and prostate) in both nonelderly and elderly populations in the United States. The 2008 to 2012 Medical Expenditure Panel Survey data were used to identify colorectal (n = 540), female breast (n = 1568), and prostate (n = 1170) cancer survivors and individuals without a cancer history (n = 109 423). Excess economic burden attributable to cancer included per-person excess annual medical expenditures and productivity losses (employment disability, missed work days, and days stayed in bed). All analyses were stratified by cancer site and age (nonelderly: 18-64 years vs elderly: ≥ 65 years). Multivariable analyses controlled for age, sex, race/ethnicity, marital status, education, number of comorbidities, and geographic region. All statistical tests were two-sided. Compared with individuals without a cancer history, cancer survivors experienced annual excess medical expenditures (for the nonelderly population, colorectal: $8647, 95% confidence interval [CI] = $4932 to $13 974, P productivity loss at work (7.2 days, P productivity losses as those without a cancer history. Colorectal, breast, and prostate cancer survivors experienced statistically significantly higher economic burden compared with individuals without a cancer history; however, excess economic burden varies by cancer site and age. Targeted efforts will be important in reducing the economic burden of colorectal, breast, and prostate cancer. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Medical revalidation as professional regulatory reform: Challenging the power of enforceable trust in the United Kingdom.

Science.gov (United States)

Spendlove, Zoey

2018-05-01

For more than two decades, international healthcare crises and ensuing political debates have led to increasing professional governance and regulatory policy reform. Governance and policy reforms, commonly representing a shift from embodied trust in professionals to state enforceable trust, have challenged professional power and self-regulatory privileges. However, controversy remains as to whether such policies do actually shift the balance of power and what the resulting effects of policy introduction would be. This paper explores the roll-out and operationalisation of revalidation as medical regulatory reform within a United Kingdom National Health Service hospital from 2012 to 2013, and its impact upon professional power. Revalidation policy was subject to the existing governance and management structures of the organisation, resulting in the formal policy process being shaped at the local level. This paper explores how the disorganised nature of the organisation hindered rather than facilitated robust processes of professional governance and regulation, fostering formalistic rather than genuine professional engagement with the policy process. Formalistic engagement seemingly assisted the medical profession in retaining self-regulatory privileges whilst maintaining professional power over the policy process. The paper concludes by challenging the concept of state enforceable trust and the theorisation that professional groups are effectively regulated and controlled by means of national and organisational objectives, such as revalidation. Copyright © 2018 Elsevier Ltd. All rights reserved.

The performance and customization of SAPS 3 admission score in a Thai medical intensive care unit.

Science.gov (United States)

Khwannimit, Bodin; Bhurayanontachai, Rungsun

2010-02-01

The aim of this study was to evaluate the performance of Simplified Acute Physiology Score 3 (SAPS 3) admission scores, both the original and a customized version, in mixed medical critically ill patients. A prospective cohort study was conducted over a 2-year period in the medical intensive care unit (MICU) of a tertiary referral university teaching hospital in Thailand. The probability of hospital mortality of the original SAPS 3 was calculated using the general and customized Australasia version (SAPS 3-AUS). The patients were randomly divided into equal calibration and validation groups for customization. A total of 1,873 patients were enrolled. The hospital mortality rate was 28.6%. The general equation of SAPS 3 had excellent discrimination with an area under the receiver operating characteristic curve of 0.933, but poor calibration with the Hosmer-Lemeshow goodness-of-fit H = 106.7 and C = 101.2 (P customized SAPS 3 showed a good calibration of all patients in the validation group (H = 14, P = 0.17 and C = 11.3, P = 0.33) and all subgroups according to main diagnosis, age, gender and co-morbidities. The SAPS 3 provided excellent discrimination but poor calibration in our MICU. A first level customization of the SAPS 3 improved the calibration and could be used to predict mortality and quality assessment in our ICU or other ICUs with a similar case mix.

Predictors associated with unplanned hospital readmission of medical and surgical intensive care unit survivors within 30 days of discharge.

