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Sample records for unit milieu medical

  1. A BASIC CAMERA UNIT FOR MEDICAL PHOTOGRAPHY.

    Science.gov (United States)

    SMIALOWSKI, A; CURRIE, D J

    1964-08-22

    A camera unit suitable for most medical photographic purposes is described. The unit comprises a single-lens reflex camera, an electronic flash unit and supplementary lenses. Simple instructions for use of th's basic unit are presented. The unit is entirely suitable for taking fine-quality photographs of most medical subjects by persons who have had little photographic training.

  2. INTERPERSONAL COMMUNICATION IN MEDICAL UNITS

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    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.

  3. Architecture and Design of Medical Processor Units for Medical Networks

    CERN Document Server

    Ahamed, Syed V; 10.5121/ijcnc.2010.2602

    2011-01-01

    This paper introduces analogical and deductive methodologies for the design medical processor units (MPUs). From the study of evolution of numerous earlier processors, we derive the basis for the architecture of MPUs. These specialized processors perform unique medical functions encoded as medical operational codes (mopcs). From a pragmatic perspective, MPUs function very close to CPUs. Both processors have unique operation codes that command the hardware to perform a distinct chain of subprocesses upon operands and generate a specific result unique to the opcode and the operand(s). In medical environments, MPU decodes the mopcs and executes a series of medical sub-processes and sends out secondary commands to the medical machine. Whereas operands in a typical computer system are numerical and logical entities, the operands in medical machine are objects such as such as patients, blood samples, tissues, operating rooms, medical staff, medical bills, patient payments, etc. We follow the functional overlap betw...

  4. Architecture and Design of Medical Processor Units for Medical Networks

    Directory of Open Access Journals (Sweden)

    Syed V. Ahamed

    2010-11-01

    Full Text Available This paper1 introduces analogical and deductive methodologies for the design medical processor units(MPUs. From the study of evolution of numerous earlier processors, we derive the basis for thearchitecture of MPUs. These specialized processors perform unique medical functions encoded as medicaloperational codes (mopcs. From a pragmatic perspective, MPUs function very close to CPUs. Bothprocessors have unique operation codes that command the hardware to perform a distinct chain of subprocessesupon operands and generate a specific result unique to the opcode and the operand(s. Inmedical environments, MPU decodes the mopcs and executes a series of medical sub-processes and sendsout secondary commands to the medical machine. Whereas operands in a typical computer system arenumerical and logical entities, the operands in medical machine are objects such as such as patients, bloodsamples, tissues, operating rooms, medical staff, medical bills, patient payments, etc. We follow thefunctional overlap between the two processes and evolve the design of medical computer systems andnetworks.

  5. Smeerolie en Milieu

    NARCIS (Netherlands)

    Straelen, van B.C.P.M.

    1996-01-01

    In de Nederlandse landbouw gaat een flinke hoeveelheid aan smeermiddelen om. Uit een recent Duits onderzoek blijkt dat de helft van de olie die in de mobiele sector, waartoe de landbouw behoort, gebruikt wordt ongecontroleerd in het milieu terecht komt. Het is onwaarschijnlijk dat de situatie in

  6. Smeerolie en Milieu

    NARCIS (Netherlands)

    Straelen, van B.C.P.M.

    1996-01-01

    In de Nederlandse landbouw gaat een flinke hoeveelheid aan smeermiddelen om. Uit een recent Duits onderzoek blijkt dat de helft van de olie die in de mobiele sector, waartoe de landbouw behoort, gebruikt wordt ongecontroleerd in het milieu terecht komt. Het is onwaarschijnlijk dat de situatie in Ned

  7. [Medication errors in Spanish intensive care units].

    Science.gov (United States)

    Merino, P; Martín, M C; Alonso, A; Gutiérrez, I; Alvarez, J; Becerril, F

    2013-01-01

    To estimate the incidence of medication errors in Spanish intensive care units. Post hoc study of the SYREC trial. A longitudinal observational study carried out during 24 hours in patients admitted to the ICU. Spanish intensive care units. Patients admitted to the intensive care unit participating in the SYREC during the period of study. Risk, individual risk, and rate of medication errors. The final study sample consisted of 1017 patients from 79 intensive care units; 591 (58%) were affected by one or more incidents. Of these, 253 (43%) had at least one medication-related incident. The total number of incidents reported was 1424, of which 350 (25%) were medication errors. The risk of suffering at least one incident was 22% (IQR: 8-50%) while the individual risk was 21% (IQR: 8-42%). The medication error rate was 1.13 medication errors per 100 patient-days of stay. Most incidents occurred in the prescription (34%) and administration (28%) phases, 16% resulted in patient harm, and 82% were considered "totally avoidable". Medication errors are among the most frequent types of incidents in critically ill patients, and are more common in the prescription and administration stages. Although most such incidents have no clinical consequences, a significant percentage prove harmful for the patient, and a large proportion are avoidable. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  8. Medical responsibility in the United Arab Emirates.

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    Benomran, Fawzi

    2010-05-01

    Medical responsibility in the United Arab Emirates was formerly defined and governed according to Law 7 of 1975 for the practice of medical professions, which had been a part of civil law. The passing of Law 10 of 2008, namely the "Law on Medical Responsibility in UAE", enacted on 16th December 2008 created a new framework to deal with this issue. One of its provisions required medical practitioners to hold insurance policies, so that insurance companies pays damages to the plaintiff (patient) injured as a result of a physicians' negligence. This paper outlines the issue of medical responsibility and medical negligence. The author's translation of the new law into English is included so that its full text is available for the readers, especially expatriate doctors working in the UAE. Where appropriate, a brief comparison between the old law and new laws is also presented. The objective of this paper is to provide medical practitioners with basic information about the subject in general and to this legislation in particular. It is mandatory for doctors to realize inherent risks involved in the course of their practice. A basic knowledge of the law is required to avoid pitfalls and to safeguard oneself against errors arising from ignorance of the duties and rights of the professional person.

  9. MILIEU DALAM PENDIDIKAN ISLAM

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    Najahah Mudzakir

    2015-12-01

    Full Text Available Environment is one the urgent thing in education wolrd because environment has funcion as a place where education process is taking place. He same as with social environment, it has important role for human being. As we know human being is social creature that created from a blood cloth or something that adherence on the uterus wall, but it is also can be understood that he uterus wall created always based on oher pary or it can’t live by it self. So it can be understood that human being wih all characterization and their growth is the result of two achievment factors. Namely Heritage factor and environment factor. There factors influence human being in their interaction since they become embryo till to the end of their life. Key words :   Milieu, Islamic education

  10. [Triage in acute medical admission units.

    DEFF Research Database (Denmark)

    Brabrand, Mikkel; Folkestad, Lars; Hallas, Peter

    2010-01-01

    . At 87% of the MAUs, a doctor was contacted by the admitting physician, while the contact was the responsibility of a nurse in 13% of MAUs. None of the contacted MAUs used a validated triage tool and 95% answered that they triaged on the basis of individual clinical assessment of patients. However, 22......INTRODUCTION: Many emergency departments use validated triage tools. It is currently undocumented if such a practice is common in Danish medical admission units (MAU). The current study was conducted in order to clarify this. MATERIAL AND METHODS: Questionnaire survey with data collected from......% answered that selected groups of patients were routinely assessed by a senior physician. CONCLUSION: None of the Danish MAUs uses a validated triage tool to prioritize acutely admitted medical patients. Udgivelsesdato: 2010-May-31...

  11. Psychotropic Medication Use among Adolescents: United States, 2005-2010

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    ... from the National Technical Information Service NCHS Psychotropic Medication Use Among Adolescents: United States, 2005–2010 Recommend ... 0% of adolescents reported the use of psychotropic medications. Figure 1. Percentage of adolescents aged 12–19 ...

  12. Medication administration errors in an intensive care unit in Ethiopia

    OpenAIRE

    2012-01-01

    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...

  13. Faculty development and medical education units in India: a survey.

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    Adkoli, B V; Sood, Rita

    2009-01-01

    Faculty development in medical education is gaining momentum in India. While planning a National Conference on Medical Education (NCME 2007), we did a survey of principals and faculty of medical colleges to understand the status of faculty development programmes and medical education units in medical colleges in India. Questionnaires were sent to principals of medical colleges by surface mail and to faculty through a web-based programme to elicit information on various aspects of faculty development programmes and medical education units. The responses of both groups were analysed. The number of medical education units has increased rapidly after regulations have been revised in 1997 by the Medical Council of India. The main activities of medical education units were to conduct workshops targeted at medical teachers. The frequently covered topics were teaching-learning, media and student assessment. Lectures dominated the methodology of imparting information. Evaluation was done mainly by feedback questionnaires and pre-test/post-test questionnaires. Projects and follow up were rarely used. The responses from both groups were strikingly similar. The major strengths of medical education units were perceived as availability of trained and motivated faculty, good infrastructure and supportive leadership. The shortcomings were lack of infrastructure, funding and full-time faculty, besides time constraints and resistance to change. The respondents suggested strengthening of infrastructure, appointment of full-time faculty and staff, incentives and recognition of contributions to faculty development, making participation a mandatory requirement, extending the scope of faculty development programmes to include research and networking at the national level. Conclusion. The study reveals the need for policy decisions that support functioning of medical education units in India besides active participation of the faculty.

  14. Structure determines medication errors in nursing units: a mechanistic approach.

    Science.gov (United States)

    Hung, Chang-Chiao; Lee, Bih-O; Tsai, Shu-Ling; Tseng, Yun Shan; Chang, Chia-Hao

    2015-03-01

    Medication errors have long been considered critical in global health care systems. However, few studies have been conducted to explore the effects of nursing unit structure on medication errors. The purpose of this study, therefore, was to determine the effects of structural factors on medication errors in nursing units. A total of 977 staff nurses and 62 head nurses participated in this cross-sectional design study. The findings show that professional autonomy (β = .53, t = 6.03, p nursing experts (β = .52, t = 5.99, p medication error rates. This study shows that the structural factors influence medication administration and the mechanistic approach is specifically in relation of low medication error rates. The author suggests that head nurses should consider strategies that require adjustments to unit control mechanisms.

  15. Orthopaedic Teaching in United Kingdom Medical Schools.

    Science.gov (United States)

    Di Paola, M; And Others

    1986-01-01

    Describes a study of medical students' training in orthopedics. Discusss discrepancies between course content and duration and the deficiencies that exist in basic knowledge of anatomy relevant to orthopedics. Recommends that orthopedic courses should appear earlier in the curriculum and practice should be emphasized. (TW)

  16. Pharmacy collected medication histories in an observation unit

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    Gabrielle L Procopio

    2015-08-01

    Full Text Available Background: Clear processes to facilitate medication reconciliation in a hospital setting are still undefined. The observation unit allows for a high patient turnover rate, where obtaining accurate medication histories is critical. Objectives: The objective of this study was to assess the ability of pharmacists and student pharmacists to identify discrepancies in medication histories obtained at triage in observation patients. Methods: Pharmacists and student pharmacists obtained a medication history for each patient placed in observation status. Patients were excluded if they were unable to provide a medication history and family, caregiver, or community pharmacy was also unable to provide the history. A comparison was made between triage and pharmacy collected medication histories to identify discrepancies. Results: A total of 501 medications histories were collected, accounting for 3213 medication records. There were 1176 (37% matched medication records and 1467 discrepancies identified, including 808 (55% omissions, 296 (20.2% wrong frequency, 278 (19% wrong dose, 51 (3.5% discontinued, and 34 (2.3% wrong medication. There was an average of 2.9 discrepancies per patient profile. In all, 76 (15% of the profiles were matched. The median time to obtain a medication history was 4 min (range: 1–48 min. Conclusion: Pharmacy collected medication histories in an observation unit identify discrepancies that can be reconciled by the interdisciplinary team.

  17. Training programs in medical physics in the United States

    Energy Technology Data Exchange (ETDEWEB)

    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. (RWR)

  18. 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

    Objectives Over the last decades, several papers have evaluated clinical pharmacy interventions in hospital settings with conflicting findings as results. Medication reviews are frequently a central component of these interventions. However, the term ‘medication review’ covers a plethora.......Methods A procedure was developed based on clinical experience and inspiration from previous studies and literature on medication review models. The procedure was developed to fit the busy workflow in acute admissions units.Results The procedure consists of five steps: (1) collection of clinical patient data, (2...... 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...

  19. Unit of measurement used and parent medication dosing errors.

    Science.gov (United States)

    Yin, H Shonna; Dreyer, Benard P; Ugboaja, Donna C; Sanchez, Dayana C; Paul, Ian M; Moreira, Hannah A; Rodriguez, Luis; Mendelsohn, Alan L

    2014-08-01

    Adopting the milliliter as the preferred unit of measurement has been suggested as a strategy to improve the clarity of medication instructions; teaspoon and tablespoon units may inadvertently endorse nonstandard kitchen spoon use. We examined the association between unit used and parent medication errors and whether nonstandard instruments mediate this relationship. Cross-sectional analysis of baseline data from a larger study of provider communication and medication errors. English- or Spanish-speaking parents (n = 287) whose children were prescribed liquid medications in 2 emergency departments were enrolled. Medication error defined as: error in knowledge of prescribed dose, error in observed dose measurement (compared to intended or prescribed dose); >20% deviation threshold for error. Multiple logistic regression performed adjusting for parent age, language, country, race/ethnicity, socioeconomic status, education, health literacy (Short Test of Functional Health Literacy in Adults); child age, chronic disease; site. Medication errors were common: 39.4% of parents made an error in measurement of the intended dose, 41.1% made an error in the prescribed dose. Furthermore, 16.7% used a nonstandard instrument. Compared with parents who used milliliter-only, parents who used teaspoon or tablespoon units had twice the odds of making an error with the intended (42.5% vs 27.6%, P = .02; adjusted odds ratio=2.3; 95% confidence interval, 1.2-4.4) and prescribed (45.1% vs 31.4%, P = .04; adjusted odds ratio=1.9; 95% confidence interval, 1.03-3.5) dose; associations greater for parents with low health literacy and non-English speakers. Nonstandard instrument use partially mediated teaspoon and tablespoon-associated measurement errors. Findings support a milliliter-only standard to reduce medication errors. Copyright © 2014 by the American Academy of Pediatrics.

  20. 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

  1. Caring for migrant farm workers on medical-surgical units.

    Science.gov (United States)

    Anthony, Maureen J

    2011-01-01

    Over 3 million migrant farm workers are employed in the United States. Many factors place them at risk for work-related disease and injury. Knowledge of workers' health issues can prepare medical-surgical nurses to anticipate and meet the needs of this underserved population.

  2. [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.

  3. Residency Applicants Misinterpret Their United States Medical Licensing Exam Scores

    Science.gov (United States)

    Jones, Roger C.; Desbiens, Norman A.

    2009-01-01

    Proper interpretation of the results of the United States Medical Licensing Exam (USMLE) is important for program directors, residents, and faculty who advise applicants about applying for residency positions. We suspected that applicants often misinterpreted their performance in relationship to others who took the same examination. In 2005, 54…

  4. Managing acute medical admissions: a survey of acute medical services and medical assessment and planning units in New Zealand.

    Science.gov (United States)

    Providence, C; Gommans, J; Burns, A

    2012-01-01

    To determine the current provision of acute medical services, including the development of medical assessment and planning units (MAPUs), by district health boards (DHBs) throughout New Zealand (NZ). A questionnaire-based survey about organisation of acute medical services and establishment of MAPUs was sent to all 21 DHBs in NZ. All 21 DHBs responded. Seven DHBs serving 42% of the population have established MAPUs since 2003 and a further six have plans to do so over the next 3 years, potentially expanding service to 73% of the NZ population. All seven current MAPUs are in close proximity to and accept patients directly from emergency departments. Each MAPU has a documented target length of stay, four units have referral protocols, five provide guidelines for management of common medical emergencies and five routinely audit unit performance. Five MAPUs have cardiac monitored beds and isolation rooms. Rapid access is available to computed tomography scanning (six units), ultrasound (five) and echocardiography (four). Two units have no nominated physician leadership and two lack dedicated therapy resources. General physicians are involved in provision of acute medical services in 20 of 21 DHBs. Medical assessment and planning units have become an important component of acute medical service provision in NZ. The established units largely comply with Australasian recommendations, although important deficiencies exist. Training of physicians must combine the needs of acute medical patients and clinical roles of physicians within MAPUs with local DHB requirements for services to be most effective. © 2010 The Authors. Internal Medicine Journal © 2010 Royal Australasian College of Physicians.

  5. The ethics of medical tourism: from the United Kingdom to India seeking medical care.

    Science.gov (United States)

    Meghani, Zahra

    2013-01-01

    Is the practice of UK patients traveling to India as medical tourists morally justified? This article addresses that question by examining three ethically relevant issues. First, the key factor motivating citizens of the United Kingdom to seek medical treatment in India is identified and analyzed. Second, the life prospects of the majority of the citizens of the two nations are compared to determine whether the United Kingdom is morally warranted in relying on India to meet the medical needs of its citizens. Third, as neoliberal reforms are justified on the grounds that they will help the indigent populations affected by them, the impact of medical tourism--a neoliberal initiative--on India's socially and economically marginalized groups is scrutinized.

  6. Medication reconciliation in patients hospitalized in a cardiology unit.

    Science.gov (United States)

    Magalhães, Gabriella Fernandes; Santos, Gláucia Noblat de Carvalho; Santos, Gláucia Beisl Noblat de Carvalho; Rosa, Mário Borges; Noblat, Lúcia de Araújo Costa Beisl

    2014-01-01

    To compare drugs prescribed on hospital admission with the list of drugs taken prior to admission for adult patients admitted to a cardiology unit and to identify the role of a pharmacist in identifying and resolving medication discrepancies. This study was conducted in a 300 bed university hospital in Brazil. Clinical pharmacists taking medication histories and reconciling medications prescribed on admission with a list of drugs used prior to admission. Discrepancies were classified as justified (e.g., based on the pharmacotherapeutic guidelines of the hospital studied) or unintentional. Treatments were reviewed within 48 hours following hospitalization. Unintentional discrepancies were further classified according to the categorization of medication error severity. Pharmacists verbally contacted the prescriber to recommend actions to resolve the discrepancies. A total of 181 discrepancies were found in 50 patients (86%). Of these discrepancies, 149 (82.3%) were justified changes to the patient's home medication regimen; however, 32 (17.7%) discrepancies found in 24 patients were unintentional. Pharmacists made 31 interventions and 23 (74.2%) were accepted. Among unintentional discrepancies, the most common was a different medication dose on admission (42%). Of the unintentional discrepancies 13 (40.6%) were classified as error without harm, 11 (34.4%) were classified as error without harm but which could affect the patient and require monitoring, 3 (9.4%) as errors could have resulted in harm and 5 (15.6%) were classified as circumstances or events that have the capacity to cause harm. The results revealed a high number of unintentional discrepancies and the pharmacist can play an important role by intervening and correcting medication errors at a hospital cardiology unit.

  7. Medication reconciliation in patients hospitalized in a cardiology unit.

    Directory of Open Access Journals (Sweden)

    Gabriella Fernandes Magalhães

    Full Text Available To compare drugs prescribed on hospital admission with the list of drugs taken prior to admission for adult patients admitted to a cardiology unit and to identify the role of a pharmacist in identifying and resolving medication discrepancies.This study was conducted in a 300 bed university hospital in Brazil. Clinical pharmacists taking medication histories and reconciling medications prescribed on admission with a list of drugs used prior to admission. Discrepancies were classified as justified (e.g., based on the pharmacotherapeutic guidelines of the hospital studied or unintentional. Treatments were reviewed within 48 hours following hospitalization. Unintentional discrepancies were further classified according to the categorization of medication error severity. Pharmacists verbally contacted the prescriber to recommend actions to resolve the discrepancies.A total of 181 discrepancies were found in 50 patients (86%. Of these discrepancies, 149 (82.3% were justified changes to the patient's home medication regimen; however, 32 (17.7% discrepancies found in 24 patients were unintentional. Pharmacists made 31 interventions and 23 (74.2% were accepted. Among unintentional discrepancies, the most common was a different medication dose on admission (42%. Of the unintentional discrepancies 13 (40.6% were classified as error without harm, 11 (34.4% were classified as error without harm but which could affect the patient and require monitoring, 3 (9.4% as errors could have resulted in harm and 5 (15.6% were classified as circumstances or events that have the capacity to cause harm.The results revealed a high number of unintentional discrepancies and the pharmacist can play an important role by intervening and correcting medication errors at a hospital cardiology unit.

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

    Science.gov (United States)

    Jackson, G; Patel, S; Khan, S

    2012-03-01

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

  9. [Medical entomology for the Armed services: preliminary results from the medical entomology unit].

    Science.gov (United States)

    Pages, F; Girod, R

    2004-01-01

    Vector-borne diseases constitutes a threat to the operational capability of armed forces personnel operating outside or stationed overseas. To take this risk into account, the French armed forces medical corps created a medical entomology unit in 2003. The primary function of this unit is to monitor the entomological status of French military bases in sub-Saharan Africa (identification of vectors, study of vector behavior, and measurement of resistance to insecticides) as a means of maintaining an effective vector-control strategy. The French medical entomology unit takes part in the Impact Vector project aimed at evaluating the vector-borne disease risks for troops in combat situations, contributes its expertise to the investigation of epidemic disease, and participates in the development of a global strategy for vector-control for the armed services. To improve understanding and control of vector-borne disease risks, the unit provides basic training in medical entomology to army physicians, veterinarians, and pharmacists as well as to others involved in control programs. The purpose of this article is to present the results of the unit's first activities: investigation of a malaria epidemic that occurred in Ivory Coast in 2003, measurement of malaria exposure over a 4-month period in a combat group on duty in rural Africa, and initial evaluation of control techniques (spraying around living quarters and use of insecticide-impregnated battle dress).