Science.gov (United States)

Ohnuma, Tetsu; Shinjo, Daisuke; Brookhart, Alan M; Fushimi, Kiyohide

2018-01-01

Reducing the 30-day unplanned hospital readmission rate is a goal for physicians and policymakers in order to improve quality of care. However, data on the readmission rate of critically ill patients in Japan and knowledge of the predictors associated with readmission are lacking. We investigated predictors associated with 30-day rehospitalization for medical and surgical adult patients separately. Patient data from 502 acute care hospitals with intensive care unit (ICU) facilities in Japan were retrospectively extracted from the Japanese Diagnosis Procedure Combination (DPC) database between April 2012 and February 2014. Factors associated with unplanned hospital readmission within 30 days of hospital discharge among medical and surgical ICU survivors were identified using multivariable logistic regression analysis. Of 486,651 ICU survivors, we identified 5583 unplanned hospital readmissions within 30 days of discharge following 147,423 medical hospitalizations (3.8% readmitted) and 11,142 unplanned readmissions after 339,228 surgical hospitalizations (3.3% readmitted). The majority of unplanned hospital readmissions, 60.9% of medical and 63.1% of surgical case readmissions, occurred within 15 days of discharge. For both medical and surgical patients, the Charlson comorbidity index score; category of primary diagnosis during the index admission (respiratory, gastrointestinal, and metabolic and renal); hospital length of stay; discharge to skilled nursing facilities; and having received a packed red blood cell transfusion, low-dose steroids, or renal replacement therapy were significantly associated with higher unplanned hospital readmission rates. From patient data extracted from a large Japanese national database, the 30-day unplanned hospital readmission rate after ICU stay was 3.4%. Further studies are required to improve readmission prediction models and to develop targeted interventions for high-risk patients.

Using the computer to optimize human performance in health care delivery. The pathologist as medical information specialist.

Science.gov (United States)

Korpman, R A

1987-07-01

The demands for information retrieval, processing, and synthesis placed on all providers of health care have increased dramatically in the last several decades. Although systems have been developed to capture charge-related data in support of cost reimbursement, there has been a conspicuous lack of attention paid to information tools to directly enhance the delivery of patient care. The termination of cost reimbursement, together with an increasing recognition of the problems inherent in current manual record-keeping systems, is creating a significant new focus on medical information. This change in focus requires a shift in systems orientation away from financial and departmentally centered systems and toward patient-centered approaches. There is thus increasing recognition of the need for a physician-level medical information specialist to serve as an institution's chief information officer, assuming responsibility for the collection, manipulation, and availability of all patient care-related data. By virtue of training, typical experience, hospital presence, and a noncompetitive position with the hospital's medical staff, the pathologist is uniquely suited for this position. To effectively perform this role, a variety of new specialized data management tools are becoming available. Integrated information systems, patient care management by exception, decision support tools, and, in the future, "artificial intelligence" assists can all be expected to become staples of pathology practice, especially impacting those pathologists who choose to be responsive to the new practice milieu of medical information science.

Ethnographic research into nursing in acute adult mental health units: a review.

Science.gov (United States)

Cleary, Michelle; Hunt, Glenn E; Horsfall, Jan; Deacon, Maureen

2011-01-01

Acute inpatient mental health units are busy and sometimes chaotic settings, with high bed occupancy rates. These settings include acutely unwell patients, busy staff, and a milieu characterised by unpredictable interactions and events. This paper is a report of a literature review conducted to identify, analyse, and synthesize ethnographic research in adult acute inpatient mental health units. Several electronic databases were searched using relevant keywords to identify studies published from 1990-present. Additional searches were conducted using reference lists. Ethnographic studies published in English were included if they investigated acute inpatient care in adult settings. Papers were excluded if the unit under study was not exclusively for patients in the acute phase of their mental illness, or where the original study was not fully ethnographic. Ten research studies meeting our criteria were found (21 papers). Findings were grouped into the following overarching categories: (1) Micro-skills; (2) Collectivity; (3) Pragmatism; and (4) Reframing of nursing activities. The results of this ethnographic review reveal the complexity, patient-orientation, and productivity of some nursing interventions that may not have been observed or understood without the use of this research method. Additional quality research should focus on redefining clinical priorities and philosophies to ensure everyday care is aligned constructively with the expectations of stakeholders and is consistent with policy and the realities of the organisational setting. We have more to learn from each other with regard to the effective nursing care of inpatients who are acutely disturbed.

Use of web services for computerized medical decision support, including infection control and antibiotic management, in the intensive care unit.

Science.gov (United States)

Steurbaut, Kristof; Van Hoecke, Sofie; Colpaert, Kirsten; Lamont, Kristof; Taveirne, Kristof; Depuydt, Pieter; Benoit, Dominique; Decruyenaere, Johan; De Turck, Filip

2010-01-01

The increasing complexity of procedures in the intensive care unit (ICU) requires complex software services, to reduce improper use of antibiotics and inappropriate therapies, and to offer earlier and more accurate detection of infections and antibiotic resistance. We investigated whether web-based software can facilitate the computerization of complex medical processes in the ICU. The COSARA application contains the following modules: Infection overview, Thorax, Microbiology, Antibiotic therapy overview, Admission cause with comorbidity and admission diagnosis, Infection linking and registration, and Feedback. After the implementation and test phase, the COSARA software was installed on a physician's office PC and then on the bedside PCs of the patients. Initial evaluation indicated that the services had been integrated easily into the daily clinical workflow of the medical staff. The use of a service oriented architecture with web service technology for the development of advanced decision support in the ICU offers several advantages over classical software design approaches.

Ontological Model-Based Transparent Access To Information In A Medical Multi-Agent System

Directory of Open Access Journals (Sweden)

Felicia GÎZĂ-BELCIUG

2012-01-01

Full Text Available Getting the full electronic medical record of a patient is an important step in providing a quality medical service. But the degree of heterogeneity of data from health unit informational systems is very high, because each unit can have a different model for storing patients’ medical data. In order to achieve the interoperability and integration of data from various medical units that store partial patient medical information, this paper proposes a multi-agent systems and ontology based approach. Therefore, we present an ontological model for describing the particular structure of the data integration process. The system is to be used for centralizing the information from a patient’s partial medical records. The main advantage of the proposed model is the low ratio between the complexity of the model and the amount of information that can be retrieved in order to generate the complete medical history of a patient.

Survey of pharmacy involvement in hospital medication reconciliation programs across the United States

Directory of Open Access Journals (Sweden)

Gregory R Stein

2015-11-01

Full Text Available Objective: The objective of this study is to conduct a review of pertinent literature, assess pharmacy involvement in medication reconciliation, and offer insight into best practices for hospitals to implement and enhance their medication reconciliation programs. Method: Pharmacists in hospitals nationwide were asked to complete an anonymous survey via the American College of Clinical Pharmacy online database. The multiple choice survey analyzed the roles that healthcare professionals play in medication reconciliation programs at hospitals. Results: Of the survey responses received, 32/91 (35% came from pharmacists at hospitals with a pharmacy-led medication reconciliation program. Of these pharmacy-led programs, 17/32 (53% have a dedicated pharmacist or pharmacy staff to perform medication reconciliation. Conclusion: A comprehensive review of literature suggests that pharmacy involvement has the potential to reduce medication reconciliation errors and may improve patient satisfaction. Focused, full-time medication reconciliation pharmacists can help hospitals save time and money, improve outcomes, and meet higher standards issued by the Joint Commission. Data obtained in this study show the extent to which pharmacists contribute to achieving these goals in healthcare systems nationwide. This baseline study provides a strong case for hospitals to implement a pharmacy-led medication reconciliation program.

Improving adherence to medication in adults with diabetes in the United Arab Emirates.