  10. An Introduction to Medical Malpractice in the United States

    Science.gov (United States)

    2008-01-01

    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. PMID:19034593

  11. Variability in Medical Marijuana Laws in the United States

    OpenAIRE

    Bestrashniy, Jessica; Winters, Ken C.

    2015-01-01

    Marijuana use and its distribution raise several complex health, social and legal issues in the United States. Marijuana is prohibited in only 23 states and pro-marijuana laws are likely to be introduced in these states in the future. Increased access to and legalization of medical marijuana may have an impact on recreational marijuana use and perception through increased availability and decreased restrictiveness around the drug. The authors undertook an analysis to characterize the policy f...

  12. 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.

  13. International students in United States' medical schools: does the medical community know they exist?

    Science.gov (United States)

    Datta, Jashodeep; Miller, Bonnie M

    2012-01-01

    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. While these students' numbers are on the rise, the visibility for their unique issues remains largely ignored in the medical literature. 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. 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 healthcare disparity eradication, minority health issues, and service in

  14. 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

  15. Patient access to medical records on a psychiatric inpatient unit.

    Science.gov (United States)

    Stein, E J; Furedy, R L; Simonton, M J; Neuffer, C H

    1979-03-01

    The authors studied the effects of patient access to medical records during hospitalization in a psychiatric unit of a community general hospital. Questionnaires were completed by about 20 staff and 88 patients, and records were compared with those from an earlier period to note any changes in the written record. Patients reported feeling better informed and more involved in their treatment, and staff said that they became more thoughtful about their notes in the chart. The availability of staff seems crucial to this process and facilitates the working alliance.

  16. Readmission to medical intensive care units: risk factors and prediction.

    Science.gov (United States)

    Jo, Yong Suk; Lee, Yeon Joo; Park, Jong Sun; Yoon, Ho Il; Lee, Jae Ho; Lee, Choon-Taek; Cho, Young-Jae

    2015-03-01

    The objectives of this study were to find factors related to medical intensive care unit (ICU) readmission and to develop a prediction index for determining patients who are likely to be readmitted to medical ICUs. We performed a retrospective cohort study of 343 consecutive patients who were admitted to the medical ICU of a single medical center from January 1, 2008 to December 31, 2012. We analyzed a broad range of patients' characteristics on the day of admission, extubation, and discharge from the ICU. Of the 343 patients discharged from the ICU alive, 33 (9.6%) were readmitted to the ICU unexpectedly. Using logistic regression analysis, the verified factors associated with increased risk of ICU readmission were male sex [odds ratio (OR) 3.17, 95% confidence interval (CI) 1.29-8.48], history of diabetes mellitus (OR 3.03, 95% CI 1.29-7.09), application of continuous renal replacement therapy during ICU stay (OR 2.78, 95% CI 0.85-9.09), white blood cell count on the day of extubation (OR 1.13, 95% CI 1.07-1.21), and heart rate just before ICU discharge (OR 1.03, 95% CI 1.01-1.06). We established a prediction index for ICU readmission using the five verified risk factors (area under the curve, 0.76, 95% CI 0.66-0.86). By using specific risk factors associated with increased readmission to the ICU, a numerical index could be established as an estimation tool to predict the risk of ICU readmission.

  17. Unit-based clinical pharmacists' prevention of serious medication errors in pediatric inpatients.

    Science.gov (United States)

    Kaushal, Rainu; Bates, David W; Abramson, Erika L; Soukup, Jane R; Goldmann, Donald A

    2008-07-01

    Rates of serious medication errors in three pediatric inpatient units (intensive care, general medical, and general surgical) were measured before and after introduction of unit-based clinical pharmacists. Error rates on the study units and similar patient care units in the same hospital that served as controls were determined during six- to eight-week baseline periods and three-month periods after the introduction of unit-based clinical pharmacists (full-time in the intensive care unit [ICU] and mornings only on the general units). Nurses trained by the investigators reviewed medication orders, medication administration records, and patient charts daily to detect errors, near misses, and adverse drug events (ADEs) and determine whether near misses were intercepted. Two physicians independently reviewed and rated all data collected by the nurses. Serious medication errors were defined as preventable ADEs and nonintercepted near misses. The baseline rates of serious medication errors per 1000 patient days were 29 for the ICU, 8 for the general medical unit, and 7 for the general surgical unit. With unit-based clinical pharmacists, the ICU rate dropped to 6 per 1000 patient days. In the general care units, there was no reduction from baseline in the rates of serious medication errors. A full-time unit-based clinical pharmacist substantially decreased the rate of serious medication errors in a pediatric ICU, but a part-time pharmacist was not as effective in decreasing errors in pediatric general care units.

  18. Improving emergency department flow through Rapid Medical Evaluation unit.

    Science.gov (United States)

    Chartier, Lucas; Josephson, Timothy; Bates, Kathy; Kuipers, Meredith

    2015-01-01

    The Toronto Western Hospital is an academic hospital in Toronto, Canada, with an annual Emergency Department (ED) volume of 64,000 patients. Despite increases in patient volumes of almost six percent per annum over the last decade, there have been no commensurate increases in resources, infrastructure, and staffing. This has led to substantial increase in patient wait times, most specifically for those patients with lower acuity presentations. Despite requiring only minimal care, these patients contribute disproportionately to ED congestion, which can adversely impact resource utilization and quality of care for all patients. We undertook a retrospective evaluation of a quality improvement initiative aimed at improving wait times experienced by patients with lower acuity presentations. A rapid improvement event was organized by frontline workers to rapidly overhaul processes of care, leading to the creation of the Rapid Medical Evaluation (RME) unit - a new pathway of care for patients with lower acuity presentations. The RME unit was designed by re-purposing existing resources and re-assigning one physician and one nurse towards the specific care of these patients. We evaluated the performance of the RME unit through measurement of physician initial assessment (PIA) times and total length of stay (LOS) times for multiple groups of patients assigned to various ED care pathways, during three periods lasting three months each. Weekly measurements of mean and 90th percentile of PIA and LOS times showed special cause variation in all targeted patient groups. Of note, the patients seen in the RME unit saw their median PIA and LOS times decrease from 98min to 70min and from 165min to 130min, respectively, from baseline. Despite ever-growing numbers of patient visits, wait times for all patients with lower acuity presentations remained low, and wait times of patients with higher acuity presentations assigned to other ED care pathways were not adversely affected. By

  19. Using the Milieu: Treatment-Environment Consistency.

    Science.gov (United States)

    Szekais, Barbara

    1985-01-01

    Describes trial use of milieu and activity-based therapy in two adult day centers to increase client involvement in physical and social environments of treatment settings. Reports results from empirical observations and recommends further investigation of this treatment modality in settings for the elderly. (Author/NRB)

  20. Milieu Therapy with the Adolescent Sociopath.

    Science.gov (United States)

    Walker, Betty A.

    1978-01-01

    This paper defines sociopathy and presents current findings on its causes and treatment. A milieu therapy program is described, including the preventive and active treatment methods used to keep the adolescent sociopath fully occupied in constructive activities and "sponsor" relationships to overcome antisocial behavior patterns. (Author/SJL)

  1. Medical and Scientific Illustration in the United States (US).

    Science.gov (United States)

    Peres, Michael

    2015-06-01

    The field of Medical and Scientific Illustration in the United States is large and constantly changing. In 1974, when the author began his studies, everything about the field was different. At the time, a student in the U.S. could go to a number of Universities (4 year) or Colleges (2 year) to study this subject. More than forty years later, only a few programs still offer similar programs of study. The Rochester Institute of Technology (RIT), where the author is a professor and Randolph Community College in North Carolina are all that remain from the more than ten that had operated. These two programs are very different from one another and there is not adequate space in this article to expand on these differences. Program details can be found online at: http://cias.rit.edu/schools/photographic-arts-sciences/undergraduate-biomedical-photographic-communications.

  2. Partnered medication review and charting between the pharmacist and medical officer in the Emergency Short Stay and General Medicine Unit.

    Science.gov (United States)

    Tong, Erica Y; Roman, Cristina P; Smit, De Villiers; Newnham, Harvey; Galbraith, Kirsten; Dooley, Michael J

    2015-08-01

    A partnered medication review and charting model involving a pharmacist and medical officer was implemented in the Emergency Short Stay Unit and General Medicine Unit of a major tertiary hospital. The aim of the study was to describe the safety and effectiveness of partnered medication charting in this setting. A partnered medication review and charting model was developed. Credentialed pharmacists charted pre-admission medications and venous thromboembolism prophylaxis in collaboration with the admitting medical officer. The pharmacist subsequently had a clinical discussion with the treating nurse regarding the medication management plan for the patient. A prospective audit was undertaken of all patients from the initiation of the service. A total of 549 patients had medications charted by a pharmacist from the 14th of November 2012 to the 30th of April 2013. A total of 4765 medications were charted by pharmacists with 7 identified errors, corresponding to an error rate of 1.47 per 1000 medications charted. Partnered medication review and charting by a pharmacist in the Emergency Short Stay and General Medicine unit is achievable, safe and effective. Benefits from the model extend beyond the pharmacist charting the medications, with clinical value added to the admission process through early collaboration with the medical officer. Further research is required to provide evidence to further support this collaborative model. Copyright © 2015. Published by Elsevier Ltd.

  3. Joining the Conversation: Predictors of Success on the United States Medical Licensing Examinations (USMLE)

    Science.gov (United States)

    Gohara, Sabry; Shapiro, Joseph I.; Jacob, Adam N.; Khuder, Sadik A.; Gandy, Robyn A.; Metting, Patricia J.; Gold, Jeffrey; Kleshinski, James; and James Kleshinski

    2011-01-01

    The purpose of this study was to evaluate whether models based on pre-admission testing, including performance on the Medical College Admission Test (MCAT), performance on required courses in the medical school curriculum, or a combination of both could accurately predict performance of medical students on the United States Medical Licensing…

  4. 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.

  5. Unit cost of medical services at different hospitals in India.

    Directory of Open Access Journals (Sweden)

    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

  6. Challenges implementing bar-coded medication administration in the emergency room in comparison to medical surgical units.

    Science.gov (United States)

    Glover, Nancy

    2013-03-01

    Bar-coded medication administration has been successfully implemented and utilized to decrease medication errors at a number of hospitals in recent years. The purpose of this article was to discuss the varying success in utilization of bar-coded medication administration on medical-surgical units and in the emergency department. Utilization reports were analyzed to better understand the challenges between the units. Many factors negatively impacted utilization in the emergency department, including the inability to use bar-coded medication administration for verbal orders or to document medications distributed by the prescribing providers, unique aspects of emergency department nursing workflow, additional steps to chart when using bar-coded medication administration, and alert fatigue. Hardware problems affected all users. Bar-coded medication administration in its current form is more suitable for use on medical-surgical floors than in the emergency department. New solutions should be developed for bar-coded medication administration in the emergency department, keeping in mind requirements to chart medications when there is no order in the system, document medications distributed by prescribing providers, adapt to unpredictable nursing workflow, minimize steps to chart with bar-coded medication administration, limit alerts to those that are clinically meaningful, and choose reliable hardware with adequate bar-code scanning capability.

  7. Le Secteur de Psychiatrie en Milieu Pénitentiaire : Solutions de continuité ?

    Directory of Open Access Journals (Sweden)

    Catherine Paulet

    2012-10-01

    Full Text Available Une petite mise en mots et en sigles pour commencer si vous le voulez bien. Par secteur de psychiatrie en milieu pénitentiaire (SPMP, j’entends non seulement les 26 services médico-psychologiques régionaux (SMPR à vocation régionale, mais aussi tous les dispositifs de soins psychiatriques (DSP qui sont implantés dans les prisons, services constitués parfois, ou plus souvent unités fonctionnelles de secteurs de psychiatrie.Après vingt ans ou presque de pratique de la psychiatrie en milieu p...

  8. 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.

  9. 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 onl

  10. FAKTOR PENYEBAB MEDICATION ERROR DI INSTALASI RAWAT DARURAT FACTORS AFFECTING MEDICATION ERRORS AT EMERGENCY UNIT

    OpenAIRE

    2014-01-01

    Background: Incident of medication errors is an importantindicator in patient safety and medication error is most commonmedical errors. However, most of medication errors can beprevented and efforts to reduce such errors are available.Due to high number of medications errors in the emergencyunit, understanding of the causes is important for designingsuccessful intervention. This research aims to identify typesand causes of medication errors.Method: Qualitative study was used and data were col...

  11. 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

  12. Professionalism among multicultural medical students in the United Arab Emirates.

    Science.gov (United States)

    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.

  13. Student Perspectives on Oncology Curricula at United States Medical Schools.

    Science.gov (United States)

    Neeley, Brandon C; Golden, Daniel W; Brower, Jeffrey V; Braunstein, Steve E; Hirsch, Ariel E; Mattes, Malcolm D

    2017-08-07

    Delivering a cohesive oncology curriculum to medical students is challenging due to oncology's multidisciplinary nature, predominantly outpatient clinical setting, and lack of data describing effective approaches to teaching it. We sought to better characterize approaches to oncology education at US medical schools by surveying third and fourth year medical students who serve on their institution's curriculum committee. We received responses from students at 19 schools (15.2% response rate). Key findings included the following: (1) an under-emphasis of cancer in the curriculum relative to other common diseases; (2) imbalanced involvement of different clinical subspecialists as educators; (3) infrequent requirements for students to rotate through non-surgical oncologic clerkships; and (4) students are less confident in their knowledge of cancer treatment compared to basic science/natural history or workup/diagnosis. Based on these findings, we provide several recommendations to achieve robust multidisciplinary curriculum design and implementation that better balances the clinical and classroom aspects of oncology education.

  14. Managing medical technology: lessons for the United States from Quebec and France.

    Science.gov (United States)

    Rosenau, P V

    2000-01-01

    Important modifications to technology assessment, diffusion, adoption, and utilization must take place if the United States is to better employ medical technology and save resources so as to assure access for the uninsured and underinsured. The United States can learn from other health systems that are more successful in achieving these goals. The author selects for comparison the health systems of France and Quebec. The discussion focuses on the differences between the three systems in the management of medical technology on a range of policy-relevant dimensions, including health system structure, attitudes about planning versus market competition, government regulation, the balance between decentralization and centralization, the needs of the individual and those of the society, linkages between technology assessment and policy-making, and the importance of medical technology assessment for medical practice. Seven specific recommendations are made for better managing medical technology in the United States, drawing on what can be observed from the experiences of Quebec and France.

  15. United States Army Medical Department Journal, January-March 2010

    Science.gov (United States)

    2010-03-01

    kidney dialysis treatment, and artificial nutrition and hydration. The term does not include the administration of pain management medication or the...person the right to refuse lifesaving hydration and nutrition . The Court noted that "most state courts have based a right to refuse treatment on...and Cosmetic Act (FFDCA) defines substantial evidence as ...evidence consisting of adequate and well-controlled investigations, including clinical

  16. The United States Army Medical Department Journal. October - December 2010

    Science.gov (United States)

    2010-12-01

    Hall et al14 compared the success rate of endotracheal intubation among paramedic students trained on a human patient simulator group or on human...Kang J, Hall CA. Human patient simulation is effective for teaching paramedic students endotracheal intubation . Acad Emerg Med. 2005;12(9):850-855...published in The Army Medical Department Journal are listed and indexed in MEDLINE, the National Library of Medicine’s premier bibliographic database of life

  17. The United States Army Medical Department Journal, April - June 2008

    Science.gov (United States)

    2008-06-01

    Certification exam. Additionally, they are offered the opportunity to take the ServSafe ® certification examination.† The Navy trains Preventive Medicine...the ServSafe Exam.5(p5) Navy  Scope of practice – a concern because Navy PMTs operate clinically, unlike Army preventive medicine personnel...with other programs relocating and integrating into the Medical Education and Training Campus concept. *Army Training Course 322-68S10 †The ServSafe

  18. The United States Army Medical Department Journal. October - December 2012

    Science.gov (United States)

    2012-12-01

    THIS PAGE unclassified Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 October – December 2012 The Army Medical Department Center...health benefits increase as you spend more time being active. Children and adolescents : get 60 minutes or more a day. Adults: get 2 hours and 30...AFB, Delaware ; and Fort Sam Houston, Texas.7 In addition, the Joint Pa- thology Center, the federal govern- ment’s pathology resource center, was

  19. 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

  20. 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

  1. 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

  2. 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 (

  3. [Medical and technical means for united circle of evacuation measures in military-medical organisations of the Ministry of Defence].

    Science.gov (United States)

    Fisun, A Ya; Kalachev, O V; Shchegolev, A V; Vertii, B D

    2015-06-01

    Experts of the medical service of the Armed Forces carried out an analysis of capabilities of modern Russian enterprises and their innovative projects regarding creation of unified means of evacuation of wounded and providing to them necessary types of emergency care with the use of existing and future special and regular means of transport for medical evacuation. As a result of the work of industrial enterprises of the OAO Kazan "Vertoletniy Zavod", "Zarechie", "Vysota" was created a device for the medical evacuation of severe wounded patients. The device is designed for medical evacuation of severe wounded patients from the military medical unit to the site providing comprehensive medical care with maintenance of vital functions and monitoring of his condition. Testing was conducted on the products of regular vehicles medical company of one of the brigades of the Western Military District. The device was presented at the special tactical exercises the Armed Forces Medical Service "Frontier-2014", "Innovation Day" of the Defence Ministry in 2014.

  4. 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.

  5. 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.

  6. 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

  7. United States Army Medical Department Journal. Leadership in the Army Medical Department, October - December 2009

    Science.gov (United States)

    2009-12-01

    work, The Origin of Species,’ is that the key to survival in biological evolution is the ability of a species to adapt. A species that does not adapt...attorneys, military paralegals , and civilian paralegals providing legal support throughout the AMEDD at the 8 medical centers and numerous hospitals...Army Medical Command (MEDCOM), mobilized 18 Judge Advocates and paralegals in 2007 and has continued a cycle of mobilizations of legal personnel to

  8. [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.

  9. Pediatric medication errors in the postanesthesia care unit: analysis of MEDMARX data.

    Science.gov (United States)

    Payne, Christopher H; Smith, Christopher R; Newkirk, Laura E; Hicks, Rodney W

    2007-04-01

    Medication errors involving pediatric patients in the postanesthesia care unit may occur as frequently as one in every 20 medication orders and are more likely to cause harm when compared to medication errors in the overall population. Researchers examined six years of records from the MEDMARX database and used consecutive nonprobability sampling and descriptive statistics to compare medication errors in the pediatric data set to those occurring in the total population data set. Nineteen different causes of error involving 28 different products were identified. The results of the study indicate that an organization can focus on causes of errors and products involved in errors to mitigate future error occurrence.

  10. Assessing Interprofessional Teamwork in Inpatient Medical Oncology Units.

    Science.gov (United States)

    Weaver, A Charlotta; Callaghan, Mary; Cooper, Abby L; Brandman, James; O'Leary, Kevin J

    2015-01-01

    Teamwork is important to providing safe and effective care for hospitalized patients with cancer; however, few studies have evaluated teamwork in this setting. We surveyed all nurses, residents, hospitalists, and oncology physicians in oncology units at a large urban teaching hospital from September to November 2012. Respondents rated teamwork using a validated instrument (Safety Attitudes Questionnaire; scale, 0 to 100) and rated the quality of collaboration they had experienced with other professionals using a 5-point ordinal response scale (1, very low quality; 5, very high quality). Respondents also rated potential barriers to collaboration using a 4-point ordinal response scale (1, not at all a barrier; 4, major barrier). We compared ratings by professionals using analysis of variance (ANOVA). Overall, 129 (67%) of 193 eligible participants completed the survey. Teamwork scores differed across professional types, with nurses providing the lowest ratings (69.7) and residents providing the highest (81.9; ANOVA P = .01). Ratings of collaboration with nurses were high across all types of professionals. Ratings of collaboration with physicians varied significantly by professional type (P ≤ .02), with nurses giving lower ratings of collaboration with all physician types. Similarly, perceived barriers to collaboration differed by professional type, with nurses perceiving the biggest barrier to be negative attitudes regarding the importance of communication. Oncologists did not perceive any of the listed options as major barriers to collaboration. In inpatient oncology units, discrepancies exist between nurses' and physicians' ratings of teamwork and collaboration. Oncologists seem to be unaware that teamwork is suboptimal in this setting. Copyright © 2015 by American Society of Clinical Oncology.

  11. 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

  12. 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.

  13. 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

  14. 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.

  15. Computer-delivered patient simulations in the United States Medical Licensing Examination (USMLE).

    Science.gov (United States)

    Dillon, Gerard F; Clauser, Brian E

    2009-01-01

    To obtain a full and unrestricted license to practice medicine in the United States, students and graduates of the MD-granting US medical schools and of medical schools located outside of the United States must take and pass the United States Medical Licensing Examination. United States Medical Licensing Examination began as a series of paper-and-pencil examinations in the early 1990s and converted to computer-delivery in 1999. With this change to the computerized format came the opportunity to introduce computer-simulated patients, which had been under development at the National Board of Medical Examiners for a number of years. This testing format, called a computer-based case simulation, requires the examinee to manage a simulated patient in simulated time. The examinee can select options for history-taking and physical examination. Diagnostic studies and treatment are ordered via free-text entry, and the examinee controls the advance of simulated time and the location of the patient in the health care setting. Although the inclusion of this format has brought a number of practical, psychometric, and security challenges, its addition has allowed a significant expansion in ways to assess examinees on their diagnostic decision making and therapeutic intervention skills and on developing and implementing a reasonable patient management plan.