Science.gov (United States)

Al-Haj Mohd, Mohammed M M; Phung, Hai; Sun, Jing; Morisky, Donald E

2016-08-24

Diabetes is a chronic medical condition and adherence to medication in diabetes is important. Improving medication adherence in adults with diabetes would help prevent the chronic complications associated with diabetes. A case control trial was used to study the effects of an educational session on medication adherence among adults with diabetes as measured by the Morisky Medication adherence scale (MMAS-8©). The study took place at the Dubai Police Health Centre between February 2015 and November 2015. Questionnaires were used to collect socio-demographic, clinical and disease related variables and the primary measure of outcome was adherence levels as measured by the Morisky Medication Adherence Scale (MMAS-8©). The intervention group involved a standardized thirty minute educational session focusing on the importance of adherence to medication. The change in MMAS-8© was measured at 6 months. Four hundred and forty six patients were enrolled. Mean age 61 year +/- 11. 48.4 % were male. The mean time since diagnosis of diabetes was 3.2 years (Range 1-15 years). At baseline two hundred and eighty eight (64.6 %) patients were considered non-adherent (MMAS-8© adherence score strategies should focus on wider educational strategies targeting medication adherence in diabetic patients in the UAE.

Medical Tourism within the Czech Republic

OpenAIRE

Němečková, Eva

2016-01-01

The thesis analyses factors influencing medical tourism within the Czech Re- public where districts ("okresy") and regions ("kraje") are considered as the units where the patient can travel to receive health care. The dataset was pro- vided by the Czech general health insurance (VZP). The research covers the period 2011-2014 and reveals the differences between "medical tourism" for hospitalizations and for medical treatments and between travelling into other districts ("okresy") and travellin...

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

Science.gov (United States)

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

2009-05-12

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

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

Directory of Open Access Journals (Sweden)

Timmermann Arnd

2009-05-01

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

Medical device software: defining key terms.

Science.gov (United States)

Pashkov, Vitalii; Gutorova, Nataliya; Harkusha, Andrii

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

AAPM Medical Physics Practice Guideline 3.a: Levels of supervision for medical physicists in clinical training.

Science.gov (United States)

Seibert, J Anthony; Clements, Jessica B; Halvorsen, Per H; Herman, Michael G; Martin, Melissa C; Palta, Jatinder; Pfeiffer, Douglas E; Pizzutiello, Robert J; Schueler, Beth A; Shepard, S Jeff; Fairobrent, Lynne A

2015-05-08

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States.The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner.Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized.The following terms are used in the AAPM practice guidelines:Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline.Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

Discharge against Medical Advice at Neonatal Intensive Care Unit in Gujarat, India

Directory of Open Access Journals (Sweden)

Bhanu Devpura

2016-01-01

Full Text Available Objective. We explored reasons for discharged against medical advice (DAMA of neonates from a neonatal intensive care unit (NICU through in-depth interviews of the parents/guardians. Methods. Of 456 babies admitted to NICU during April 2014 to March 2015, 116 babies were DAMA. Parents of randomly selected 50 babies of these 116, residing within 50 kilometers, were approached for in-depth interviews at their homes. Audio recordings were done and manually transcribed, analyzed in detail to explore common threads leading to DAMA. Basic demographic information of the newborns was retrieved from hospital records. Results. The prevalence of DAMA was 25.4%. Of 50 parents approached, 41 in-depth interviews were completed. Nonaffordability (38.6%, no improvement (14.6%, poor prognosis (12%, and inappropriate behavior of the patient relation office personnel (10.6% were major factors contributing to DAMA. Parents of 6.6% neonates wanted guarantee of survival and 5.3% parents reported poor behavior of nurses. No gender bias was observed related to DAMA. One-third of neonates (34.1% were DAMA on first day of admission. Conclusions. The issue of DAMA needs attention. Besides nonaffordability and clinical characteristics of the baby, communication (breaking bad news, counseling, etc. and lack of adequate infrastructure for relatives emerged as modifiable factors leading to DAMA.

Medication reconciliation by a pharmacy technician in a mental health assessment unit.

Science.gov (United States)

Brownlie, Kay; Schneider, Carl; Culliford, Roger; Fox, Chris; Boukouvalas, Alexis; Willan, Cathy; Maidment, Ian D

2014-04-01

Medication discrepancies are common when patients cross organisational boundaries. However, little is known about the frequency of discrepancies within mental health and the efficacy of interventions to reduce discrepancies. To evaluate the impact of a pharmacy-led reconciliation service on medication discrepancies on admissions to a secondary care mental health trust. In-patient mental health services. Prospective evaluation of pharmacy technician led medication reconciliation for admissions to a UK Mental Health NHS Trust. From March to June 2012 information on any unintentional discrepancies (dose, frequency and name of medication); patient demographics;and type and cause of the discrepancy was collected. The potential for harm was assessed based on two scenarios; the discrepancy was continued into primary care, and the discrepancy was corrected during admission. Logistic regression identified factors associated with discrepancies. Mean number of discrepancies per admission corrected by the pharmacy technician. Unintentional medication discrepancies occurred in 212 of 377 admissions (56.2 %). Discrepancies involving 569 medicines (mean 1.5 medicines per admission) were corrected.The most common discrepancy was omission(n = 464). Severity was assessed for 114 discrepancies. If the discrepancy was corrected within 16 days the potential harm was minor in 71 (62.3 %) cases and moderate in 43(37.7 %) cases whereas if the discrepancy was not corrected the potential harm was minor in 27 (23.7 %) cases and moderate in 87 (76.3 %) cases. Discrepancies were associated with both age and number of medications; the stronger association was age. Medication discrepancies are common within mental health services with potentially significant consequences for patients.Trained pharmacy technicians are able to reduce the frequency of discrepancies, improving safety.

Current practices in library/informatics instruction in academic libraries serving medical schools in the Western United States: a three-phase action research study.

Science.gov (United States)

Eldredge, Jonathan D; Heskett, Karen M; Henner, Terry; Tan, Josephine P

2013-09-04

To conduct a systematic assessment of library and informatics training at accredited Western U.S. medical schools. To provide a structured description of core practices, detect trends through comparisons across institutions, and to identify innovative training approaches at the medical schools. Action research study pursued through three phases. The first phase used inductive analysis on reported library and informatics skills training via publicly-facing websites at accredited medical schools and the academic health sciences libraries serving those medical schools. Phase Two consisted of a survey of the librarians who provide this training to undergraduate medical education students at the Western U.S. medical schools. The survey revealed gaps in forming a complete picture of current practices, thereby generating additional questions that were answered through the Phase Three in-depth interviews. Publicly-facing websites reviewed in Phase One offered uneven information about library and informatics training at Western U.S. medical schools. The Phase Two survey resulted in a 77% response rate. The survey produced a clearer picture of current practices of library and informatics training. The survey also determined the readiness of medical students to pass certain aspects of the United States Medical Licensure Exam. Most librarians interacted with medical school curricular leaders through either curricula committees or through individual contacts. Librarians averaged three (3) interventions for training within the four-year curricula with greatest emphasis upon the first and third years. Library/informatics training was integrated fully into the respective curricula in almost all cases. Most training involved active learning approaches, specifically within Problem-Based Learning or Evidence-Based Medicine contexts. The Phase Three interviews revealed that librarians are engaged with the medical schools' curricular leaders, they are respected for their knowledge and

The financial burden of out-of-pocket expenses in the United States and Canada: How different is the United States?

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Katherine E Baird

2016-01-01

Full Text Available Background: This article compares the burden that medical cost-sharing requirements place on households in the United States and Canada. It estimates the probability that individuals with similar demographic features in the two countries have large medical expenses relative to income. Method: The study uses 2010 nationally representative household survey data harmonized for cross-national comparisons to identify individuals with high medical expenses relative to income. Using logistic regression, it estimates the probability of high expenses occurring among 10 different demographic groups in the two countries. Results: The results show the risk of large medical expenses in the United States is 1.5–4 times higher than it is in Canada, depending on the demographic group and spending threshold used. The United States compares least favorably when evaluating poorer citizens and when using a higher spending threshold. Conclusion: Recent health care reforms can be expected to reduce Americans’ catastrophic health expenses, but it will take very large reductions in out-of-pocket expenditures—larger than can be expected—if poorer and middle-class families are to have the financial protection from high health care costs that their counterparts in Canada have.

A before and after study of medical students' and house staff members' knowledge of ACOVE quality of pharmacologic care standards on an acute care for elders unit.