  16. Information Specificity Vulnerability: Comparison of Medication Information Flows in Different Health Care Units

    Science.gov (United States)

    Aarnio, Eeva; Raitoharju, Reetta

    Information on patient's medication is often vital especially when patient's condition is critical. However, the information does not yet move freely between different health care units and organizations. Before reaching the point of putting into practice any system that makes the inter-organizational medication information transmission possible, some prerequisites and characteristics of the information in different user organization should be defined. There are for instance units with different level of urgency and data/information intensity (e.g. emergency department vs. medical floor). The higher the urgency level, the more vulnerable the medication information flow is to different discontinuation situations. As a conceptual framework, a scoring system based on the asset specificity in the transaction cost theory and previous literacy on information flows of different health care units is created to define the vulnerability of the information flows. As there is a national medication database under planning, the scoring system could be used to assess the prerequisites for the medication database in Finland.

  17. Medication errors in the intensive care unit: literature review using the SEIPS model.

    Science.gov (United States)

    Frith, Karen H

    2013-01-01

    Medication errors in intensive care units put patients at risk for injury or death every day. Safety requires an organized and systematic approach to improving the tasks, technology, environment, and organizational culture associated with medication systems. The Systems Engineering Initiative for Patient Safety model can help leaders and health care providers understand the complicated and high-risk work associated with critical care. Using this model, the author combines a human factors approach with the well-known structure-process-outcome model of quality improvement to examine research literature. The literature review reveals that human factors, including stress, high workloads, knowledge deficits, and performance deficits, are associated with medication errors. Factors contributing to medication errors are frequent interruptions, communication problems, and poor fit of health information technology to the workflow of providers. Multifaceted medication safety interventions are needed so that human factors and system problems can be addressed simultaneously.

  18. 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.

  19. Over-the-counter medication patterns in households in Sharjah, United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Zaghloul AA

    2013-12-01

    Full Text Available Ashraf Ahmad Zaghloull,1 Moetaz Elsergany,2 Nagwa Abou El-Enein,1 Hamda Alsuwaidi,3 Mohamed Ayoub3 1Health Administration and Behavioral Sciences Department, High Institute of Public Health, University of Alexandria, Alexandria, Egypt; 2e-School Health and Environmental Studies, Hamdan Bin Mohamed eUniversity, Dubai, United Arab Emirates; 3College of Health Sciences, University of Sharjah, United Arab Emirates. Background: Self-medication and acquisition of over-the-counter (OTC medications are emerging community health issues. Besides being a cheap alternative for treating common illnesses, the behavior entails serious ramifications, such as medication wastage, increasing pathogen resistance, and adverse drug reactions. The present study was conducted to explore the extent of OTC medications in households in Sharjah, United Arab Emirates (UAE, including native UAE and expatriate families. Methods: The study employed a population-based, cross-sectional, analytical study design. The study population included native and expatriate households residing in the Emirate of Sharjah, UAE. The snowball sampling technique was used, and the sample included a total of 335 households. Results: Expatriate households acquired more OTC medications than did native households (adjusted odds ratio [aOR]=1.7. The demographic determinants for expatriate households were number of family members (aOR=1.6, age of children in the family (aOR=1.8, and annual income (aOR=0.5. Expatriate households purchased more OTC medication practices than did native households (aOR=2.2. In the statistical sense, expatriate household practices were buying medication upon relatives' advice (aOR=0.3, storage condition of medication (aOR=2.4, and disposal of expired medication (aOR=0.6. The highest percentages of OTC medications in native and expatriate households were those related to gastric and ear, nose, and throat illnesses. Conclusion: The presence of OTC medications in expatriate

  20. Evaluation of medical devices in thoracic radiograms in intensive care unit - time to pay attention!

    Science.gov (United States)

    Moreira, Ana Sofia Linhares; Afonso, Maria da Graça Alves; Dinis, Mónica Ribeiro dos Santos Alves; dos Santos, Maria Cristina Granja Teixeira

    2016-01-01

    Objective To identify and evaluate the correct positioning of the most commonly used medical devices as visualized in thoracic radiograms of patients in the intensive care unit of our center. Methods A literature search was conducted for the criteria used to evaluate the correct positioning of medical devices on thoracic radiograms. All the thoracic radiograms performed in the intensive care unit of our center over an 18-month period were analyzed. All admissions in which at least one thoracic radiogram was performed in the intensive care unit and in which at least one medical device was identifiable in the thoracic radiogram were included. One radiogram per admission was selected for analysis. The radiograms were evaluated by an independent observer. Results Out of the 2,312 thoracic radiograms analyzed, 568 were included in this study. Several medical devices were identified, including monitoring leads, endotracheal and tracheostomy tubes, central venous catheters, pacemakers and prosthetic cardiac valves. Of the central venous catheters that were identified, 33.6% of the subclavian and 23.8% of the jugular were malpositioned. Of the endotracheal tubes, 19.9% were malpositioned, while all the tracheostomy tubes were correctly positioned. Conclusion Malpositioning of central venous catheters and endotracheal tubes is frequently identified in radiograms of patients in an intensive care unit. This is relevant because malpositioned devices may be related to adverse events. In future studies, an association between malpositioning and adverse events should be investigated. PMID:27737432

  1. 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.

  2. The Role of International Medical Graduate Psychiatrists in the United States Healthcare System

    Science.gov (United States)

    Boulet, John Robin; Cassimatis, Emmanuel G.; Opalek, Amy

    2012-01-01

    Objective: International medical graduates (IMGs) make up a substantial proportion of the United States physician workforce, including psychiatrists in practice. The purpose of this study was to describe, based on current data, the characteristics and qualities of IMG psychiatrists who provide patient care in the US. Method: Physician data from…

  3. 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.

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

    Science.gov (United States)

    2012-01-01

    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, papp usage of several times a day. Over 24hours apps were used for between 1–30 minutes for students and 1–20 minutes for doctors, students used disease diagnosis/management and drug reference apps, with doctors favouring clinical score/calculator apps. Conclusions This study found a high level of

  5. Comparison of United States and Canadian Glaucoma Medication Costs and Price Change from 2006 to 2013

    Directory of Open Access Journals (Sweden)

    Matthew B. Schlenker

    2015-01-01

    Full Text Available Objective. Compare glaucoma medication costs between the United States (USA and Canada. Methods. We modelled glaucoma brand name and generic medication annual costs in the USA and Canada based on October 2013 Costco prices and previously reported bottle overfill rates, drops per mL, and wastage adjustment. We also calculated real wholesale price changes from 2006 to 2013 based on the Average Wholesale Price (USA and the Ontario Drug Benefit Price (Canada. Results. US brand name medication costs were on average 4x more than Canadian medication costs (range: 1.9x–6.9x, averaging a cost difference of $859 annually. US generic costs were on average the same as Canadian costs, though variation exists. US brand name wholesale prices increased from 2006 to 2013 more than Canadian prices (US range: 29%–349%; Canadian range: 9%–16%. US generic wholesale prices increased modestly (US range: −23%–58%, and Canadian wholesale prices decreased (Canadian range: −38%–0%. Conclusions. US brand name glaucoma medications are more expensive than Canadian medications, though generic costs are similar (with some variation. The real prices of brand name medications increased more in the USA than in Canada. Generic price changes were more modest, with real prices actually decreasing in Canada.

  6. Formation of Medical Units in Response to Epidemics in the Australian Imperial Force in Palestine 1918

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    Prof. G Dennis Shanks MD

    2014-06-01

    Full Text Available In the closing days of the First World War, British cavalry operations defeated the Turkish Armies in Palestine. Australian Light Horse Regiments as part of the Australian Imperial Forces (AIF were prominent in the capture of Amman, Beirut and Damascus. Epidemic infectious diseases were part of the severe desert environment faced by soldiers in the Middle East. Cholera and dysentery epidemics required reformation of medical units to emphasize mobility in an austere environment. A large epidemic of falciparum malaria coinciding with pandemic influenza shut down military operations and caused many deaths in late 1918. Three separate military medical units were formed in Egypt to address epidemic infectious diseases during mobile operations in the desert: ANZAC Field Laboratory, 5th Malaria Diagnosis Station and 7th Mobile Sanitary Section. Laboratory and preventive medicine units were critical to the military’s ability to conduct operations in the Middle East in 1918 and are likely to become vital for future missions in developing countries. As was the case in 1918, military medical units may have to be acutely restructured to control infectious disease outbreaks

  7. 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.

  8. E-Cigarette Topics Shared by Medical Professionals: A Comparison of Tweets from the United States and United Kingdom.

    Science.gov (United States)

    Glowacki, Elizabeth M; Lazard, Allison J; Wilcox, Gary B

    2017-02-01

    Medical professionals are now relying on social media platforms like Twitter to express their recommendations for the use or avoidance of products like electronic cigarettes (e-cigs), which may have long-term health consequences for users. The goal of this study is to compare how physicians from the United States and the United Kingdom talk about e-cigs on Twitter and identify the topics that these groups perceive as salient. Comparing tweets from the U.S. and U.K. will allow for a better understanding of how medical professionals from these countries differ in their attitudes toward e-cigs. This information can be also used to inform policies designed to regulate the use of e-cigs. Using a text-mining program, we analyzed approximately 3,800 original tweets sent by physicians from the U.S. and the U.K. within a 1-year time span (June 2015 through June 2016). The program clustered the tweets by topics, which allowed us to categorize the topics by importance. Both sets of tweets contained debates about the degree to which e-cigs pose a threat to health, but the U.S. tweets emphasized the dangers of e-cig use for teens, while the U.K. tweets focused more on the potential that e-cigs have to be used as a smoking cessation aid. Doctors are using Twitter to share timely information about the potential risks, benefits, and regulations associated with e-cigs. Evaluating these tweets allows researchers to collect information about topics that doctors find important and make comparisons about how medical professionals from the U.S. and the U.K. regard e-cigs.

  9. Social allostasis: anticipatory regulation of the internal milieu

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    Jay eSchulkin

    2011-01-01

    Full Text Available Social regulation of the internal milieu is a fundamental behavioral adaptation. Cephalic capabilityis reflected by anticipatory behaviors to serve systemic physiological regulation. Homeostaticregulation, a dominant perspective, reflects reactive responses; allostatic regulation, thephysiology of change, emphasizes longer-term anticipatory, and feedforward systems. Steroids,such as cortisol, and peptides such as corticotrophin releasing hormone are but one exampleof such anticipatory regulatory systems. The concept of allostasis is in part to take accountof anticipatory control amidst diverse forms of adaptation underlying this regulatory adaptationthat supports social contact and internal milieu.

  10. 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.

  11. Medical Student Core Clinical Ultrasound Milestones: A Consensus Among Directors in the United States.

    Science.gov (United States)

    Dinh, Vi Am; Lakoff, Daniel; Hess, Jamie; Bahner, David P; Hoppmann, Richard; Blaivas, Michael; Pellerito, John S; Abuhamad, Alfred; Khandelwal, Sorabh

    2016-02-01

    Many medical schools are implementing point-of-care ultrasound in their curricula to help augment teaching of the physical examination, anatomy, and ultimately clinical management. However, point-of-care ultrasound milestones for medical students remain unknown. The purpose of this study was to formulate a consensus on core medical student clinical point-of-care ultrasound milestones across allopathic and osteopathic medical schools in the United States. Directors who are leading the integration of ultrasound in medical education (USMED) at their respective institutions were surveyed. An initial list of 205 potential clinical ultrasound milestones was developed through a literature review. An expert panel consisting of 34 USMED directors across the United States was used to produce consensus on clinical ultrasound milestones through 2 rounds of a modified Delphi technique, an established anonymous process to obtain consensus through multiple rounds of quantitative questionnaires. There was a 100% response rate from the 34 USMED directors in both rounds 1 and 2 of the modified Delphi protocol. After the first round, 2 milestones were revised to improve clarity, and 9 were added on the basis of comments from the USMED directors, resulting in 214 milestones forwarded to round 2. After the second round, only 90 milestones were found to have a high level of agreement and were included in the final medical student core clinical ultrasound milestones. This study established 90 core clinical milestones that all graduating medical students should obtain before graduation, based on consensus from 34 USMED directors. These core milestones can serve as a guide for curriculum deans who are initiating ultrasound curricula at their institutions. The exact method of implementation and competency assessment needs further investigation. © 2016 by the American Institute of Ultrasound in Medicine.

  12. The Changing Milieu for Educational Planning.

    Science.gov (United States)

    Keller, George

    1995-01-01

    Three major demographic trends (immigration patterns, dissolution of the traditional family structure, and the emerging age profile of the United States population) and three social trends (socioeconomic polarization, growing importance of the Pacific Rim countries to American trade, and new communications technology) are examined as they affect…

  13. Comparison of dietetics service delivery (demand and determinants within two Australian Medical Assessment and Planning Units

    Directory of Open Access Journals (Sweden)

    Angela P Vivanti

    2017-03-01

    Full Text Available Aims Assessment and Planning Units have increased globally however, models of care literature is limited. With high malnutrition prevalence amongst ageing populations, this case report identifies demands for dietetic services. Methods Descriptive data compared and contrasted two service including medical models, eligibility criteria, malnutrition screening, dietetic services, clinical follow-up, and team composition. Results High malnutrition prevalence (17 per cent, 31 per cent was evident with different screening approaches successfully implemented. Both units favoured rapid assessment and intervention. Conclusion Dietetic expertise was required for malnutrition assessment, and ongoing management in acute or community setting as determined by differing health-care system arrangements

  14. The United States Army Medical Department Journal. July-September 2012

    Science.gov (United States)

    2012-01-01

    virus antigens were detected in hair follicles of nuchal skin biopsy specimens by direct immunofl uorescence, and rabies viral RNA was found in...be reprinted if credit is given to the author(s). OFFICIAL DISTRIBUTION: This publication is targeted to US Army Medical Department units and...Louis, MO: Saunders/Elsevier; 2006:676- 681. Godfrey MER. Non- target and secondary poison-24. ing hazards of “second generation” anticoagulants

  15. Singly-qualified medical senior house officer in oral and maxillofacial surgery: perspectives from a unit.

    Science.gov (United States)

    Solanki, Kohmal; Bhatti, Nabeel; Bridle, Christopher

    2016-06-01

    Despite constituting a minority of senior house officers (SHO) in oral and maxillofacial surgery (OMFS), the number of singly-qualified medical trainees is growing. We describe the experience of a singly qualified medical trainee in OMFS and the unique benefits and opportunities for potential trainees and the department. Overall, the advantages of synergistic training outweigh any deficiencies in knowledge, and in our experience, having both medical and dental trainees in our unit has maximised training opportunities and provided a more holistic approach to patient care. Increased exposure to conditions in the head and neck also benefits trainees who wish to pursue careers in other specialties such as ear, nose, and throat (ENT), neurosurgery, ophthalmology, and plastic surgery. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  16. Focused Acute Medicine Ultrasound (FAMUS) - point of care ultrasound for the Acute Medical Unit.

    Science.gov (United States)

    Smallwood, Nicholas; Dachsel, Martin; Matsa, Ramprasad; Tabiowo, Eugene; Walden, Andrew

    2016-01-01

    Point of care ultrasound (POCU) is becoming increasingly popular as an extension to clinical examination techniques. Specific POCU training pathways have been developed in specialties such as Emergency and Intensive Care Medicine (CORE Emergency Ultrasound and Core UltraSound Intensive Care, for example), but until this time there has not been a curriculum for the acutely unwell medical patient outside of Critical Care. We describe the development of Focused Acute Medicine Ultrasound (FAMUS), a curriculum designed specifically for the Acute Physician to learn ultrasound techniques to aid in the management of the unwell adult patient. We detail both the outline of the curriculum and the process involved for a candidate to achieve FAMUS accreditation. It is anticipated this will appeal to both Acute Medical Unit (AMU) clinicians and general physicians who deal with the unwell or deteriorating medical or surgical patient. In time, the aspiration is for FAMUS to become a core part of the AIM curriculum.

  17. Development and Evaluation of the Habitat Demonstration Unit Medical Operations Workstation and Opportunities for Future Research

    Science.gov (United States)

    Howard, Robert L., Jr.

    2012-01-01

    As NASA develops missions to leave Earth orbit and explore distant destinations (Mars, Moon, Asteroids) it is necessary to rethink human spaceflight paradigms in the life sciences. Standards developed for low earth orbit human spaceflight may not be fully applicable and in-space research may be required to develop new standards. Preventative and emergency medical care may require new capabilities never before used in space. Due to spacecraft volume limitations, this work area may also be shared with various animal and plant life science research. This paper explores the prototype Medical Operations Workstation within the NASA Habitat Demonstration Unit and discusses some of the lessons learned from field analogue missions involving the workstation. Keywords: Exploration, medical, health, crew, injury emergency, biology, animal, plant, science, preventative, emergency.

  18. Outcomes of Emergency Medical Patients Admitted to an Intermediate Care Unit With Detailed Admission Guidelines.

    Science.gov (United States)

    Simpson, Catherine E; Sahetya, Sarina K; Bradsher, Robert W; Scholten, Eric L; Bain, William; Siddique, Shazia M; Hager, David N

    2017-01-01

    An important, but not well characterized, population receiving intermediate care is that of medical patients admitted directly from the emergency department. To characterize emergency medical patients and their outcomes when admitted to an intermediate care unit with clearly defined admission guidelines. Demographic data, admitting diagnoses, illness severity, comorbid conditions, lengths of stay, and hospital mortality were characterized for all emergency medical patients admitted directly to an intermediate care unit from July through December 2012. A total of 317 unique patients were admitted (mean age, 54 [SD, 16] years). Most patients were admitted with respiratory (26.5%) or cardiac (17.0%) syndromes. The mean (SD) Acute Physiology and Chronic Health Evaluation score version II, Simplified Acute Physiology Score version II, and Charlson Comorbidity Index were 15.6 (6.5), 20.7 (11.8), and 2.7 (2.3), respectively. Severity of illness and length of stay were significantly different for patients who required intensive care within 24 hours of admission (n = 16) or later (n = 25), patients who continued with inter mediate care for more than 24 hours (n = 247), and patients who were downgraded or discharged in less than 24 hours (n = 29). Overall hospital mortality was 4.4% (14 deaths). Emergency medical patients with moderate severity of illness and comorbidity can be admitted to an intermediate level of care with relatively infrequent transfer to intensive care and relatively low mortality. ©2016 American Association of Critical-Care Nurses.

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

    Directory of Open Access Journals (Sweden)

    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.

  20. The thesis of the alkaline milieu in oncology: a review.

    Science.gov (United States)

    Malhotra, S L

    1993-02-01

    An alkaline milieu is a common factor in some carcinomas of the oropharynx and oesophagus, the stomach, the bronchus, the cervix and the large bowel. The hypothesis is advanced that a change to an alkaline pH enhances the mitotic activity of mucous cells and that this change can be often avoided by alterations in diet and habit.

  1. Les associations en milieu urbain dakarois: classification et ...

    African Journals Online (AJOL)

    Les associations en milieu urbain dakarois: classification et capacités développantes. ... They shift and adjust, in both their forms and objectives, to the social and ... increasingly meet individual and collective needs, which makes them appear ...

  2. Benchmark en Beleidstoets voor de Drinkwatersector. Indicatoren Waterkwaliteit en Milieu

    NARCIS (Netherlands)

    Versteegh JFM; Tangena BH; Mulschlegel JHC; IMD

    2004-01-01

    De aanleiding van de studie is het voornemen van de Minister van VROM de benchmark op te nemen in de Waterleidingwet. Deze verplichte benchmark zal bestaan uit vier onderdelen: waterkwaliteit, dienstverlening, milieu en financien. De drinkwatersector voert sinds 1999 op vrijwillige basis een bench

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

    Science.gov (United States)

    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.

  4. An effective system to measure and report quality indicators in acute medical units.

    Science.gov (United States)

    Atkinson, J; Barton, L; Harrison, A; Roper, N

    2012-01-01

    The Society for Acute Medicine has developed a number of clinical quality indicators by which all UK Acute Medicine Units can bench mark their activity. These will help to ensure high quality care for patients, inform the continuing development of acute medical services and demonstrate the positive impact of this new specialty. Prospective collection of these data may be a challenge for many busy units. This paper describes a local solution developed in house in a North East hospital. It demonstrates how the data collected can be analysed to assess the effect of changes in consultant presence on the unit and also time taken for patients to be seen by a doctor. The limitations of the system and potential for future development are considered.