Science.gov (United States)

Jellinek, Samantha P; Cohen, Victor; Nelson, Marcia; Likourezos, Antonios; Goldman, William; Paris, Barbara

2008-06-01

The Assessing Care of Vulnerable Elders (ACOVE) comprehensive set of quality assessment tools for ill older persons is a standard designed to measure overall care delivered to vulnerable elders (ie, those aged > or =65 years) at the level of a health care system or plan. The goal of this research was to quantify the pretest and posttest results of medical students and house staff participating in a pharmacotherapist-led educational intervention that focused on the ACOVE quality of pharmacologic care standards. This was a before and after study assessing the knowledge ofACOVE standards following exposure to an educational intervention led by a pharmacotherapist. It was conducted at the 29-bed Acute Care for Elders (ACE) unit of Maimonides Medical Center, a 705-bed, independent teaching hospital located in Brooklyn, New York. Participants included all medical students and house staff completing a rotation on the ACE unit from August 2004 through May 2005 who completed both the pre-and posttests. A pharmacotherapist provided a 1-hour active learning session reviewing the evidence supporting the quality indicators and reviewed case-based questions with the medical students and house staff. Educational interventions also occurred daily through pharmacotherapeutic consultations and during work rounds. Medical students and house staff were administered the same 15-question, patient-specific, case-based, multiple-choice pre-and posttest to assess knowledge of the standards before and after receiving the intervention. A total of 54 medical students and house staff (median age, 28.58 years; 40 men, 14 women) completed the study. Significantly higher median scores were achieved on the multiple-choice test after the intervention than before (median scores, 14/15 [93.3%] vs 12/15 [80.0%], respectively; P = 0.001). A pharmacotherapist-led educational intervention improved the scores of medical students and house staff on a test evaluating knowledge of evidence

Predicting performance at medical school: can we identify at-risk students?

Directory of Open Access Journals (Sweden)

Shaban S

2011-05-01

Full Text Available Sami Shaban, Michelle McLeanDepartment of Medical Education, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab EmiratesBackground: The purpose of this study was to examine the predictive potential of multiple indicators (eg, preadmission scores, unit, module and clerkship grades, course and examination scores on academic performance at medical school, with a view to identifying students at risk.Methods: An analysis was undertaken of medical student grades in a 6-year medical school program at the Faculty of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates, over the past 14 years.Results: While high school scores were significantly (P < 0.001 correlated with the final integrated examination, predictability was only 6.8%. Scores for the United Arab Emirates university placement assessment (Common Educational Proficiency Assessment were only slightly more promising as predictors with 14.9% predictability for the final integrated examination. Each unit or module in the first four years was highly correlated with the next unit or module, with 25%–60% predictability. Course examination scores (end of years 2, 4, and 6 were significantly correlated (P < 0.001 with the average scores in that 2-year period (59.3%, 64.8%, and 55.8% predictability, respectively. Final integrated examination scores were significantly correlated (P < 0.001 with National Board of Medical Examiners scores (35% predictability. Multivariate linear regression identified key grades with the greatest predictability of the final integrated examination score at three stages in the program.Conclusion: This study has demonstrated that it may be possible to identify “at-risk” students relatively early in their studies through continuous data archiving and regular analysis. The data analysis techniques used in this study are not unique to this institution.Keywords: at-risk students, grade

Using Social Cognitive Theory to Predict Medication Compliance Behavior in Patients with Depression in Southern United States in 2016 in a Cross-Sectional Study.

Science.gov (United States)

Bennett, Britney; Sharma, Manoj; Bennett, Russell; Mawson, Anthony R; Buxbaum, Sarah G; Sung, Jung Hye

2018-03-01

Introduction: Depression is a major public health issue. One of the concerns in depression research and practice pertains to non-compliance to prescribed medications. The purpose of the study was to predict compliance with medication use for patients with depression using social cognitive theory (SCT). Based on this study it was envisaged that recommendations for interventions to enhance compliance for medication use could be developed for patients with depression. Methods: The study was conducted using cross sectional design (n=148) in southern United States with a convenience sample of clinic-based depression patients with a 37-item valid and reliable questionnaire. Sample size was calculated to be 148 using G*Power (five predictors with a 0.80 power at the 0.05 alpha level and an estimated effect size of 0.10 with an inflation by 10% for missing data). Social cognitive theory constructs of expectations, self-efficacy and self-efficacy in overcoming barriers, self-control, and environment were reified. Data were analyzed using multiple linear regression and multiple logistic regression analyses. Results: Self-control for taking medication for depression (P=0.04), expectations for taking medication for depression (P=0.025), age (P<0.0001) and race (P=0.04) were significantly related to intent for taking medication for depression (Adjusted R 2 = 0.183). In race, Blacks had lower intent to take medication for depression. Conclusion: Social cognitive theory is weakly predictive with low explained variance for taking medication for depression. It needs to be bolstered by newer theories like integrative model or multi-theory model of health behavior change for designing educational interventions aimed at enhancing compliance to medication for depression.

Using Social Cognitive Theory to Predict Medication Compliance Behavior in Patients with Depression in Southern United States in 2016 in a Cross-Sectional Study

Directory of Open Access Journals (Sweden)

Britney Bennett

2018-03-01

Full Text Available Introduction: Depression is a major public health issue. One of the concerns in depression research and practice pertains to non-compliance to prescribed medications. The purpose of the study was to predict compliance with medication use for patients with depression using social cognitive theory (SCT. Based on this study it was envisaged that recommendations for interventions to enhance compliance for medication use could be developed for patients with depression. Methods: The study was conducted using cross sectional design (n=148 in southern United States with a convenience sample of clinic-based depression patients with a 37-item valid and reliable questionnaire. Sample size was calculated to be 148 using G*Power (five predictors with a 0.80 power at the 0.05 alpha level and an estimated effect size of 0.10 with an inflation by 10% for missing data. Social cognitive theory constructs of expectations, self-efficacy and self-efficacy in overcoming barriers, self-control, and environment were reified. Data were analyzed using multiple linear regression and multiple logistic regression analyses. Results: Self-control for taking medication for depression (P=0.04, expectations for taking medication for depression (P=0.025, age (P<0.0001 and race (P=0.04 were significantly related to intent for taking medication for depression (Adjusted R2 = 0.183. In race, Blacks had lower intent to take medication for depression. Conclusion: Social cognitive theory is weakly predictive with low explained variance for taking medication for depression. It needs to be bolstered by newer theories like integrative model or multi-theory model of health behavior change for designing educational interventions aimed at enhancing compliance to medication for depression.

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

Science.gov (United States)

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

2015-01-01

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

Medical physics education and training activities in India

International Nuclear Information System (INIS)

Kumar, Munish; Gomathi, K.; Sharma, S.D.; Chourasiya, G.; Mayya, Y.S.; Sahani, G.; Sharma Dash, P.K.; Agarwal, S.P.

2008-01-01

Since the discovery of x-rays and radioactivity, ionising radiations are finding extensive applications in human health care programmes worldwide. X-rays are being used in India for various applications since 1898. Further the establishment of Tata Memorial Hospital in 1941, as a centre for the treatment of cancer was the stepping-stone for medical physics in India with Dr. Ramaiah Naidu as the first medical physicist. Since then, the field of medical physics has made a tremendous progress. At cancer treatment centre, medical physicist cum RSO is required not only to ensure and maintain quality of radiation treatment by ensuring quality assurance, treatment planning and resonance with radiation oncologist but also acts as a bridge between the cancer treatment centre and regulatory authority (AERB) and also ensures radiation safety. Currently there are around 399 teletherapy units (280 telecobalt and 119 medical linear accelerator) in our country and the number is further likely to increase in future due to i) More awareness about cancer and prevalence of around 1 million new cancer cases per year and ii) The indigenous production of telecobalt and linear accelerator units has brought down the cost. In fact in India, there is a need of more than 1000 teletherapy units. In view of above, well-trained and qualified medical physicists are required. In this paper, various educational and training activities in India are described. The paper also casts light on growing demands for starting M.Phil and Ph.D. degrees in medical physics in India