  5. Cost of pain medication to treat adult patients with nonmalignant chronic pain in the United States.

    Science.gov (United States)

    Rasu, Rafia S; Vouthy, Kiengkham; Crowl, Ashley N; Stegeman, Anne E; Fikru, Bithia; Bawa, Walter Agbor; Knell, Maureen E

    2014-09-01

    Nonmalignant chronic pain (NMCP) is a public health concern. Among primary care appointments, 22% focus on pain management. The American Academy of Pain Medicine guidelines for NMCP recommend combination medication therapy (including analgesics, nonsteroidal anti-inflammatory drugs [NSAIDs], opioids, antidepressants, and anticonvulsants) as a key component to effective treatment for many chronic pain diagnoses. However, there has been little evidence outlining the costs of pain medications in adult patients with NMCP in the United States, an area that necessitates further consideration as the nation moves toward value-based benefit design. To estimate the cost of pain medication attributable to treating adult patients with NMCP in the United States and to analyze the trend of outpatient pain visits. This cross-sectional study used the National Ambulatory Medical Care Survey (NAMCS) data from 2000-2007. The Division of Health Care Statistics, National Center for Health Statistics, and the Centers for Disease Control and Prevention conducted the survey. The study included patients aged ≥18 years with chronic pain diagnoses (identified by the ICD-9-CM codes: primary, secondary, and tertiary). Patients prescribed at least 1 pain medication were included in the cost analysis. Pain-related prescription medications prescribed during ambulatory care visits were retrieved by using NAMCS drug codes/National Drug Code numbers. National pain prescription frequencies (weighted) were obtained from NAMCS data, using the statistical software STATA. We created pain therapy categories (drug classes) for cost analysis based on national pain guidelines. Drug classes used in this analysis were opioids/opioid-like agents, analgesics/NSAIDs, tricyclic antidepressants, selective serotonin reuptake inhibitors, antirheumatics/immunologics, muscle relaxants, topical products, and corticosteroids. We calculated average prices based on the 3 lowest average wholesale prices reported in the

  6. Self-medication practice among pension housed patients at the central healthcare unit of Teresina

    Directory of Open Access Journals (Sweden)

    Wemíria de Fátima Lima Lopes

    2014-01-01

    Full Text Available Objective: To investigate the prevalence and characteristics of self-medication among pension housed patients at the central healthcare unit of Teresina in the downtown region. Method: This is an exploratory epidemiological study with a quantitative, cross-sectional descriptive approach. For data collection a semi-structured questionnaire was applied on the behaviors of 300 patients. Results: Of the total respondents, the practice of self-medication was common in 241 (80.33% of individuals. The greatest achievement of this was seen in those coming from municipalities in the interior of Maranhao 116 (48.13%, which surpassed even that with a small gap the individuals from the interior of Piaui, to practice self-medication in 101 (41.91%. Conclusion: It is understood that self-medication is an old widespread practice. The search for relief from their ailments and the poor public healthcare offered to the population admits that individuals opt for self-medication as a first option.

  7. Discharge against medical advice from Neonatal Intensive Care Unit: 10 years experience at a University Hospital

    Directory of Open Access Journals (Sweden)

    Hatim K Al-Turkistani

    2013-01-01

    Full Text Available Background: Discharging patients against medical advice is a problem of every age-group. However, because of their physiological vulnerability, the risk for the neonatal population is greater when discharged against medical advice (DAMA. This article is a study of the prevalence of the problem, the possible causes and/or risk factors. Materials and Methods: A retrospective review of 10 years of medical records of neonates discharged against medical advice from a Neonatal Intensive Care Unit (NICU at a university hospital. Results: The overall prevalence of DAMA was 1.6%. Most of the 51 infants who were taken out of hospital against medical advice (AMA were term (72.5% with a mean gestational age of 37.78 ± 2.5 weeks, of normal birth weight, with a mean of 2736 ± 661 g, Saudis (96%, those delivered vaginally (69%, and those that were provisionally diagnosed with transient tachypnea of newborn (TTN and/or query sepsis (49%. There was no difference between males and females (M/F = 1.2. There was an association between DAMA and the timing of DAMA (27.5% of DAMA at weekends and 67% of DAMA from May to October. Conclusion: DAMA of neonates is particularly critical. The causes and risk factors are many and difficult to predict. In addition to several other factors, its prevalence is influenced negatively by some socio-cultural beliefs.

  8. Quality of documentation of electronic medical information systems at primary health care units in Alexandria, Egypt.

    Science.gov (United States)

    Noureldin, M; Mosallam, R; Hassan, S Z

    2014-03-13

    Limited data are available about the implementation of electronic records systems in primary care in developing countries. The present study aimed to assess the quality of documentation in the electronic medical records at primary health care units in Alexandria, Egypt and to elicit physician's feedback on barriers and facilitators to the system. Data were collected at 7 units selected randomly from each administrative region and in each unit 50 paper-based records and their corresponding e-records were randomly selected for patients who visited the unit in the first 3 months of 2011. Administrative data were almost complete in both paper and e-records, but the completeness of clinical data varied between 60.0% and 100.0% across different units and types of record. The accuracy rate of the main diagnosis in e-records compared with paper-based records ranged between 44.0% and 82.0%. High workload and system complexity were the most frequently mentioned barriers to implementation of the e-records system.

  9. State-Level Lifetime Medical and Work-Loss Costs of Fatal Injuries - United States, 2014.

    Science.gov (United States)

    Luo, Feijun; Florence, Curtis

    2017-01-13

    Injury-associated deaths have substantial economic consequences in the United States. The total estimated lifetime medical and work-loss costs associated with fatal injuries in 2013 were $214 billion (1). In 2014, unintentional injury, suicide, and homicide (the fourth, tenth, and seventeenth leading causes of death, respectively) accounted for 194,635 deaths in the United States (2). In 2014, a total of 199,756 fatal injuries occurred in the United States, and the associated lifetime medical and work-loss costs were $227 billion (3). This report examines the state-level economic burdens of fatal injuries by extending a previous national-level study (1). Numbers and rates of fatal injuries, lifetime costs, and lifetime costs per capita were calculated for each of the 50 states and the District of Columbia (DC) and for four injury intent categories (all intents, unintentional, suicide, and homicide). During 2014, injury mortality rates and economic burdens varied widely among the states and DC. Among fatal injuries of all intents, the mortality rate and lifetime costs per capita ranged from 101.9 per 100,000 and $1,233, respectively (New Mexico) to 40.2 per 100,000 and $491 (New York). States can engage more effectively and efficiently in injury prevention if they are aware of the economic burden of injuries, identify areas for immediate improvement, and devote necessary resources to those areas.

  10. Tijd voor tijdschrijven : resultaten van het project Tijdschrijven milieu-openbaar ministerie, ressort Amsterdam

    NARCIS (Netherlands)

    Berg, E.A.I.M. van den

    1993-01-01

    Als doelstelling van het onderzoek in gekoppeld aan het project Tijdschrijven is geformuleerd: Het zichtbaar maken van de tijde die het milieu-OM besteedt aan de milieutaak en aan de niet-milieutaak, alsmede inzicht verschaffen in de aard van milieu-activiteiten van het milieu-OM en de verdeling van

  11. Brede inventarisatie milieu-effecten van veehouderij en landbouw = Environmental impacts of livestock systems

    NARCIS (Netherlands)

    Radersma, S.

    2010-01-01

    Inventarisatie van milieu-effecten, met informatie over de rol van de landbouw/veeteelt: Wat zijn de bronnen van het betreffende milieu-effect en hoe groot is de bijdrage door de landbouw en welke gevolgen hebben de betreffende milieu-effecten en hoe (on)herstelbaar zijn die gevolgen.Inventarization

  12. 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.

  13. Current Practices in Assessing Professionalism in United States and Canadian Allopathic Medical Students and Residents

    Science.gov (United States)

    Nittur, Nandini

    2017-01-01

    Professionalism is a critically important competency that must be evaluated in medical trainees but is a complex construct that is hard to assess. A systematic review was undertaken to give insight into the current best practices for assessment of professionalism in medical trainees and to identify new research priorities in the field. A search was conducted on PubMed for behavioral assessments of medical students and residents among the United States and Canadian allopathic schools in the last 15 years. An initial search yielded 594 results, 28 of which met our inclusion criteria. Our analysis indicated that there are robust generic definitions of the major attributes of medical professionalism. The most commonly used assessment tools are survey instruments that use Likert scales tied to attributes of professionalism. While significant progress has been made in this field in recent years, several opportunities for system-wide improvement were identified that require further research. These include a paucity of information about assessment reliability, the need for rater training, a need to better define competency in professionalism according to learner level (preclinical, clerkship, resident etc.) and ways to remediate lapses in professionalism. Student acceptance of assessment of professionalism may be increased if assessment tools are shifted to better incorporate feedback. Tackling the impact of the hidden curriculum in which students may observe lapses in professionalism by faculty and other health care providers is another priority for further study. PMID:28652951

  14. Patterns of admissions in an acute medical unit: priorities for service development and education.

    Science.gov (United States)

    James, Natalie J; Hussain, Rumana; Moonie, Alasdair; Richardson, Donald; Waring, W Stephen

    2012-01-01

    An Acute Medical Unit has recently been established at York Hospital. The present study sought to characterise the case mix of acutely unwell medical patients to allow identification of priorities for ongoing service development and to assess educational opportunities for trainees in the region. Data were collected for 16001 admission episodes between January 2010 and April 2011 inclusive. These allowed characterisation of the case mix, and identified key priorities where clinical pathway do not yet exist, namely heart failure, urinary tract infection, and acute diarrhoea. Good educational opportunities exist for most aspects of the Acute Medicine curriculum; several weaknesses were identified, and trainees might address these by undertaking a specific period of specialty training in endocrinology and neurology.

  15. SELECTION VARIETALE ET MILIEU Sélection pour l’adaptation au milieu et prise en compte des interactions génotype/milieu

    Directory of Open Access Journals (Sweden)

    Brancourt-Hulmel Maryse

    2000-11-01

    Full Text Available L’adaptation au milieu est un objectif de sélection recherché pour un grand nombre d’espèces végétales et elle fait le plus souvent appel à l’analyse du rendement. L’améliorateur peut rechercher des génotypes présentant une « adaptation spécifique », c’est-à-dire une adaptation à des milieux spécifiques, ou au contraire une « adaptation générale » à des conditions de milieux variés *1+. L’adaptation spécifique pourra être obtenue pour des stress particuliers, observés en l’occurrence dans des milieux particuliers : citons, par exemple, l’adaptation du maïs à des froids printaniers dans les régions françaises septentrionales, l’adaptation du blé tendre d’hiver à une alimentation azotée sub-optimale, la tolérance de l’orge à la mosaïque modérée, etc. L’adaptation générale, parfois appelée adaptabilité, est conférée par une adaptation simultanée à un ensemble de contraintes du milieu, telles que le froid, la sécheresse, le manque d’eau, le manque ou l’excès d’azote, les maladies, etc. C’est en quelque sorte une somme d’adaptations spécifiques. Mais le nombre de contraintes du milieu est tel qu’il est difficile de les étudier toutes. Il faudrait, en effet, des dispositifs factoriels très lourds à mettre en place car nécessitant l’étude d’un grand nombre de facteurs à la fois, avec toutes les combinaisons entre facteurs. Les conditions naturelles sont, de surcroît, difficiles à reproduire en enceintes contrôlées. Ainsi, l’adaptation générale s’observe le plus souvent en conditions naturelles dans des réseaux d’expérimentation regroupant un ensemble de milieux sur plusieurs années, les « réseaux multilocaux et pluriannuels ». La notion d’adaptation est à replacer dans le contexte des interactions génotype/milieu car des variations d’adaptation se traduisent par des interactions génotype/milieu. Lorsque plusieurs génotypes sont

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

    National Research Council Canada - National Science Library

    Seoyoung Lee; Eun-Kyung Kim

    2017-01-01

    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...

  17. [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.

  18. 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.

  19. Effect of Medication Label Units of Measure on Parent Choice of Dosing Tool: A Randomized Experiment.

    Science.gov (United States)

    Yin, H Shonna; Parker, Ruth M; Sanders, Lee M; Dreyer, Benard P; Mendelsohn, Alan; Bailey, Stacy; Patel, Deesha A; Jimenez, Jessica J; Kim, Kwang-Youn A; Jacobson, Kara; Hedlund, Laurie; Landa, Rosa; Maness, Leslie; Tailor Raythatha, Purvi; McFadden, Terri; Wolf, Michael S

    Some experts recommend eliminating "teaspoon" and "tablespoon" terms from pediatric medication dosing instructions, because these terms could inadvertently encourage use of nonstandard tools (ie, kitchen spoons), which are associated with dosing errors. We examined whether use of "teaspoon" or "tsp" on prescription labels affects parents' choice of dosing tools, and the role of health literacy and language. Analysis of data collected as part of a controlled experiment (SAFE Rx for Kids [Safe Administration For Every Prescription for Kids] study), which randomized English- and Spanish-speaking parents (n = 2110) of children 8 years of age and younger to 1 of 5 groups, which varied in unit of measurement pairings on medication labels and dosing tools. Outcome assessed was parent self-reported choice of dosing tool. Parent health literacy was measured using the Newest Vital Sign. Seventy-seven percent had limited health literacy (36.0% low, 41.0% marginal); 35.0% completed assessments in Spanish. Overall, 27.7% who viewed labels containing either "tsp" or "teaspoon" units (alone or with "mL") chose nonstandard dosing tools (ie, kitchen teaspoon, kitchen tablespoon), compared with 8.3% who viewed "mL"-only labels (adjusted odds ratio [AOR] = 4.4 [95% confidence interval (CI), 3.3-5.8]). Odds varied based on whether "teaspoon" was spelled out or abbreviated ("teaspoon"-alone: AOR = 5.3 [95% CI, 3.8-7.3]); "teaspoon" with mL: AOR = 4.7 [95% CI, 3.3-6.5]; "tsp" with mL: AOR = 3.3 [95% CI, 2.4-4.7]; P units ("teaspoon" or "tsp") on prescription labels is associated with increased likelihood of parent choice of nonstandard dosing tools. Future studies might be helpful to examine the real-world effect of eliminating teaspoon units from medication labels, and identify additional strategies to promote the safe use of pediatric liquid medications. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  20. 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.

  1. Improving safety culture on adult medical units through multidisciplinary teamwork and communication interventions: the TOPS Project.

    Science.gov (United States)

    Blegen, M A; Sehgal, N L; Alldredge, B K; Gearhart, S; Auerbach, A A; Wachter, R M

    2010-08-01

    The goal of this project was to improve unit-based safety culture through implementation of a multidisciplinary (pharmacy, nursing, medicine) teamwork and communication intervention. The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture was used to determine the impact of the training with a before-after design. Surveys were returned from 454 healthcare staff before the training and 368 staff 1 year later. Five of eleven safety culture subscales showed significant improvement. Nurses perceived a stronger safety culture than physicians or pharmacists. While it is difficult to isolate the effects of the team training intervention from other events occurring during the year between training and postevaluation, overall the intervention seems to have improved the safety culture on these medical units.

  2. 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.

  3. 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

  4. Clinical and behavioral characteristics of adults receiving medical care for HIV infection --- Medical Monitoring Project, United States, 2007.

    Science.gov (United States)

    Blair, Janet M; McNaghten, A D; Frazier, Emma L; Skarbinski, Jacek; Huang, Ping; Heffelfinger, James D

    2011-09-02

    As of December 31, 2008, an estimated 663,084 persons were living with a diagnosis of human immunodeficiency virus (HIV) infection in the 40 U.S. states that have had confidential name-based HIV infection reporting since at least January 2006. Although HIV surveillance programs in the United States collect information about persons who have received a diagnosis of HIV infection and acquired immunodeficiency syndrome (AIDS), supplemental surveillance projects are needed to collect information about care-seeking behaviors, health-care use, and other behaviors among persons living with HIV. Data on the clinical and behavioral characteristics of persons receiving medical care for HIV infection are critical to reduce HIV-related morbidity and mortality and for program planning to allocate services and resources, guide prevention planning, assess unmet medical and ancillary service needs, and help develop intervention programs and health policies at the local, state, and national levels. Data were collected during June 2007-September 2008 for patients who received medical care in 2007 (sampled from January 1-April 30). The Medical Monitoring Project (MMP) is an ongoing, multisite supplemental surveillance project that assesses behaviors, clinical characteristics, and quality of care of HIV-infected persons who are receiving medical care. Participants must be aged ≥ 18 years and have received medical care at sampled facilities that provide HIV medical care within participating MMP project areas. Self-reported behavioral and selected clinical data are collected using an in-person interview. A total of 26 project areas in 19 states and Puerto Rico were funded to collect data during the 2007 MMP data collection cycle. The results from the 2007 MMP cycle indicated that among 3,643 participants, a total of 3,040 (84%) had some form of health insurance or coverage during the 12 months before the interview; of these, 45% reported having Medicaid, 37% reported having private

  5. Amelioration of transference resistance: substitute therapists in milieu group psychotherapy.

    Science.gov (United States)

    Sperling, M B; Kibel, H D; Loutsch, E M

    1990-01-01

    Building upon Wolf's (1949) notion of the use of an alternate session in group psychotherapy, this paper suggests that an alternate therapist substituting for an absent regular therapist in milieu group psychotherapy can facilitate similar therapeutic benefits. The mechanism of this process of overcoming transference resistance is seen as twofold: (1) sessions with a substitute therapist allow patients to confront the infantilization often present in a milieu setting and experiment with more autonomous ego functioning. (2) Sessions with a substitute therapist create conditions which are apart from the ongoing process of the therapy group, thereby allowing for a therapeutic splitting process to develop wherein transference feelings about the regular therapist can be expressed to his or her "alter ego." Several case vignettes are presented in order to illustrate the clinical utility of a substitute therapist.

  6. [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

    2017-05-09

    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.

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

    Directory of Open Access Journals (Sweden)

    Andréia Tomazoni

    2014-10-01

    Full Text Available 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.

  8. Patient dosimetry workshop - Scanner in clinical practice: how to optimize one's protocols (acquisition, interpretation, dosimetry)? - Radiation protection in medical environment; Atelier dosimetrie patient - Scanner en pratique clinique: comment optimiser ses protocoles (acquisition, interpretation, dosimetrie)? - Radioprotection en milieu medical

    Energy Technology Data Exchange (ETDEWEB)

    Valero, M. [Autorite de Surete Nucleaire, 75 Paris (France); Pilleul, F.; Favre, F. [Centre Hospitalier Universitaire, 69 - Lyon (France); Tack, D. [Braine-L' Alleud (Belgium); Etard, C.; Aubert, B.; Roch, P. [Institut de Protection et de Surete Nucleaire 92 - Fontenay aux Roses (France); Sinno-Tellier, S. [Institut de veille sanitaire, 94 - Saint Maurice (France); Gevenois, P.A. [Bruxelles (Belgium); Marelle, P. [77 Bourron Marlotte (France); Noel, A. [54 Vandoeuvre-Les-Nancy (France); Coquel, P. [74 Cran Gevrier (France); Museux, E. [44 Saint Nazaire (France); Lair, F. [75 Paris (France); Francois, A. [69 Sainte Colombe (France); Lemaire, P. [62 Lens (France); Delgoffe, C. [54 Maxeville (France); Puech, J.L. [31 Toulouse (France); Haller Montejo, M. [57 Strasbourg (France); Rousselle, I. [69 Lyon (France); Noel, A. [54 Vandoeuvre-Les-Nancy (France); Pierrat, N.; Lasalle, S.; Brisse, H. [Institut Pierre et Marie Curie, 75 - Paris (France); Guerson, T. [78 - Buc (France); Mertz, L.; Mertz, M.; Wasylczenko, T.; Bietry, J.; Notter, S. [57 Strasbourg (France); Jahnen, A.; Back, C.; Kohler, S.; Harpes, N.

    2010-10-15

    A selection of eleven brief communications given at the 2010 French days of radiology are compiled here and deal with: 1 - patient's dosimetry in classical radiology (Valero, M.); 2 - Oncology: how to optimize monitoring (dosimetry, new response criteria)? (Pilleul, F.; Favre, F.); 3 - Thorax: how to optimize lecture (MPR - Multi-Planar Reformat, MIP - Maximum Intensity Projection, MinIP - minimum intensity projection) and dosimetry? (Braine-L'Alleud); 4 - Medical exposure of the French population to diagnostic techniques in 2007 (Etard, C.; Aubert, B.; Sinno-Tellier, S.); 5 - Doses delivered to patients in radio-diagnostics: status of a national inquiry in the public sector (Etard, C.; Sinno-Tellier, S.; Aubert, B.); 6 - External help for the dose per section optimization in tomodensitometry (Tack, D.; Jahnen, A.; Back, C.; Kohler, S.; Harpes, N.; Gevenois, P.A.); 7 - Diagnostic reference levels (DRL) in radiology and scanography: status and evolution (Roch, P.; Aubert, B.); 8 - What conclusions can be drawn from the analysis of the DRLs in conventional radiology addressed to the CEPPIM (College for the evaluation of professional practices in medical imaging) (Marelle, P.; Coquel, P.; Museux, E.; Lair, F.; Francois, A.; Lemaire, P.; Delgoffe, C.; Puech, J.L.; Haller Montejo, M.); 9 - DRL analysis in scanography, an optimization tool? (Rousselle, I.; Noel, A.); 10 - Iterative reconstruction in scanography: potential dosimetric benefit and impact on image quality (Pierrat, N.; Lasalle, S.; Guerson, T.; Brisse, H.); 11 - Development of a patient's dose optimisation aided system in medical imaging (Mertz, L.; Mertz, M.; Wasylczenko, T.; Bietry, J.; Notter, S.)

  9. Milieu matters: Evidence that ongoing lifestyle activities influence health behaviors

    OpenAIRE

    Lowe, R; Norman, P.; Sheeran, P.