Growth Modeling of the Maternal Cytokine Milieu throughout Normal Pregnancy: Macrophage-Derived Chemokine Decreases as Inflammation/Counterregulation Increases

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Shernan G. Holtan

2015-01-01

Full Text Available Several recent studies have shown differences in the maternal immune milieu at different phases of pregnancy, but most studies have been cross-sectional or of relatively few time points. Levels of 42 cytokines were determined using a multiplex bead-based assay on archived serum from a cohort of pregnant women N=16 at median of 18 time points tested, from the first trimester through to parturition, per woman. Unconditional growth modeling was then used to determine time-dependent changes in levels of these cytokines. Macrophage-derived chemokine (MDC, aka CCL22 decreases as pregnancy progresses. IL-1β, IL-6, IL-8, IL-12p70, IL-13, IL-15, IP-10, and FLT3-ligand increase as a function of gestational weeks, and IFNα2, IL-1ra, IL-3, IL-9, IL-12p40, and soluble CD40 ligand increase as a function of trimester. As pregnancy normally progresses, a maternal shift away from a type 2-biased immune response and toward an inflammatory/counterregulatory response is observed.

MEE-project: One year of public relations on the environment and energy. MEE-projekt: Een jaar voorlichten over milieu en energie

Energy Technology Data Exchange (ETDEWEB)

Anon.

1991-06-26

A final overview is presented of the MEE-project ('Milieu- En Energie projekt' or Environmental and Energy project). The MEE-project was aimed at stimulating energy saving and improving the public attitude concerning energy and the environment. The project is also considered as an employment project for the unemployed. The main target group of the project was the households in the Dutch municipality Heerhugowaard. Five persons in search of employment offered interested private households options to save energy and the environment within their own surroundings by means of information and documentation. 5610 information packets were delivered. The costs did not exceed 115,000 Dutch guilders. The overall conclusion is positive: the people of the municipality are active in trying to save energy and the environment. Four of the five project members have new and better perspectives for a job.

Synthèse d'esters de l'acide benzoïque par catalyse enzymatique en milieu hétérogène microaqueux

OpenAIRE

Leszczak , Jean-Pierre

1998-01-01

171 pages; No english abstract; La synthèse d'esters de l'acide benzoïque par voie enzymatique en milieu hétérogène microaqueux est envisagée. Cette estérification est possible et est catalysée par la lipase de Candida rugosa en suspension dans un mélange hexane/toluène. Le toluène permet la solubilisation de l'acide benzoïque. De nombreux paramètres influencent la synthèse des benzoates de méthyle et de butyle. La teneur en eau initiale agit uniquement sur la cinétique de réaction sans modif...

Medical writers i medicinsk forskning

DEFF Research Database (Denmark)

Burcharth, Jakob; Pommergaard, Hans-Christian; Danielsen, Anne Kjærgaard

2013-01-01

Larger research units often comprise persons of several professions in order to secure a high level of efficiency and quality in the different tasks. In Denmark, employees with special competencies within the field of writing and publication are rarely used in research units. The purpose of this ...... of this study was to present the advantages and challenges associated with the involvement of medical writers in academic environments....

Assessment of the Nurse Medication Administration Workflow Process

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Nathan Huynh

2016-01-01

Full Text Available This paper presents findings of an observational study of the Registered Nurse (RN Medication Administration Process (MAP conducted on two comparable medical units in a large urban tertiary care medical center in Columbia, South Carolina. A total of 305 individual MAP observations were recorded over a 6-week period with an average of 5 MAP observations per RN participant for both clinical units. A key MAP variation was identified in terms of unbundled versus bundled MAP performance. In the unbundled workflow, an RN engages in the MAP by performing only MAP tasks during a care episode. In the bundled workflow, an RN completes medication administration along with other patient care responsibilities during the care episode. Using a discrete-event simulation model, this paper addresses the difference between unbundled and bundled workflow and their effects on simulated redesign interventions.

Antimicrobial susceptibility and molecular epidemiology of extended-spectrum beta-lactamase-producing Enterobacteriaceae from intensive care units at Hamad Medical Corporation, Qatar.