    2017-01-01

    Health behaviors occur within a milieu of lifestyle activities that could conflict with health actions. We examined whether cognitions about, and performance of, other lifestyle activities augment the prediction of health behaviors, and whether these lifestyle factors are especially influential among individuals with low health behavior engagement. Participants (N = 211) completed measures of past behavior and cognitions relating to five health behaviors (e.g., smoking, getting drunk) and 23 ...

  10. End-of-Life and Palliative Care Issues in Medical and Nursing Schools in the United States

    Science.gov (United States)

    Dickinson, George E.

    2007-01-01

    Medical and nursing schools in the United States have traditionally had a limited emphasis on end-of-life care. The present study is a comparison of these 2 professional programs' current offerings on death education. Data were gathered via a mailed survey from the 122 medical schools in 2005 and the 580 baccalaureate nursing programs in 2006.…

  11. 42 CFR 436.1004 - FFP in expenditures for medical assistance for individuals who have declared United States...

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false FFP in expenditures for medical assistance for... Financial Participation (FFP) Ffp for Expenditures for Determining Eligibility and Providing Services § 436.1004 FFP in expenditures for medical assistance for individuals who have declared United...

  12. Bioinspired assembly of small molecules in cell milieu.

    Science.gov (United States)

    Wang, Huaimin; Feng, Zhaoqianqi; Xu, Bing

    2017-03-30

    Self-assembly, the autonomous organization of components to form patterns or structures, is a prevalent process in nature at all scales. Particularly, biological systems offer remarkable examples of diverse structures (as well as building blocks) and processes resulting from self-assembly. The exploration of bioinspired assemblies not only allows for mimicking the structures of living systems, but it also leads to functions for applications in different fields that benefit humans. In the last several decades, efforts on understanding and controlling self-assembly of small molecules have produced a large library of candidates for developing the biomedical applications of assemblies of small molecules. Moreover, recent findings in biology have provided new insights on the assemblies of small molecules to modulate essential cellular processes (such as apoptosis). These observations indicate that the self-assembly of small molecules, as multifaceted entities and processes to interact with multiple proteins, can have profound biological impacts on cells. In this review, we illustrate that the generation of assemblies of small molecules in cell milieu with their interactions with multiple cellular proteins for regulating cellular processes can result in primary phenotypes, thus providing a fundamentally new molecular approach for controlling cell behavior. By discussing the correlation between molecular assemblies in nature and the assemblies of small molecules in cell milieu, illustrating the functions of the assemblies of small molecules, and summarizing some guiding principles, we hope this review will stimulate more molecular scientists to explore the bioinspired self-assembly of small molecules in cell milieu.

  13. 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.

  14. Dialysis vascular access management by interventional nephrology programs at University Medical Centers in the United States.

    Science.gov (United States)

    Vachharajani, Tushar J; Moossavi, Shahriar; Salman, Loay; Wu, Steven; Dwyer, Amy C; Ross, Jamie; Dukkipati, Ramanath; Maya, Ivan D; Yevzlin, Alexander S; Agarwal, Anil; Abreo, Kenneth D; Work, Jack; Asif, Arif

    2011-01-01

    The development of interventional nephrology has undoubtedly led to an improvement in patient care at many facilities across the United States. However, these services have traditionally been offered by interventional nephrologists in the private practice arena. While interventional nephrology was born in the private practice setting, several academic medical centers across the United States have now developed interventional nephrology programs. University Medical Centers (UMCs) that offer interventional nephrology face challenges, such as smaller dialysis populations, limited financial resources, and real or perceived political "turf" issues." Despite these hurdles, several UMCs have successfully established interventional nephrology as an intricate part of a larger nephrology program. This has largely been accomplished by consolidating available resources and collaborating with other specialties irrespective of the size of the dialysis population. The collaboration with other specialties also offers an opportunity to perform advanced procedures, such as application of excimer laser and endovascular ultrasound. As more UMCs establish interventional nephrology programs, opportunities for developing standardized training centers will improve, resulting in better quality and availability of nephrology-related procedures, and providing an impetus for research activities.

  15. 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.

  16. Medical causes of temporary or definitive leaves from a French counterterrorist unit pre-internship.

    Science.gov (United States)

    Thabouillot, Oscar; Roffi, R; Bertho, K; Ramon, F; Commeau, D; Fressancourt, Y; Quemeneur, E; Roche, N-C; Dubourg, O

    2017-04-01

    Each year, the French Special Weapons And Tactics team, Groupe d'Intervention de la Gendarmerie Nationale, recruits new members through a physically demanding 8-week selection process. The goal of this study is to estimate the incidence and the causes for temporary or final interruptions during this process for medical reasons. All of the candidates for the November 2015 selection process were included in this prospective study. The number and reasons for temporary or final interruptions were documented by military general practitioners. The applicants were 48 law enforcement professionals (2 women, mean age 29.4 years, range 22-35). In 14 cases, a temporary interruption was required and in five cases the selection process prematurely ended. Fifty-two per cent of the temporary interruptions were due to sprains, tendinopathies, fractures or muscle tears, 11% were due to burns, wounds or subcutaneous bruises, 16% were due to cranial trauma and 21% were due to medical causes. The high prevalence of minor traumatology that we observed is similar to the ones observed in other cohorts describing initial training for military personnel in the conventional forces. However, the presence of other pathologies in our study, such as cranial trauma or medical causes, is due to the specificity of this internship selection granting access to an elite unit. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  17. Frequency and outcome of patients with nonthyroidal illness syndrome in a medical intensive care unit.

    Science.gov (United States)

    Plikat, Katharina; Langgartner, Julia; Buettner, Roland; Bollheimer, L Cornelius; Woenckhaus, Ulrike; Schölmerich, Jürgen; Wrede, Christian E

    2007-02-01

    Acute and chronic critical conditions are associated with reduced serum levels of free triiodothyronine (FT(3)), free thyroxine FT(4), and thyrotropin, known as nonthyroidal illness syndrome (NTIS). It is still controversial whether these changes reflect a protective mechanism or a maladaptive process during prolonged illness. However, larger studies to determine the prevalence of the NTIS and its association with outcome in medical intensive care units (ICUs) are missing. Complete thyroid hormone levels from 247 of 743 patients admitted to our ICU between October 2002 and February 2004 were retrospectively evaluated. From these patients, Acute Physiology and Chronic Health II scores, ICU mortality, length of stay, mechanical ventilation, and concomitant medication were recorded. Ninety-seven patients (44.1%) had low FT(3) levels indicating an NTIS, either with normal (23.6%) or reduced (20.5%) serum thyrotropin levels. Of 97 patients with NTIS, 24 (23.3%) also showed reduced serum FT(4) levels. The NTIS was significantly associated with Acute Physiology and Chronic Health II scores, mortality, length of stay, and mechanical ventilation. In a multivariate Cox regression analysis, the combination of low FT(3) and low FT(4) was an independent risk factor for survival. Nonthyroidal illness syndrome is frequent at a medical ICU. A reduction of FT(4) together with FT(3) is associated with an increase in mortality and might reflect a maladaptive process, thereby worsening the disease.

  18. An exploratory examination of medical gas booms versus traditional headwalls in intensive care unit design.

    Science.gov (United States)

    Pati, Debajyoti; Evans, Jennie; Waggener, Laurie; Harvey, Tom

    2008-01-01

    Should power, medical gases, and monitoring and communications systems be located in a headwall or a ceiling-mounted boom in intensive care unit (ICU) rooms? Often, only the financial costs could be determined for the options, whereas data regarding its potential influence on teamwork, safety, and efficiency are lacking. Hence, purchase decisions are more arbitrary than evidence based. This study simulated care delivery in settings with a traditional headwall and a ceiling boom. Observed were the way the following elements were managed and the extent either system affected flexibility, ergonomics, and teamwork: tubing for intravenous fluids, medical gases, and suction drainage; monitoring leads and equipment power cords; and the medical equipment itself. Simulation runs involving 6 scenarios were conducted with the voluntary participation of 2 physicians, 2 nurse practitioners, 2 respiratory therapists, and 4 registered nurses at a children's tertiary care center in December 2007. Analysis suggests that booms have an advantage over headwalls in case of high-acuity ICU patients and when procedures are performed inside patient rooms. However, in case of lower-acuity ICU patients, as well as when procedures are not typically conducted in the patient room, booms may not provide a proportionate level of advantage when compared with the additional cost involved in its procurement.

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

    Directory of Open Access Journals (Sweden)

    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

  20. The effect of robotic telerounding in the surgical intensive care units impact on medical education.

    Science.gov (United States)

    Marini, Corrado Paolo; Ritter, Garry; Sharma, Cordelia; McNelis, John; Goldberg, Michael; Barrera, Rafael

    2015-03-01

    Robotic telerounding is effective from the standpoint of patients' satisfaction and patients' care in teaching and community hospitals. However, the impact of robotic telerounding by the intensivist rounding remotely in the surgical intensive care unit (SICU), on patients' outcome and on the education of medical students physician assistants and surgical residents, as well as on nurses' satisfaction has not been studied. Prospective evaluation of robotic telerounding (RT) using a Likert Scale measuring tool to assess whether it can replace conventional rounding (CR) from the standpoint of patients' care and outcome, nursing satisfaction, and educational effectiveness. RT did not have a negative impact on patients' outcome during the study interval: mortality 5/42 (12 %) versus 6/37 (16 %), RT versus CR, respectively, p = 0.747. The intensivists rounding in the SICU were satisfied with their ability to deliver the same patients' care remotely (Likert score 4.4 ± 0.2). The educational experience of medical students, physicia assistants, and surgical residents was not affected by RT (average Likert score 4.5 ± 0.2, 3.9 ± 0.4, and 4.4 ± 0.4 for surgical residents, medical students and PAs, respectively, p > 0.05). However, as shown by a Likert score of 3.5 ± 1.0, RT did not meet nurses' expectations from several standpoints. Intensivists regard robotic telerounding as an effective alternative to conventional rounding from the standpoint of patients' care and teaching. Medical students, physician assistants (PA's), and surgical residents do not believe that RT compromises their education. Despite similar patients' outcome, nurses have a less favorable opinion of RT; they believe that the physical presence of the intensivist is favorable at all times.

  1. 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

  2. Tobacco counseling experience prior to starting medical school, tobacco treatment self-efficacy and knowledge among first-year medical students in the United States.

    Science.gov (United States)

    Xiao, Rui S; Hayes, Rashelle B; Waring, Molly E; Geller, Alan C; Churchill, Linda C; Okuyemi, Kolawole S; Adams, Michael; Huggett, Kathryn N; Ockene, Judith K

    2015-04-01

    To explore students' tobacco dependence counseling experiences prior to medical school and their associations with tobacco counseling self-efficacy, and familiarity with and perceived effectiveness of tobacco dependence treatment among first-year medical students in the United States. In 2010, 1266 first-year medical students from 10 US medical schools completed a survey reporting their clinical experiences with specific tobacco counseling skills (e.g., 5As) prior to medical school. The survey also included questions on tobacco counseling self-efficacy, perceived physician impact on smokers, and familiarity and effectiveness of tobacco-related treatments. Half (50.4%) reported some tobacco counseling experiences prior to medical school (i.e. at least one 5A). Students with prior counseling experiences were more likely to have higher tobacco counseling self-efficacy, and greater familiarity with medication treatment, nicotine replacement treatment, and behavioral counseling for smoking cessation, compared to those with no prior experiences. Perceived physician impact on patient smoking outcomes did not differ by prior tobacco counseling experiences. Many first-year medical students may already be primed to learn tobacco dependence counseling skills. Enhancing early exposure to learning these skills in medical school is likely to be beneficial to the skillset of our future physicians. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. 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

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

    Science.gov (United States)

    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.

  5. Adolescents and young adults on the acute medical unit: how might we do it better?

    Science.gov (United States)

    Albon, Lorraine; Vaughan, Louella

    2014-12-01

    It is a common perception that young people do not become ill and do not pose a challenge in the unscheduled healthcare setting. The research, however, increasingly suggests that young adults and adolescents (YAAs) are a highly vulnerable group, with poorer outcomes than either older adults or children, and distinct healthcare needs. The acute medical unit (AMU) setting poses particular challenges to the care of this patient group. To improve care and patient experience, adult clinicians need to look critically at their services and seek to adapt them to meet the needs of YAAs. This requires cooperation and linkage with local paediatric and emergency services, as well as the input of other relevant stakeholder groups. Staff on AMUs also need to develop the knowledge, skills and attitudes to communicate effectively and address the developmental and health needs of YAAs and their parents/carers at times of high risk and stress.

  6. [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.

  7. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. The local cytokine and chemokine milieu within malignant effusions.

    Science.gov (United States)

    Atanackovic, Djordje; Cao, Yanran; Kim, Ji-Won; Brandl, Stephan; Thom, Ina; Faltz, Christiane; Hildebrandt, York; Bartels, Katrin; de Weerth, Andreas; Hegewisch-Becker, Susanna; Hossfeld, Dieter Kurt; Bokemeyer, Carsten

    2008-01-01

    Malignant effusions offer a unique opportunity for the study of interactions between the human immune system and cancer. We have recently demonstrated that malignant effusions are characterized by an accumulation of T cells expressing chemokine receptors such as CCR4, which is commonly found on Th2 cells. In contrast, effector T cells expressing chemokine receptors typical for Th1 cells, such as CCR5, showed a diminished homing into malignant effusions. We analyzed concentrations of 12 different cytokines and 9 chemokines within malignant and nonmalignant effusions and investigated cytokine expression by effusion-infiltrating leukocytes. We observed that concentrations of the immunoregulatory cytokine TGF-beta(1) and of angiogenic factors VEGF and IL-8 were markedly increased within effusions caused by malignancies. However, we did not observe signs of a typical Th1 or Th2 milieu. Analyzing concentrations of 9 different chemokines, we found elevated concentrations of the chemokines MDC, eotaxin, I-TAC, and MCP-1 in malignant effusions. Interestingly, tumor-infiltrating leukocytes themselves seemed to contribute strongly to the creation of a distinct cytokine/chemokine pattern within cancer-related effusions. Additional analyses suggested that this cytokine/chemokine milieu might support an enrichment of immunosuppressive leukocytes. The local cytokine and chemokine milieu within malignant effusions seems to promote angiogenesis and to block an efficient immune-mediated antitumor response. An elimination of such tumor-promoting influences will be necessary in order to transform local immunotolerance into clinically relevant immune recognition of tumors causing malignant effusions. (c) 2008 S. Karger AG, Basel

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

    Science.gov (United States)

    Jiang, Sai-Ping; Chen, Jian; Zhang, Xing-Guo; Lu, Xiao-Yang; Zhao, Qing-Wei

    2014-01-01

    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. 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. 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. 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.

  11. Description of Medication Administration by Emergency Medical Services during Mass-casualty Incidents in the United States.

    Science.gov (United States)

    El Sayed, Mazen; Tamim, Hani; Mann, N Clay

    2016-04-01

    Emergency Medical Services (EMS) preparedness and availability of essential medications are important to reduce morbidity and mortality from mass-casualty incidents (MCIs). This study describes prehospital medication administration during MCIs by different EMS service levels. The US National EMS Public-Release Research Dataset maintained by the National Emergency Medical Services Information System (NEMSIS) was used to carry out the study. Emergency Medical Services activations coded as MCI at dispatch, or by EMS personnel, were included. The Center for Medicare and Medicaid Services (CMS) service level was used for the level of service provided. A descriptive analysis of medication administration by EMS service level was carried out. Among the 19,831,189 EMS activations, 53,334 activations had an MCI code, of which 26,110 activations were included. There were 8,179 (31.3%) Advanced Life Support (ALS), 5,811 (22.3%) Basic Life Support (BLS), 399 (1.5%) Air Medical Transport (AMT; fixed or rotary), and 38 (0.2%) Specialty Care Transport (SCT) activations. More than 80 different medications from 18 groups were reported. Seven thousand twenty-one activations (26.9%) had at least one medication administered. Oxygen was most common (16.3%), followed by crystalloids (6.9%), unknown (5.2%), analgesics (3.2%) mainly narcotics, antiemetics (1.5%), cardiac/vasopressors/inotropes (0.9%), bronchodilators (0.9%), sedatives (0.8%), and vasodilators/antihypertensives (0.7%). Overall, medication administration rates and frequencies of medications groups significantly varied between EMS service levels (Psystems can use the findings of this study to better prepare their stockpiles for MCIs.

  12. THE ROLE OF AUTOPSY IN MEDICAL INTENSIVE CARE UNIT: COMPARISON OF CLINICAL AND POSTMORTEM DIAGNOSES

    Directory of Open Access Journals (Sweden)

    Vandana Tukaram

    2016-03-01

    Full Text Available BACKGROUND Autopsy is an essential auditing tool in clinical practice. The autopsy teaches us not only what is killing people right now, but points to what will kill us in the near future. This is the first autopsy study in Medical Intensive Care Unit (MICU in India as per our knowledge. METHODS Retro-prospective study of total of 141 medical autopsies of MICU deaths performed in the Department of Pathology during a period of three years. A meticulous study was performed to compare ante-mortem clinical diagnosis and post-mortem final cause of death. Cases showing a discrepancy between the clinical diagnosis and post-mortem final cause of death were categorized into IV classes according to Goldman classification. RESULTS Maximum autopsies were performed in 21-40 years (58.15%. Female preponderance noted. Non-infectious aetiology was most common cause of death (50%, of which lesions of respiratory system were the most common (33.8%. Amongst the infections, pneumonia was the most common cause of death (29.23%. Discrepancies between ante-mortem and post-mortem were noted in 63 cases (44.68%. Class I and class II discrepancies were 49.21% and 44.45%, respectively. CONCLUSION Our study stresses that routine autopsy is still very useful in MICU and emphasis must be placed on autopsy evaluation for the improvement of quality of patient care.

  13. MEDICAL BRIGADES, GLOBAL HEALTH AND THE UNITED NATIONS: MILLENNIUM DEVELOPMENT GOALS AND DEVELOPING NATIONS.

    Science.gov (United States)

    Portman, Mark T; Martin, Edward J

    2015-01-01

    Recently, recommendations have been made that global health initiatives change their focus from disease specific intervention to bolstering health systems and general health care. The aim of this is to ultimately increase access to primary care, clean water, education, hygiene, and prevent malnutrition, among other goals. While many major global health initiatives have followed this trend, so have many smaller scale programs including short-term medical brigades. Despite a trending increase in the number of privately run short-term medical brigades, until recently, little research has been done on the potential positive and negative effects that can arise from such programs. Now, guidelines have been initiated to create well-structured programs. When followed, these smaller scale initiatives can be successful in helping increase access to healthcare, sustainably strengthening communities in terms of general health. While recent legislation in the United States has addressed domestic policy in the Patient Protection Affordable Care Act of 2010 (ACA), the ACA should also consider some of the basic "sustainable" policies being implemented by international health care providers.

  14. [Quality analysis by external users of the non-medical health transport unit of Alicante].

    Science.gov (United States)

    Soriano Clemor, C; Cano, F Soriano; Gimeno, F Morant

    2011-01-01

    Non-medical health transport has great health, media and social repercussions and requires a very considerable amount of human and economic resources. To describe the quality, evaluated by external users of our Health Department, in order to know what are the most important elements for external users. Cross-sectional, descriptive observational study. Population to study: patients with a social security health card who come to the Hospital of Alicante and are non-medical health transport unit users. Waiting time to be delivered to hospital in 92.7% of the cases was less than an hour, and was between one and two hours for 7.2%. The most frequent destinations were rehabilitation service and outpatient clinics. When users were asked if the would recommend this service, 60.9% said "for sure" and 39.1% said "probably yes". This study allows us to know patient needs and expectations, as well as the factors they value the most and which of our work areas to improve. Copyright © 2009 SECA. Published by Elsevier Espana. All rights reserved.

  15. Variation in use of antipsychotic medications in nursing homes in the United States: A systematic review.

    Science.gov (United States)

    Cioltan, Hannah; Alshehri, Samah; Howe, Carol; Lee, Jeannie; Fain, Mindy; Eng, Howard; Schachter, Kenneth; Mohler, Jane

    2017-01-26

    The use of antipsychotic medications (APMs) in nursing home residents in the U.S. is an increasingly prominent issue and has been associated with increased risk of hospitalization, cardiovascular events, hip fractures, and mortality, among other adverse health events. The Food and Drug Administration has placed a black box warning on these drugs, specifying that they are not meant for residents with dementia, and has asked providers to review their treatment plans. The purpose of this systematic PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses)-based review was to summarize original research studies on facility level characteristics contributing to the use of antipsychotics in nursing homes across the United States, in order to investigate the variation of use. We searched Ovid Medline, Embase, Cochrane Library, Web of Science, CINAHL, PsycInfo, and Sociological Abstracts. Articles were selected according to the following criteria: (1) Population of interest: older adults (≥60 years of age) residing in nursing homes (not home-based or inpatient hospital settings) in the U.S. (2) Receiving APMs, typical and/or atypical. Specifically excluded were studies of psychotropic medications such as antidepressants, benzodiazepines, anxiolytics, hypnotics, mood stabilizers, and stimulants. All study designs were considered, though reviews, editorials, letters to the editor and opinion pieces were excluded. An expert consultant panel was consulted to categorize facility characteristics into domains and determine possible etiologies of APM use based upon each characteristic. Nineteen observational studies, both quantitative and qualitative, published from 2000 to 2015, met full inclusion criteria and were included in this review. APM use varied based on multiple facility characteristics across several domains: 1) physical, 2) staffing, 3) occupancy, 4) market, and 5) quality. Variation in use of APMs in U.S. nursing homes based upon facility

  16. Improving medical student intensive care unit communication skills: a novel educational initiative using standardized family members.

    Science.gov (United States)

    Lorin, Scott; Rho, Lisa; Wisnivesky, Juan P; Nierman, David M

    2006-09-01

    To determine whether intensive care unit (ICU) communication skills of fourth-year medical students could be improved by an educational intervention using a standardized family member. Prospective study conducted from August 2003 to May 2004. Tertiary care university teaching hospital. All fourth-year students were eligible to participate during their mandatory four-week critical care medicine clerkship. The educational intervention focused on the initial meeting with the family member of an ICU patient and included formal teaching of a communication framework followed by a practice session with an actor playing the role of a standardized family member of a fictional patient. At the beginning of the critical care medicine rotation, the intervention group received the educational session, whereas students in the control group did not. At the end of each critical care medicine rotation, all students interacted with a different standardized family member portraying a different fictional scenario. Sessions were videotaped and were scored by an investigator blinded to treatment assignment using a standardized grading tool across four domains: a) introduction; b) gathering information; c) imparting information; and d) setting goals and expectations. A total of 106 (97% of eligible) medical students agreed to participate in the study. The total mean score as well as the scores for the gathering information, imparting information, setting goals, and expectations domains for the intervention group were significantly higher than for the control group (p communication skills of fourth-year medical students can be improved by teaching and then practicing a framework for an initial ICU communication episode with a standardized family member.

  17. 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

  18. Implementation of unit-based interventions to improve teamwork and patient safety on a medical service.

    Science.gov (United States)

    O'Leary, Kevin J; Creden, Amanda J; Slade, Maureen E; Landler, Matthew P; Kulkarni, Nita; Lee, Jungwha; Vozenilek, John A; Pfeifer, Pamela; Eller, Susan; Wayne, Diane B; Williams, Mark V

    2015-01-01

    In a prior study involving 2 medical units, Structured Interdisciplinary Rounds (SIDRs) improved teamwork and reduced adverse events (AEs). SIDR was implemented on 5 additional units, and a pre- versus postintervention comparison was performed. SIDR combined a structured format for communication with daily interprofessional meetings. Teamwork was assessed using the Safety Attitudes Questionnaire (score range = 0-100), and AEs were identified using queries of information systems confirmed by 2 physician researchers. Paired analyses for 82 professionals completing surveys both pre and post implementation revealed improved teamwork (mean 76.8 ± 14.3 vs 80.5 ± 11.6; P = .02), which was driven mainly by nurses (76.4 ± 14.1 vs 80.8 ± 10.4; P = .009). The AE rate was similar across study periods (3.90 vs 4.07 per 100 patient days; adjusted IRR = 1.08; P = .60). SIDR improved teamwork yet did not reduce AEs. Higher baseline teamwork scores and lower AE rates than the prior study may reflect a positive cultural shift that began prior to the current study. © The Author(s) 2014.

  19. Screening difficult-to-reach populations for tuberculosis using a mobile medical unit, Punjab India

    Science.gov (United States)

    Binepal, G.; Agarwal, P.; Kaur, N.; Singh, B.; Bhagat, V.; Verma, R. P.; Satyanarayana, S.; Oeltmann, J. E.

    2015-01-01

    Background: In India, the National Health Mission has provided one mobile medical unit (MMU) per district in the state of Punjab to provide primary health care services for difficult-to-reach populations. Objectives: To determine the number of patients with presumptive tuberculosis (TB) and the number of TB cases detected and treated among patients who used the MMU services from May to December 2012 in Mohali district, Punjab, India. Methods: A cross-sectional study was conducted and registers of the out-patient, laboratory, radiology, and TB departments of the MMU were reviewed to determine the number of persons presumed to have TB and the number of persons diagnosed with TB. Results: Of 8346 patients who attended the MMUs, 663 (8%) had symptoms suggestive of TB. Among those with TB symptoms, 540 (81%) were evaluated for pulmonary TB using sputum examination or chest X-ray. In total, 58 (11%) patients had clinical or laboratory evidence of pulmonary TB, of whom 21 (36%) started anti-tuberculosis treatment. Conclusion: As MMUs are an integral part of the general public health system, these units have the potential to detect TB cases among difficult-to-reach populations. Additional research is required to optimise the diagnosis of TB at MMUs and to increase rates of TB treatment initiation. PMID:26767177

  20. Advancing science diplomacy: Indonesia and the US Naval Medical Research Unit.

    Science.gov (United States)

    Smith, Frank L

    2014-12-01

    Science diplomacy supposedly builds international cooperation through scientific and technical exchange. In practice, however, there are important but often overlooked instances where it might create conflict instead--as with accusations of espionage surrounding the US Naval Medical Research Unit 2 (NAMRU-2) in Indonesia. Did American science diplomacy backfire in Indonesia and, if so, why? Most literature fails to anticipate this possibility, let alone explain it, since science diplomacy is rarely subject to critical analysis. Rather than shun politics or, similarly, simply blame the demise of NAMRU-2 on the military or avian influenza, I consider both the successes and failures of this research unit in the context of Indonesia's transition to democracy and America's legacy from the Cold War. Based on this history, I propose that the effects of science diplomacy depend on strategic communication and exchange, as well as elite influence and material incentives. Therefore, by challenging the conventional wisdom about science diplomacy, NAMRU-2 can help advance the theory and practice of this potentially useful tool of statecraft.

  1. Recovery of cost of hospital and medical care and treatment furnished by the United States; delegation of authority. Final rule.

    Science.gov (United States)

    2010-03-01

    This rule amends Department of Justice regulations to increase the settlement and waiver authority delegated to heads of departments and agencies of the United States responsible for the furnishing of hospital, medical, surgical, or dental care. This change responds to the increase in medical costs since 1992, when the current level of delegated settlement and waiver authority was established, and will further the efficient operation of the government.

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

    DEFF Research Database (Denmark)

    Daugaard, S; Andersen, JH; Grynderup, M B

    2014-01-01

    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...... National Prescription Registry. Odds ratios (OR) comparing the highest and lowest third of the population at individual and work-unit level, respectively, were estimated by multilevel logistic regression adjusted for confounders. Psychological demands and decision latitude were tested for interaction...

  3. Erros medicamentosos em unidade de terapia intensiva neonatal Medication errors in a neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Renata Bandeira de Melo Escovedo Lerner

    2008-04-01

    Full Text Available OBJETIVO: Determinar a incidência e o tipo de erros médicos em uma unidade de terapia intensiva neonatal e a relação entre o erro e o estado clínico do paciente. MÉTODOS: Revisamos os prontuários médicos, durante os primeiros 7 dias de hospitalização, de todos os recém-nascidos de alto risco admitidos por um período de 3 meses. RESULTADOS: Setenta e três pacientes foram admitidos durante o período de estudo. A média de peso de nascimento foi de 2.140 g (640-5.020 g, e a idade gestacional média foi de 34 semanas (25-40 semanas. Dos 73 prontuários analisados, 40 (55% apresentaram um ou mais erros. Um total de 365 dias de hospitalização foi analisado, e 95 erros médicos foram detectados (um erro por 3,9 dias de hospitalização. O erro mais freqüente esteve associado com uso de medicamentos (84,2%. Uso de procedimentos terapêuticos (medicamentos, fototerapia, etc. sem prescrição adequada no prontuário do paciente (erro de comissão representou 7,4% dos erros, e a incidência de erros de omissão foi de 8,4%. A incidência de erros médicos foi significativamente maior em recém-nascidos com idade gestacional menor. CONCLUSÕES: A incidência de erros no cuidado de recém-nascidos de alto risco é elevada. Deve-se incentivar estratégias para melhorar a educação de profissionais da saúde envolvidos no cuidado e o desenvolvimento da cultura local, divulgando algoritmos claros e acessíveis para orientar o comportamento quando há ocorrência de erros.OBJECTIVE: To determine the incidence and type of medical errors in a newborn intensive care unit and the relationship between the error and the patient's clinical status. METHODS: We reviewed the medical charts, during the first 7 days of hospitalization, of all high-risk newborn infants admitted for a period of 3 months. RESULTS: Seventy-three patients were admitted during the study period. Their mean birth weight was 2,140 g (640-5,020 g and mean gestational age was 34

  4. Impact of individualized learning plans on United States senior medical students advanced clinical rotations

    Directory of Open Access Journals (Sweden)

    Amalia Guardiola

    2016-11-01

    Full Text Available The individualized learning plan (ILP is a tool that promotes self-directed learning. The aim of this pilot study was to look at the perception of the ILPs in United States senior medical school students as a way to improve their learning experience during their advanced practice clerkship. We conducted a survey of graduating medical students that contained both quantitative and open-ended questions regarding the students’ experiences with the ILP during their advanced practice clerkship from July 2014 to March 2016. We systematically identified and compiled themes among the qualitative responses. Responses from 294 out of 460 subjects were included for analysis (63.9%. Ninety students (30.6% reported that the ILP was definitely reviewed at the midpoint and 88 (29.9% at the final evaluation. One hundred sixty one students (54.8% felt the ILP provided a framework for learning. One hundred sixty one students (61.6% felt it was a useful tool in helping open a discussion between the student and faculty. The qualitative data was grouped by areas most mentioned and these areas of concern centered on lack of faculty knowledge about ILP, time to complete ILP, and uncertainty of appropriate goal setting. The majority of students perceive the ILP to be helpful. Our results suggest that active intervention is needed by dedicated and trained faculty to improve ILP utilization. It is recommended that faculty gives students examples of learning goals to create their own learning framework and encourages them to discuss and review the ILP.

  5. 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

    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

  6. A Daily Goals Tool to Facilitate Indirect Nurse-Physician Communication During Morning Rounds on a Medical-Surgical Unit.

    Science.gov (United States)

    Perry, Veronica; Christiansen, Mollie; Simmons, Angela

    2016-01-01

    Interprofessional bedside rounds are essential for patient-centered care. However, it may be difficult for nurses to round with physicians on medical-surgical units. Using a daily goals tool for indirect rounds improved nurse-physician communication and interprofessional care for patients.

  7. Intra- and intercultural comparisons of the personality profiles of medical students in Argentina and the United States.

    Science.gov (United States)

    Rimoldi, Horacio J A; Raimondo, Roberto; Erdmann, James B; Hojat, Mohammadreza

    2002-01-01

    This study was designed to compare the personality profiles of medical students in Argentina and the United States. The ultimate purpose of the research was to study the value of personality measures in predicting academic and professional performances. Participants were 421 medical students in Argentina (254 women, 167 men) and 623 medical students in the United States (207 women, 416 men). Eight personality measures were administered: Perception of Stressful Life Events, Test Anxiety, General Anxiety, Loneliness, Self-Esteem, Locus of Control, Extraversion, and Neuroticism. Intracultural comparisons showed some minor gender differences in personality profiles within each culture (e.g., in the United States, women scored higher than men on the Perception of Stressful Life Events and General Anxiety scales, and in Argentina, women scored higher on the Test Anxiety scale). Intercultural comparisons of personality profiles showed that Argentine medical students obtained higher average scores than did their American counterparts on the Perception of Stressful Life Events, Test Anxiety, General Anxiety, External Locus of Control, Extraversion, and Neuroticism scales. Argentine students scored lower on the Loneliness scale than did their American counterparts. Psychometric findings supported the measurement properties of the personality measures in the two cultures (e.g., construct validity, and internal consistency aspect of reliability). Further study of the implications of the findings in predicting academic attainment in medical school and to physician performance is recommended.

  8. RECALMIN: The association between management of Spanish National Health Service Internal Medical Units and health outcomes.

    Science.gov (United States)

    Zapatero-Gaviria, Antonio; Javier Elola-Somoza, Francisco; Casariego-Vales, Emilio; Fernandez-Perez, Cristina; Gomez-Huelgas, Ricardo; Bernal, José Luis; Barba-Martín, Raquel

    2017-08-01

    To investigate the association between management of Internal Medical Units (IMUs) with outcomes (mortality and length of stay) within the Spanish National Health Service. Data on management were obtained from a descriptive transversal study performed among IMUs of the acute hospitals. Outcome indicators were taken from an administrative database of all hospital discharges from the IMUs. Spanish National Health Service. One hundred and twenty-four acute general hospitals with available data of management and outcomes (401 424 discharges). IMU risk standardized mortality rates were calculated using a multilevel model adjusted by Charlson Index. Risk standardized myocardial infarction and heart failure mortality rates were calculated using specific multilevel models. Length of stay was adjusted by complexity. Greater hospital complexity was associated with longer average length of stays (r: 0.42; P hospital mortality rates were higher at larger hospitals, but no significant differences were found when mortality was risk adjusted. There was an association between nurse workload with mortality rate for selected conditions (r: 0.25; P = 0.009). Safety committee and multidisciplinary ward rounds were also associated with outcomes. We have not found any association between complexity and intra-hospital mortality. There is an association between some management indicators with intra-hospital mortality and the length of stay. Better disease-specific outcomes adjustments and a larger number of IMUs in the sample may provide more insights about the association between management of IMUs with healthcare outcomes.

  9. Clinical Trial of an Educational Program to Decrease Monitor Alarms in a Medical Intensive Care Unit.

    Science.gov (United States)

    Brantley, Arian; Collins-Brown, Sandra; Kirkland, Jasmine; Knapp, Meghan; Pressley, Jackie; Higgins, Melinda; McMurtry, James P

    2016-07-01

    Clinical research to identify effective interventions for decreasing nonactionable alarms has been limited. The objective of this study was to determine if a staff educational program on customizing alarm settings on bedside monitors decreased alarms in a medical intensive care unit (MICU). A preintervention, postintervention, nonequivalent group design was used to evaluate an educational program on alarm management in a convenience sample of MICU nurses. A 15-minute session was provided in a 1-week period. The outcome variable (number of alarms for low oxygen saturation via pulse oximetry [SpO2]) was determined from monitor log files adjusted by patient census. Data were collected for 15 days before and after the intervention. χ(2) analysis was used, with P less than .05 considered significant. After 1 week of education, low SpO2 alarms decreased from 502 to 306 alarms per patient monitored per day, a 39% reduction (P alarm settings to patients' clinical condition decreased common monitor alarms by 39%. ©2016 American Association of Critical-Care Nurses.

  10. Successful strategy to decrease indwelling catheter utilization rates in an academic medical intensive care unit.

    Science.gov (United States)

    Gupta, Sushilkumar Satish; Irukulla, Pavan Kumar; Shenoy, Mangalore Amith; Nyemba, Vimbai; Yacoub, Diana; Kupfer, Yizhak

    2017-08-22

    Duration of indwelling urinary catheterization is an important risk factor for urinary tract infections. We devised a strategy to decrease the utilization of indwelling urinary catheters (IUCs). We also highlight the challenges of managing critically ill patients without IUCs and demonstrate some of the initiatives that we undertook to overcome these challenges. A retrospective observational outcomes review was performed in an adult medical intensive care unit (ICU) between January 2012 and December 2016. This period included a baseline and series of intervals, whereby different aspects of the strategies were implemented. IUC utilization ratio and catheter-associated urinary tract infection (CAUTI) rates were calculated. Our IUC utilization ratio had a statistically significant decrease from 0.92 (baseline) to 0.28 (after 3 interventions) (P decrease from 5.47 (baseline) to 1.08 (after 3 intervention) (P = .0134). These rates sustained a statistically significant difference over the 2-year follow-up period from the last intervention. Incontinence-associated dermatitis (IAD) was identified as a potential complication of not using an IUC. There was no statistically significant change in the IAD rates during 2013-2016. Our interventions demonstrated that aggressive and comprehensive IUC restriction protocol and provider training can lead to a successful decrease in IUC use, leading to a lower IUC utilization ratio and CAUTI rate in a large complex academic ICU setting. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  11. Patients with hematological disorders requiring admission to medical intensive care unit: Characteristics, survival and prognostic factors

    Directory of Open Access Journals (Sweden)

    Subhash H

    2003-01-01

    Full Text Available Background: This retrospective chart review assessed the characteristics and outcome of patients with hematological disorders who required admission to medical intensive care unit over a 4 year period (January 1998 to December 2001. Results: There were a total of 104 patients, 67 (64% male, 37 (36% female subjects, with a mean age of 36.3 ± 15.3 years (range 10 to 65 years. The mean duration from hospital admission to ICU transfer was 11 days. Sixty-nine (66% had malignant and 35 (34% had non-malignant conditions. Respiratory distress was the commonest reason for ICU admission 58 (56%. The other indications were hemodynamic instability 38 (36%, low sensorium 22 (21%, following cardio-pulmonary arrest 12 (11.5% and generalized tonic-clonic seizures 5 (5%. Forty-three (42% patients had absolute neutophil count (ANC less than 500, 48 (47.5% had platelet count < 20000. The mean duration of ICU stay was 4 days (range < 24 hours to 28 days. Sixty-nine (66% patients required mechanical ventilation, 61 (59% required hemodynamic support. Pneumonia or sepsis was diagnosed in 71 (68%. Twenty-five (24% survived ICU stay and 20 (19% survived to hospital discharge. ICU admission following cardio-pulmonary arrest, advanced malignancy, requirement of mechanical ventilation, vasopressor support, ANC count < 500 and platelet count < 20000 were the predictors of adverse outcome. Associated organ dysfunction further increases the mortality.

  12. Does magnesium matter in patients of Medical Intensive Care Unit: A study in rural Central India

    Science.gov (United States)

    Kumar, Sunil; Honmode, Akshay; Jain, Shraddha; Bhagat, Vijay

    2015-01-01

    Introduction: Hypomagnesemia has been common, but mostly underdiagnosed electrolyte abnormality. Studies regarding this is lacking in India especially in rural setting. Here, we have correlated serum magnesium (Mg) level with outcome in patients of medicine Intensive Care Unit (ICU) with respect to length of ICU stay, need for mechanical ventilatory support and its duration and ultimate outcome (discharge/death). Materials and Methods: This is a prospective observational study carried out over a period of 1-year enrolling 601 patients of Medical ICU (MICU). The Chi-square test is applied to correlate hypomagnesemia with the outcome. Result and Observation: About 25% patients had admission hypomagnesemia. When compared with the normal Mg group, there was significant association of hypomagnesemia with outcome in terms of duration of MICU stay 5.46 (5.75) versus 3.93 (3.88), need for mechanical ventilation (56.86% vs. 24.33%), discharge/cured from ICU (61.43% vs. 85.26%), and death (38.56% vs. 14.73%). However, no significant difference was found in the duration of ventilation between the two groups. Conclusion: Hypomagnesemia is associated with a higher mortality rate in critically ill patients. The need for ventilatory support, but not its duration is significantly higher in hypomagnesemic patients. Hypomagnesemia is commonly associated with sepsis and diabetes mellitus. The duration of MICU stay is significantly higher in patients with low serum Mg. PMID:26180429

  13. Reasons underlying interhospital transfers to an academic medical intensive care unit.

    Science.gov (United States)

    Wagner, Jason; Iwashyna, Theodore J; Kahn, Jeremy M

    2013-04-01

    Interhospital critical care transfers are common, yet few studies address the underlying reasons for transfers. We examined clinician and patient/surrogate perceptions about interhospital transfers and assessed their agreement on these transfers. This is a mixed-mode survey of 3 major stakeholders in interhospital transfers to an academic medical intensive care unit from August 2007 to April 2008. Sixty-two hospitals transferred 138 patients during the study period. Response rates varied among stakeholders (accepting physician, 90%; referring physicians, 20%; patients/surrogates, 33%). All 3 groups frequently endorsed quality of care and need for a specific test/procedure as important. Referring hospital reputation and quality were rarely endorsed. Accepting physicians and patients/surrogates substantially agreed on the need for a specific test (κ = 0.70) and increased survival (κ = 0.78) but, otherwise, had fair to poor agreement. Referring physicians and patients/surrogates rarely agreed and sometimes disagreed greater than expected by chance (κ hospital experience (κ = 0.96) but agreed less on patient satisfaction at the referring hospital (κ = 0.37) and referring hospital reputation (κ = 0.35). Stakeholders do not always agree on the reasons for critical care transfers. Efforts to improve communication are warranted to ensure informed patient choices. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Group Milieu in systemic and psychodynamic group therapy

    DEFF Research Database (Denmark)

    Lau, Marianne Engelbrecht

    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...... group was characterized by statistically significant highest scores on Relationship (ES = 1.27) and System Maintenance / Change Dimension (ES= 1.28), while the scores for Personal Growth Dimension were comparable in the two groups. Group S had statistically significant higher scores on the following...

  15. Thrombosis in the uremic milieu--emerging role of "thrombolome".

    Science.gov (United States)

    Shashar, Moshe; Francis, Jean; Chitalia, Vipul

    2015-01-01

    Chronic kidney disease (CKD) is characterized by retention of a number of toxins, which unleash cellular damage. CKD environment with these toxins and a host of metabolic abnormalities (collectively termed as uremic milieu) is highly thrombogenic. CKD represents a strong and independent risk factor for both spontaneous venous and arterial (postvascular injury) thrombosis. Emerging evidence points to a previously unrecognized role of some of the prothrombotic uremic toxins. Here, we provide an overview of thrombosis in CKD and an update on indolic uremic toxins, which robustly increase tissue factor, a potent procoagulant, in several vascular cell types enhancing thrombosis. This panel of uremic toxins, which we term "thrombolome" (thrombosis and metabolome), represents a novel risk factor for thrombosis and can be further explored as biomarker for postvascular interventional thrombosis in patients with CKD.

  16. [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.

  17. Natuur- en milieu-educatie, tussen beleven en overleven : een cultuurpedagogisch vraagstuk

    NARCIS (Netherlands)

    Praamsma, J.M.

    1993-01-01

    Er zijn in de natuur- en milieu-educatie twee wegen te onderkennen. De eerste weg vertrekt vanuit de beleving van de natuur, de andere vanuit de wetenschappelijk-technische oplossing van milieuproblemen. In mijn bijdrage wil ik duidelijk maken dat binnen de natuur- en milieu-educatie deze beide bena

  18. Milieukwaliteitseisen: een model ter beoordeling van de kwaliteit van het milieu ten aanzien van radioactiviteit

    NARCIS (Netherlands)

    Delfini MG; Leenhouts HP

    1989-01-01

    In het modeal wordt als eis voor de kwaliteit van het milieu gesteld dat de radionuclide-concentratie in de verschillende milieucompartimenten beperkt moet blijven om het effectieve dosisequivalent voor de "reference man" die zich in dat milieu bevindt, onder een bepaald referentienive

  19. Using Milieu Training to Promote Photograph Exchange for a Young Child with Autism

    Science.gov (United States)

    Ogletree, Billy T.; Davis, Patricia; Hambrecht, Georgia; Phillips, Ellen Wooten

    2012-01-01

    A milieu teaching sequence was used to train photograph exchange as a method of requesting to a 7-year-old boy with autism. A multiple baseline design across four items (ball, puzzle, books, bubbles) was used to identify a functional relation between requesting and the milieu teaching sequence. Although performance during intervention was…

  20. A prospective study on medication and total parenteral nutrition practices at a Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Vijayakumar Arumugam

    2016-01-01

    Conclusion: TPN and medication practices at the NICU should be highly monitored for avoiding medication errors, drug interactions, and mortality rate in neonates. The most effective method can be achieved when a clinical pharmacist become a part of it.

  1. Clinical and epidemiological study of stress hyperglycemia among medical intensive care unit patients in Central India

    Directory of Open Access Journals (Sweden)

    Jitendra Sharma

    2017-01-01

    Full Text Available Background: Stress hyperglycemia is common in patients presenting at the emergency medical ward and is associated with poor prognosis and increased risk of mortality. Aims and Objective: To study and determine the prevalence and factors associated with stress hyperglycemia. Materials and Methods: A cross-sectional observational study was performed on 536 nondiabetic patients presented to the Intensive Care Unit (ICU at Gandhi Medical College and allied Hamidia Hospital, Bhopal, between March 31, 2015, and May 28, 2015. A detailed history including demographic profile, presence of chronic disease, history of hospitalization and ICU admission, surgical status, and major reason for ICU admission (i.e., predominant diagnostic category was collected. Hematological and other parameters based on profile of study population were also analyzed. Results: Out of 536 patients, 109 (20.33% had stress hyperglycemia. Out of 109 patients with stress hyperglycemia, 87 (16.23% patients had glycated hemoglobin (HbA1c <5.7% and 22 (4.10% patients had HbA1c between 5.7% and 6.4%. Mean age of the study population was 40.27 ± 1.44 years, with male dominance. Mean random blood glucose level was 181.46 ± 3.80 mg/dl. Frequency of stress hyperglycemia was 24.13% in stroke, 19.54% in multiple organ dysfunction syndrome (MODS, 17.24% in chronic kidney disease (CKD, 12.64% in central nervous system (CNS infection, 8.05% in chronic liver disease (CLD, and 8.05% in seizure patients. Association between stroke and stress hyperglycemia was significant (P = 0.036. Association between hospital stay more than 7 days and stress hyperglycemia was significant in stroke patients (P = 0.0029, CKD patients (P = 0.0036, CLD (P = 0.0099, and MODS patients (P = 0.0328. Conclusions: The factors associated with stress hyperglycemia were stroke, MODS, CKD, CNS infection, CLD, seizure patients, with prolonged hospital stay and expected proportion.

  2. Clinical and epidemiological study of stress hyperglycemia among medical intensive care unit patients in Central India

    Science.gov (United States)

    Sharma, Jitendra; Chittawar, Sachin; Maniram, Ram Singh; Dubey, T. N.; Singh, Ambrish

    2017-01-01

    Background: Stress hyperglycemia is common in patients presenting at the emergency medical ward and is associated with poor prognosis and increased risk of mortality. Aims and Objective: To study and determine the prevalence and factors associated with stress hyperglycemia. Materials and Methods: A cross-sectional observational study was performed on 536 nondiabetic patients presented to the Intensive Care Unit (ICU) at Gandhi Medical College and allied Hamidia Hospital, Bhopal, between March 31, 2015, and May 28, 2015. A detailed history including demographic profile, presence of chronic disease, history of hospitalization and ICU admission, surgical status, and major reason for ICU admission (i.e., predominant diagnostic category) was collected. Hematological and other parameters based on profile of study population were also analyzed. Results: Out of 536 patients, 109 (20.33%) had stress hyperglycemia. Out of 109 patients with stress hyperglycemia, 87 (16.23%) patients had glycated hemoglobin (HbA1c) <5.7% and 22 (4.10%) patients had HbA1c between 5.7% and 6.4%. Mean age of the study population was 40.27 ± 1.44 years, with male dominance. Mean random blood glucose level was 181.46 ± 3.80 mg/dl. Frequency of stress hyperglycemia was 24.13% in stroke, 19.54% in multiple organ dysfunction syndrome (MODS), 17.24% in chronic kidney disease (CKD), 12.64% in central nervous system (CNS) infection, 8.05% in chronic liver disease (CLD), and 8.05% in seizure patients. Association between stroke and stress hyperglycemia was significant (P = 0.036). Association between hospital stay more than 7 days and stress hyperglycemia was significant in stroke patients (P = 0.0029), CKD patients (P = 0.0036), CLD (P = 0.0099), and MODS patients (P = 0.0328). Conclusions: The factors associated with stress hyperglycemia were stroke, MODS, CKD, CNS infection, CLD, seizure patients, with prolonged hospital stay and expected proportion. PMID:28217513

  3. Assessment of medical students' proficiency in dermatology: Are medical students adequately prepared to diagnose and treat common dermatologic conditions in the United States?

    Science.gov (United States)

    Ulman, Catherine A; Binder, Stephen Bruce; Borges, Nicole J

    2015-01-01

    This study assessed whether a current medical school curriculum is adequately preparing medical students to diagnose and treat common dermatologic conditions. A 15-item anonymous multiple choice quiz covering fifteen diseases was developed to test students' ability to diagnose and treat common dermatologic conditions. The quiz also contained five items that assessed students' confidence in their ability to diagnose common dermatologic conditions, their perception of whether they were receiving adequate training in dermatology, and their preferences for additional training in dermatology. The survey was performed in 2014, and was completed by 85 students (79.4%). Many students (87.6%) felt that they received inadequate training in dermatology during medical school. On average, students scored 46.6% on the 15-item quiz. Proficiency at the medical school where the study was performed is considered an overall score of greater than or equal to 70.0%. Students received an average score of 49.9% on the diagnostic items and an average score of 43.2% on the treatment items. The findings of this study suggest that United States medical schools should consider testing their students and assessing whether they are being adequately trained in dermatology. Then schools can decide if they need to re-evaluate the timing and delivery of their current dermatology curriculum, or whether additional curriculum hours or clinical rotations should be assigned for dermatologic training.

  4. Assessment of medical students’ proficiency in dermatology: Are medical students adequately prepared to diagnose and treat common dermatologic conditions in the United States?

    Directory of Open Access Journals (Sweden)

    Catherine A. Ulman

    2015-05-01

    Full Text Available This study assessed whether a current medical school curriculum is adequately preparing medical students to diagnose and treat common dermatologic conditions. A 15-item anonymous multiple choice quiz covering fifteen diseases was developed to test students’ ability to diagnose and treat common dermatologic conditions. The quiz also contained five items that assessed students’ confidence in their ability to diagnose common dermatologic conditions, their perception of whether they were receiving adequate training in dermatology, and their preferences for additional training in dermatology. The survey was performed in 2014, and was completed by 85 students (79.4%. Many students (87.6% felt that they received inadequate training in dermatology during medical school. On average, students scored 46.6% on the 15-item quiz. Proficiency at the medical school where the study was performed is considered an overall score of greater than or equal to 70.0%. Students received an average score of 49.9% on the diagnostic items and an average score of 43.2% on the treatment items. The findings of this study suggest that United States medical schools should consider testing their students and assessing whether they are being adequately trained in dermatology. Then schools can decide if they need to re-evaluate the timing and delivery of their current dermatology curriculum, or whether additional curriculum hours or clinical rotations should be assigned for dermatologic training.

  5. Assessment of medical students’ proficiency in dermatology: Are medical students adequately prepared to diagnose and treat common dermatologic conditions in the United States?

    Directory of Open Access Journals (Sweden)

    Catherine A Ulman

    2015-05-01

    Full Text Available This study assessed whether a current medical school curriculum is adequately preparing medical students to diagnose and treat common dermatologic conditions. A 15-item anonymous multiple choice quiz covering fifteen diseases was developed to test students’ ability to diagnose and treat common dermatologic conditions. The quiz also contained five items that assessed students’ confidence in their ability to diagnose common dermatologic conditions, their perception of whether they were receiving adequate training in dermatology, and their preferences for additional training in dermatology. The survey was performed in 2014, and was completed by 85 students (79.4%. Many students (87.6% felt that they received inadequate training in dermatology during medical school. On average, students scored 46.6% on the 15-item quiz. Proficiency at the medical school where the study was performed is considered an overall score of greater than or equal to 70.0%. Students received an average score of 49.9% on the diagnostic items and an average score of 43.2% on the treatment items. The findings of this study suggest that United States medical schools should consider testing their students and assessing whether they are being adequately trained in dermatology. Then schools can decide if they need to re-evaluate the timing and delivery of their current dermatology curriculum, or whether additional curriculum hours or clinical rotations should be assigned for dermatologic training.

  6. Complementary and alternative medical therapy utilization by people with chronic fatiguing illnesses in the United States

    Directory of Open Access Journals (Sweden)

    Jones Ann-Britt

    2007-04-01

    Full Text Available Abstract Background Chronic fatiguing illnesses, including chronic fatigue syndrome (CFS, pose a diagnostic and therapeutic challenge. Previous clinical reports addressed the utilization of health care provided to patients with CFS by a variety of practitioners with other than allopathic training, but did not examine the spectrum of complementary and alternative medicine (CAM therapies used. This study was designed to measure CAM therapy use by persons with fatiguing illnesses in the United States population. Methods During a random-digit dialing survey to estimate the prevalence of CFS-like illness in urban and rural populations from different geographic regions of the United States, we queried the utilization of CAM including manipulation or body-based therapies, alternative medical systems, mind-body, biologically-based, and energy modalities. Results Four hundred forty fatigued and 444 non-fatigued persons from 2,728 households completed screening. Fatigued subjects included 53 persons with prolonged fatigue, 338 with chronic fatigue, and 49 with CFS-like illness. Mind-body therapy (primarily personal prayer and prayer by others was the most frequently used CAM across all groups. Among women, there was a significant trend of increasing overall CAM use across all subgroups (p-trend = 0.003. All categories of CAM use were associated with significantly poorer physical health scores, and all but one (alternative medicine systems were associated with significantly poorer mental health scores. People with CFS-like illness were significantly more likely to use body-based therapy (chiropractic and massage than non-fatigued participants (OR = 2.52, CI = 1.32, 4.82. Use of body-based therapies increased significantly in a linear trend across subgroups of non-fatigued, prolonged fatigued, chronic fatigued, and CFS-like subjects (p-trend = 0.002. People with chronic fatigue were also significantly more likely to use body-based therapy (OR = 1.52, CI = 1

  7. 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 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 working in the UK are competent.

  8. 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.

  9. 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

    2015-02-24

    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 collaboration, more 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.

  10. Implementing medical revalidation in the United Kingdom: Findings about organisational changes and impacts from a survey of Responsible Officers

    Science.gov (United States)

    Boyd, Alan; Bryce, Marie; Luscombe, Kayleigh; Tazzyman, Abigail; Tredinnick-Rowe, John; Archer, Julian

    2017-01-01

    Objective To describe the implementation of medical revalidation in healthcare organisations in the United Kingdom and to examine reported changes and impacts on the quality of care. Design A cross-sectional online survey gathering both quantitative and qualitative data about structures and processes for medical revalidation and wider quality management in the organisations which employ or contract with doctors (termed ‘designated bodies’) from the senior doctor in each organisation with statutory responsibility for medical revalidation (termed the ‘Responsible Officer’). Setting United Kingdom Participants Responsible Officers in designated bodies in the United Kingdom. Five hundred and ninety-five survey invitations were sent and 374 completed surveys were returned (63%). Main outcome measures The role of Responsible Officers, the development of organisational mechanisms for quality assurance or improvement, decision-making on revalidation recommendations, impact of revalidation and mechanisms for quality assurance or improvement on clinical practice and suggested improvements to revalidation arrangements. Results Responsible Officers report that revalidation has had some impacts on the way medical performance is assured and improved, particularly strengthening appraisal and oversight of quality within organisations and having some impact on clinical practice. They suggest changes to make revalidation less ‘one size fits all’ and more responsive to individual, organisational and professional contexts. Conclusions Revalidation appears primarily to have improved systems for quality improvement and the management of poor performance to date. There is more to be done to ensure it produces wider benefits, particularly in relation to doctors who already perform well. PMID:28084166

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

    Directory of Open Access Journals (Sweden)

    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.

  12. 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.

  13. Development of the Medical Intensive Care Unit Shift Report Communication Scale as a measure of nurses' perception of communication

    Directory of Open Access Journals (Sweden)

    James D

    2013-04-01

    Full Text Available David James,1 Angela Jukkala,2 Andres Azuero,2 Pamela Autrey,3 Lynne Vining,4 Rebecca Miltner2 1Center for Nursing Excellence, University of Alabama at Birmingham Hospital, 2School of Nursing, University of Alabama at Birmingham, 3Nursing Administration, University of Alabama at Birmingham Hospital, 4Medical Intensive Care Unit, University of Alabama at Birmingham Hospital, Birmingham, Alabama, USA Objective: Evidence documenting the negative impact of poor communication on patient safety during intra-hospital transfer is prevalent and attributed to 80% of serious medical errors. An event particularly vulnerable to communication error is the patient "handoff." One of the more common handoffs occurring in health care settings is the report provided between nurses at the change of shift. The objective of this article is to report the process used to develop and examine the reliability and validity of a Medical Intensive Care Unit (MICU Shift Report Communication Scale to measure nurses' perception of the quality and quantity of communication during shift report. Design and participants: This was a scale development and descriptive study undertaken at the Medical Intensive Care Unit within an Academic Health Center. Forty-three medical intensive care nurses took part. Results: An exploratory factor analysis revealed three domains: communication openness, quality of information, and shift report. Medical Intensive Care Unit Shift Report Communication Scale scores ranged from 12 to 27 (mean = 18.78; standard deviation = 3.28. Perception of communication did not vary between nurses based on years of nursing experience or age. Scale reliability was good (Cronbach's alpha = 0.079. Nurses were likely to have had a positive perception of the openness of communication on the unit. However, they had a less favorable perception of peer ability to fully understand information shared during shift report and identified as a common problem the frequent need to

  14. [Medical care unit -- a suitable instrument for ambulatory patient-adequate care and performance-related remuneration].

    Science.gov (United States)

    Rudolph, P; Isensee, D; Gerlach, E; Gross, H

    2013-02-01

    The question of whether a medical care unit is an appropriate tool for outpatient care has been discussed for a long time. Our aim is to investigate whether the MCU is an effective instrument for outpatient care and adequate performance-related remuneration. This retro- and prospective overview of the work included statements on legal foundations for medical care units, for reimbursement of services in medical care units, the development of medical care centres in Germany and a listing of the specific advantages and disadvantages of an MCU. This article focuses on the generally applicable facts and complements them with examples from general, visceral and vascular surgery. The main quantitative data on medical centre statistics come from different publications of the National Association of Statutory Health Insurance for Physicians. From a legal point of view the instrument MCU allows the participating of ambulatory and stationary care in the framework of medical care contracts. This has been especially extended for stationary applications, including the spectrum of possibilities that can contribute under certain circumstances for the provision of medical care in underdeveloped regions. Freelancers can benefit primarily from financial risk and minimising bureaucratic routine. The remuneration for services performed in the MCU is analogous to that of other ambulatory care providers. Basically, there are no disadvantages, but a greater design freedom and opportunities for the generation of aggregates are visible. The number of MCU in Germany has quadrupled in the last five years, indicating an establishment of an outpatient care landscape. MCU offers from the patient's perspective, providers and policy specific advantages and disadvantages. Indeed the benefits outweigh the disadvantages, but this is not yet verified by qualitative studies. The question of the appropriateness of medical care units as outpatient care instrumentation must be considered differentially

  15. [The process of death in the intensive care unit (ICU). From a medical, thanatological and legislative point of view].

    Science.gov (United States)

    Kaneko-Wada, Francisco de J Takao; Domínguez-Cherit, Guillermo; Colmenares-Vásquez, Ariadna Marcela; Santana-Martínez, Paola; Gutiérrez-Mejía, Juan; Arroliga, Alejandro C

    2015-01-01

    Traditional goals in the intensive care unit are to reduce morbidity and mortality. Despite medical and technological advances, death in the intensive care unit remains commonplace and the modern critical care team should be familiar with palliative care and legislation in Mexico. Preserving the dignity of patients, avoiding harm, and maintaining communication with the relatives is fundamental. There is no unique, universally accepted technical approach in the management of the terminal critical care patient, so it is important to individualize each case and define objectives together under the legal framework in Mexico.

  16. DOSPERT+M: A survey of medical risk attitudes in the United States

    Directory of Open Access Journals (Sweden)

    Adam Rosman

    2013-07-01

    Full Text Available Background: The Domain-Specific Risk Taking scale (DOSPERT has been recommended as a tool for measuring risk attitudes in medical studies, but does not contain items specific to health care. Butler, et al. (2012 developed a medical risk domain subscale for DOSPERT. Objective: To characterize medical risk attitudes in a nationally-representative U.S. sample using the full DOSPERT scale with the medical risk domain add-on (DOSPERT+M, and examine associations with other risk domains. Methods: Members of a nationally-representative online panel (KnowledgePanel were randomized to complete pairs of DOSPERT+M tasks (risk attitude, risk perception, expected benefits. We explored relationships among domains through correlational and factor analysis; we tested the hypothesis that the medical risk domain and DOSPERT's health/safety domains were not highly correlated. Participants: Three hundred forty-four panelists. Results: The medical risk domain subscale had low inter-item reliability in the risk-taking task and moderate inter-item reliability in the other tasks. Medical risk domain scores were poorly correlated with the DOSPERT health/safety domain. Exploratory factor analysis largely recovered the expected DOSPERT domain structure. Conclusion: Attitudes toward risky medical activities may constitute a distinct domain from those measured by the standard DOSPERT items. Additional work is required to develop a medical risk subscale with higher inter-item reliability.

  17. Overcoming the Challenges of Conducting Early Feasibility Studies of Medical Devices in the United States.

    Science.gov (United States)

    Holmes, David R; Califf, Robert; Farb, Andrew; Abel, Dorothy; Mack, Michael; Syrek Jensen, Tamara; Zuckerman, Bram; Leon, Martin; Shuren, Jeff

    2016-10-25

    Initial clinical studies of new medical technologies involve a complex balance of research participant benefits versus risks and costs of uncertainty when novel concepts are tested. The Food and Drug Administration Center for Devices and Radiological Health has recently introduced the Early Feasibility Study (EFS) Program for facilitating the conduct of these studies under the Investigational Device Exemption regulations. However, a systematic approach is needed to successfully implement this program while affording appropriate preservation of the rights and interests of patients. For this to succeed, a holistic reform of the clinical studies ecosystem for performing early-stage clinical research in the United States is necessary. The authors review the current landscape of the U.S. EFS and make recommendations for developing an efficient EFS process to meet the goal of improving access to early-stage, potentially beneficial medical devices in the United States.

  18. Proposal for the Implementation of Quality Standards in a Medical Unit Through Integration to the Hospital Information System.

    Science.gov (United States)

    Karampela, Irene; Tzortzis, Evangelos; Kefala, Ioanna; Zygoura, Eleutheria; Mantzana, Vasiliki; Armaganidis, Apostolos

    2017-01-01

    Quality standards (QS) support and enhance health care services provided to patients and citizens, especially in sophisticated medical departments, such as Intensive Care Units (ICU). However, ICU staff lag behind in the adoption and compliance of QS protocols. In this paper, QS protocols implemented in the Intensive Care Unit of the Attiko University Hospital, a tertiary teaching hospital of the University of Athens, will be discussed. In this hospital, standardized procedures are implemented through the HIS, facilitating routine administration and services. We are aiming to facilitate educational processes and enhance staff compliance with the protocols by utilizing the Hospital Information System (HIS). In doing this, we propose the application of pop-up windows on the different user (medical or nursing) interfaces of the HIS, inter-connecting every electronic process with the corresponding QS protocol that has been developed in the ICU. This application may prove a valuable educational tool and may reinforce staff training and enhance compliance with the QS protocols.

  19. [Incidence of adverse medical events in the neonatal intensive care unit with the help of a global trigger tool].

    Science.gov (United States)

    Фастовец, Марина Н; Белорус, Андрей И; Лысак, Виктор П; Зюзина, Лариса С; Ковалева, Елена М

    Identification and monitoring of the frequency of adverse medical events are important in the organization of the patient's safety system in the intensive care units (ICU). The consistent and accurate identification of adverse events remains a problem for most medical institutions, even in developed countries of the world. To determine the frequency of adverse medical events in the NICU by using Global and Pediatric Trigger Instruments. To achieve the goal, the cross-sectional study was conducted in which in retrospect analyzed 160 newborn development records which were treated in the ICU of the newborn in the perinatal center of the M.V. Sklifosovsky Poltava Regional Clinical Hospital in 2016 to identify in them certain neonatal triggers. In 21.3% of newborns, after detecting the triggers of the "Care" module, the hospital infection was confirmed, which we regarded as medical adverse event. The trigger "Infiltration / extravasation" of the same module was detected in 1.9% medical records. Triggers "Glucose less than 3.0 mmol / L after 48 hours from birth", "Increase in creatinine" and trigger "deviation of electrolytes" of the module "Laboratory" were accordingly found in 21.9%, 6.3% and 11.3% medical records of newborns. Trigger tool is an effective way to identify adverse events that cause to patient harm. Our results can form the basis for the development of a national neonatal trigger instrument that will effectively monitor the frequency of such events in the ICU of newborn.

  20. Application of space syntax theory in the study of medical-surgical nursing units in urban hospitals.

    Science.gov (United States)

    Trzpuc, Stefnee J; Martin, Caren S

    2010-01-01

    Additional research is needed to explore how the design of urban, medical-surgical nursing units influences communication patterns, perceptions of social support, and overall job satisfaction for nurses. Space syntax theory has typically been used to study communication in office environments; more recently, it has been applied to the study of healthcare environments. The purpose of this study was to explore the applicability of space syntax theory as a theoretical framework for studying nurses' communication in medical-surgical nursing units in urban hospitals. The nursing profession is rapidly changing, and nurses' work is psychologically and physically intense. At the same time, nurses are responsible for patient safety, optimal care delivery, and patient outcomes (Bureau of Labor Statistics, 2009; Clarke, 2007; Clarke & Donaldson, 2008; Institute of Medicine, 2000; Institute of Medicine, 2004). Nurses are central to the delivery of care and act as a conduit for communication among members of the patient care team. Some of the design characteristics that create a more appealing environment for patients, such as views of nature and single-patient rooms, may not be fully understood as they relate to nurses' tasks and responsibilities, and they could be detrimental to nursing communication. This study analyzed three medical-surgical nursing unit floor plans using two constructs of space syntax theory, and it verified analysis through three semi-structured interviews with end users. The use of space syntax theory for analyzing medical-surgical nursing unit floor plans is complex. Findings indicated that nurses' perceptions of two constructs of space syntax theory, visibility and accessibility, did not consistently match the anticipated benefits of the floor plan designs. Understanding how and when nurses communicate with each other could help designers of healthcare spaces create more effective environments that support nurses' work and personal health and welfare

  1. Health disparities among highly vulnerable populations in the United States: a call to action for medical and oral health care

    OpenAIRE

    Vanderbilt, Allison A; Isringhausen, Kim T; VanderWielen, Lynn M.; Wright, Marcie S.; Slashcheva, Lyubov D.; Madden, Molly A.

    2013-01-01

    Healthcare in the United States (US) is burdened with enormous healthcare disparities associated with a variety of factors including insurance status, income, and race. Highly vulnerable populations, classified as those with complex medical problems and/or social needs, are one of the fastest growing segments within the US. Over a decade ago, the US Surgeon General publically challenged the nation to realize the importance of oral health and its relationship to general health and well-being, ...

  2. Influence of signal colored hand disinfectant dispensers on hand hygiene compliance at a medical intensive care unit.

    Science.gov (United States)

    Scheithauer, Simone; Häfner, Helga; Schröder, Jörg; Nowicki, Katharina; Lemmen, Sebastian

    2014-08-01

    To assess the influence of signal colors on hand disinfectant dispenser activities, health care workers (HCWs) at a medical intensive care unit were analyzed for a total of 20 weeks with 8 weeks before and 12 weeks after exchange to signal color. No significant increase in hand rubs (HRs) per patient day (PD) was observed (about 40 HRs/PD); however, HCW-adjusted compliance showed a 6% increase with signal colored devices. Therefore, colored devices may help to improve hand hygiene compliance.

  3. Inter-unit variability in two ParvoMedics TrueOne 2400 automated metabolic gas analysis systems.

    Science.gov (United States)

    Macfarlane, D J; Wu, H L

    2013-03-01

    Knowing the inter-unit variability, especially the technological error, is important when using many physiological measurement systems, yet no such inter-unit analysis has been undertaken on duplicate automated gas analysis systems. This study investigated the inter-unit performance of two identical ParvoMedics TrueOne 2400 automated gas analysis systems during a range of submaximal steady-state exercises performed on an electromagnetic cycle ergometer. Fifteen adult males were tested on two separate days a rest, 30, 60, 90, and 120 Watts with the duplicate gas analysis units arranged (1) collaterally (2 min of steady-state expired gas was alternately passed through each system), and (2) simultaneously (identical steady-state expired gas was passed simultaneously through both systems). Total within-subject variation (biological + technological) was determined from the collateral tests, but the unique inter-unit variability (technological error between identical systems) was shown by the simultaneous tests. Absolute percentage errors (APE), coefficient of variations (CV), effect sizes and Bland-Altman analyses were undertaken on the metabolic data, including expired ventilation (V (E)), oxygen consumption (VO(2)) and carbon dioxide production (VCO(2)). The few statistically significant differences detected between the two duplicate systems were determined to have small or trivial effect sizes, and their magnitudes to be of little physiological importance. The total within-subject variations for VO(2), VCO(2) and V (E) each equated to a mean CV and mean APE value of ~4 and ~6 %, whilst the respective inter-unit technological errors equated to ~1.5 and ~2.1 %. The two ParvoMedics TrueOne 2400 systems demonstrated excellent inter-unit agreement.

  4. 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.

  5. Influence of Clerkship on Attitudes of Medical Students toward Psychiatry across Cultures: United States and Qatar

    Science.gov (United States)

    Burgut, F. Tuna; Polan, H. Jonathan

    2013-01-01

    Objective: To assure adequate treatment for patients with mental illness worldwide, medical schools must impart positive attitudes toward psychiatry. The authors examined the effect of culture on changes in attitudes toward psychiatry among medical students receiving the same psychiatry clerkship curriculum in two different countries. Methods: A…

  6. The science of healthy aging: genes, milieu, and chance.

    Science.gov (United States)

    Rattan, Suresh I S

    2007-10-01

    Healthy aging and longevity depend on successful and dynamic interactions among biological, psychological, and environmental factors. Biological aging occurs mainly during the period of survival beyond the evolutionarily required essential lifespan (ELS). Natural selection processes for survival and successful reproduction have selected for a range of genetically determined ELS-assuring maintenance and repair systems (MRSs). The progressive failure of MRSs, and the consequent accumulation of molecular heterogeneity and damage, underlie the biological basis of aging, age-related diseases, and eventual death. However, the genetic processes of MRSs operate in a complex hierarchy of factors which range from intracellular molecular factors to physiological, psychological, environmental, and other stochastic factors, including chance. This view also facilitates setting up a framework for understanding, researching, and developing effective and realistic strategies for aging intervention, prevention, and therapies. Manipulating genes and the milieu in which genes and gene products operate opens up novel possibilities of aging intervention and prevention. Gene therapy, stem cells, and modulation through functional foods, nutriceuticals, cosmeceuticals and lifestyle alterations, including mild stress-induced hormesis, are examples of such strategies at various levels of development and practice.

  7. Milieu matters: Evidence that ongoing lifestyle activities influence health behaviors.

    Science.gov (United States)

    Lowe, Rob; Norman, Paul; Sheeran, Paschal

    2017-01-01

    Health behaviors occur within a milieu of lifestyle activities that could conflict with health actions. We examined whether cognitions about, and performance of, other lifestyle activities augment the prediction of health behaviors, and whether these lifestyle factors are especially influential among individuals with low health behavior engagement. Participants (N = 211) completed measures of past behavior and cognitions relating to five health behaviors (e.g., smoking, getting drunk) and 23 lifestyle activities (e.g., reading, socializing), as well as personality variables. All behaviors were measured again at two weeks. Data were analyzed using neural network and cluster analyses. The neural network accurately predicted health behaviors at follow-up (R2 = .71). As hypothesized, lifestyle cognitions and activities independently predicted health behaviors over and above behavior-specific cognitions and previous behavior. Additionally, lifestyle activities and poor self-regulatory capability were more influential among people exhibiting unhealthy behaviors. Considering ongoing lifestyle activities can enhance prediction and understanding of health behaviors and offer new targets for health behavior interventions.

  8. Milieu matters: Evidence that ongoing lifestyle activities influence health behaviors

    Science.gov (United States)

    Lowe, Rob; Norman, Paul

    2017-01-01

    Health behaviors occur within a milieu of lifestyle activities that could conflict with health actions. We examined whether cognitions about, and performance of, other lifestyle activities augment the prediction of health behaviors, and whether these lifestyle factors are especially influential among individuals with low health behavior engagement. Participants (N = 211) completed measures of past behavior and cognitions relating to five health behaviors (e.g., smoking, getting drunk) and 23 lifestyle activities (e.g., reading, socializing), as well as personality variables. All behaviors were measured again at two weeks. Data were analyzed using neural network and cluster analyses. The neural network accurately predicted health behaviors at follow-up (R2 = .71). As hypothesized, lifestyle cognitions and activities independently predicted health behaviors over and above behavior-specific cognitions and previous behavior. Additionally, lifestyle activities and poor self-regulatory capability were more influential among people exhibiting unhealthy behaviors. Considering ongoing lifestyle activities can enhance prediction and understanding of health behaviors and offer new targets for health behavior interventions. PMID:28662120

  9. 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.

  10. Self-medication among non-healthcare students of the University of Sharjah, United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Suleiman Ibrahim Sharif

    2014-01-01

    Full Text Available Objectives: The objective of the following study is to estimate the prevalence of self-medication among university students and evaluate factors associated with the practice. Materials and Methods: This study was conducted during May, 2012 using a pre-validated questionnaire distributed to 250 students of the 4 years of study at the college of business administration. Data were analyzed using PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc and results are expressed as counts and percentages. Chi-square test was used to evaluate significant association among the study variables and P < 0.05 were considered to be statistically significant. Results: The response rate was 80% and all respondents were Arabs with 114 (57% females and 86 (43% males. Self-medication was practiced by 118 (59% students and most (88.1% of them obtained medications from pharmacies. About 21 (11% respondents self-medicated with antibiotics. Only 34 (17% and 16 (8% of respondents were aware of bacterial resistance and rational drug use respectively. The most common reasons for self-medication were seeking quick relief (134, 67%, physician′s advice of self-management (100, 50%, illness is minor (91, 45.5%. Common reasons against self-medication include risk of misdiagnosis of illness (160, 80%, risk of using the wrong medication (154, 77%, risk of adverse effects (140, 70%. Self-medication was practiced for headache or mild pain, eye and ear symptoms, gastric problems, cold, fever and allergy. Conclusion: Self-medication among non-healthcare students is common with high prevalence. Knowledge of students of reasons for and against self-medication was adequate, but awareness of respondents of rational drug use and risk of bacterial resistance in response to misuse was poor. Orientation courses/workshops directed to university students would be beneficial.

  11. The origin of the medical research grant in the United States: the Rockefeller Foundation and the NIH Extramural Funding Program.

    Science.gov (United States)

    Schneider, William H

    2015-04-01

    The establishment of National Institutes of Health (NIH) extramural grants in the second half of the twentieth century marked a signal shift in support for medical research in the United States and created an influential model for the rest of the world. A similar landmark development occurred in the first half of the twentieth century with the creation of the Rockefeller Foundation and its funding programs for medical research. The programs and support of the foundation had a dramatic impact on medical research in the United States and globally. This paper examines early connections between these two developments. The NIH grants have usually been seen as having their roots primarily in the government programs of the Second World War. This article finds direct and indirect influence by the Rockefeller Foundation, as well as parallel developments in these two monumental programs of support for medical research. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  12. 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.

  13. Correlation of United States Medical Licensing Examination and Internal Medicine In-Training Examination Performance

    Science.gov (United States)

    Perez, Jose A., Jr.; Greer, Sharon

    2009-01-01

    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…

  14. Medication Use Among Ethnically Diverse Older Adults in the United States.

    Science.gov (United States)

    Chiang-Hanisko, Lenny; Williams, Christine L; Newman, David; Tappen, Ruth M

    2015-01-01

    As primary consumers of health care and prescription medication, older adults are more susceptible to potential drug-related adverse effects and medication interactions. With growing diversity among the older adult population, understanding ethnic differences in medication use becomes increasingly important. The current study describes polypharmacy and the occurrence of underprescribing among community-dwelling, low-income individuals 55 and older from four ethnic groups: (a) African American, (b) Afro-Caribbean, (c) European American, and (d) Hispanic American. Results revealed that number of illnesses, income level, and age were three major predictors associated with polypharmacy. No underprescription was identified. Overall, prevalence of polypharmacy was 47.5%. European American individuals had the highest prevalence followed by Hispanic American, African American, and Afro-Caribbean individuals. When caring for older adults from various ethnic groups, nurses should focus their efforts on those who have multiple illnesses and sufficient income to purchase medications to reduce the risk of polypharmacy.

  15. The response of human macrophages to β-glucans depends on the inflammatory milieu.

    Directory of Open Access Journals (Sweden)

    Cristina Municio

    Full Text Available BACKGROUND: β-glucans are fungal cell wall components that bind to the C-type lectin-like receptor dectin-1. Polymorphisms of dectin-1 gene are associated with susceptibility to invasive fungal infection and medically refractory ulcerative colitis. The purpose of this study has been addressing the response of human macrophages to β-glucans under different conditions mimicking the composition of the inflammatory milieu in view of the wide plasticity and large range of phenotypical changes showed by these cells, and the relevant role of dectin-1 in several pathophysiological conditions. PRINCIPAL FINDINGS: Serum-differentiated macrophages stimulated with β-glucans showed a low production of TNFα and IL-1β, a high production of IL-6 and IL-23, and a delayed induction of cyclooxygenase-2 and PGE2 biosynthesis that resembled the responses elicited by crystals and those produced when phagosomal degradation of the phagocytic cargo increases ligand access to intracellular pattern recognition receptors. Priming with a low concentration of LPS produced a rapid induction of cyclooxygenase-2 and a synergistic release of PGE2. When the differentiation of the macrophages was carried out in the presence of M-CSF, an increased expression of dectin-1 B isoform was observed. In addition, this treatment made the cells capable to release arachidonic acid in response to β-glucan. CONCLUSIONS: These results indicate that the macrophage response to fungal β-glucans is strongly influenced by cytokines and microbial-derived factors that are usual components of the inflammatory milieu. These responses can be sorted into three main patterns i an elementary response dependent on phagosomal processing of pathogen-associated molecular patterns and/or receptor-independent, direct membrane binding linked to the immunoreceptor tyrosine-based activation motif-bearing transmembrane adaptor DNAX-activating protein 12, ii a response primed by TLR4-dependent signals, and iii

  16. The Response of Human Macrophages to β-Glucans Depends on the Inflammatory Milieu

    Science.gov (United States)

    Montero, Olimpio; Hugo, Etzel; Rodríguez, Mario; Domingo, Esther; Alonso, Sara

    2013-01-01

    Background β-glucans are fungal cell wall components that bind to the C-type lectin-like receptor dectin-1. Polymorphisms of dectin-1 gene are associated with susceptibility to invasive fungal infection and medically refractory ulcerative colitis. The purpose of this study has been addressing the response of human macrophages to β-glucans under different conditions mimicking the composition of the inflammatory milieu in view of the wide plasticity and large range of phenotypical changes showed by these cells, and the relevant role of dectin-1 in several pathophysiological conditions. Principal Findings Serum-differentiated macrophages stimulated with β-glucans showed a low production of TNFα and IL-1β, a high production of IL-6 and IL-23, and a delayed induction of cyclooxygenase-2 and PGE2 biosynthesis that resembled the responses elicited by crystals and those produced when phagosomal degradation of the phagocytic cargo increases ligand access to intracellular pattern recognition receptors. Priming with a low concentration of LPS produced a rapid induction of cyclooxygenase-2 and a synergistic release of PGE2. When the differentiation of the macrophages was carried out in the presence of M-CSF, an increased expression of dectin-1 B isoform was observed. In addition, this treatment made the cells capable to release arachidonic acid in response to β-glucan. Conclusions These results indicate that the macrophage response to fungal β-glucans is strongly influenced by cytokines and microbial-derived factors that are usual components of the inflammatory milieu. These responses can be sorted into three main patterns i) an elementary response dependent on phagosomal processing of pathogen-associated molecular patterns and/or receptor-independent, direct membrane binding linked to the immunoreceptor tyrosine-based activation motif-bearing transmembrane adaptor DNAX-activating protein 12, ii) a response primed by TLR4-dependent signals, and iii) a response dependent

  17. Identification of microorganisms on mobile phones of intensive care unit health care workers and medical students in the tertiary hospital.

    Science.gov (United States)

    Kotris, Ivan; Drenjančević, Domagoj; Talapko, Jasminka; Bukovski, Suzana

    2017-02-01

    Aim To identify and investigate a difference between microorganisms present on intensive care unit (ICU) health care workers' (HCW, doctors, nurses or medical technicians) and medical students' mobile phones as well as to investigate a difference between the frequency and the way of cleaning mobile phones. Methods Fifty swabs were collected from HCWs who work in the ICU (University Hospital Centre Osijek) and 60 swabs from medical students (School of Medicine, University of Osijek). Microorganisms were identified according to standard microbiological methods and biochemical tests to the genus/species level. Results Out of 110 processed mobile phones, mobile phones microorganisms were not detected on 25 (22.7%), 15 (25%) students' and 10 (20%) HCW's mobile phones. No statistically significant difference was found between the number of isolated bacteria between the HCW' and students' mobile phones (p>0.05). Statistically significant difference was found between both HCW and students and frequency of cleaning their mobile phones (pmobile phones between HCWs and students (pmobile phones at least once a week, 35 (52.0%), and most medical students several times per year, 20 (33.3%). HCW clean their mobile phones with alcohol disinfectant in 26 (40.0%) and medical students with dry cloth in 20 (33.3%) cases.

  18. [Prescription and drug expenditure in gynecology and obstetrics in Northwest medical units from IMSS].

    Science.gov (United States)

    Torres Gómez, Luis Guillermo; Canales Muñoz, José Luis

    2006-08-01

    Drug prescription is the most frequent medical intervention in Gynecology and Obstetrics; however, studies of prescription profile are limited. In this study, we analyzed differences of expense by drug prescription for gynecologic and obstetrics health problems. It was performed a cross sectional study for one year analysis in each medical area that shape IMSS western district. We calculated spending and consumption coefficients for each drug and therapeutic groups. User coefficients were ordered to compare consumption differences. Besides the statistical ratio of consumption between drugs groups, we described the differences found and analyzed the prescription profile among medical regions. Data related to the expenses in each one of the regions show important differences in each one of the drugs and therapeutic groups. The most common expense for drugs is related to the treatment of osteoporosis, menopause and fertility problems. We also found differences in prescription drug preferences in each therapeutic subgroup. Drug prescription studies are useful as a basis for further specific studies in each pharmacologic subgroup. There are few studies that analyze the drug prescription profile on Gynecology and Obstetrics. In this study it is possible to suppose that medical prescription was not based on known medical evidences; therefore, we must reconsider the need of a permanent actualization and systematic medical evaluation.

  19. The humanising power of medical history: responses to biomedicine in the 20th century United States.

    Science.gov (United States)

    Warner, John Harley

    2011-12-01

    Most American historians of medicine today would be very hesitant about any claim that medical history humanises doctors, medical students or the larger health care enterprise. Yet, the idea that history can and ought to serve modern medicine as a humanising force has been a persistent refrain in American medicine. This essay explores the emergence of this idea from the end of the 19th century, precisely the moment when modern biomedicine became ascendant. At the same institutions where the new version of scientific medicine was most energetically embraced, some professional leaders warned that the allegiance to science driving the profession's technical and cultural success was endangering humanistic values fundamental to professionalism and the art of medicine. They saw in history a means for rehumanising modern medicine and countering the risk of cultural crisis. While some iteration of this vision of history was remarkably durable, the meanings attached to 'humanism' were both multiple and changing, and the role envisioned for history in a humanistic intervention was transformed. Starting in the 1960s as part of a larger cultural critique of the putative 'dehumanisation' of the medical establishment, some advocates promoted medical history as a tool to help fashion a new kind of humanist physician and to confront social inequities in the health care system. What has persisted across time is the way that the idea of history as a humanising force has almost always functioned as a discourse of deficiency-a response to perceived shortcomings of biomedicine, medical institutions and medical professionalism.

  20. Healthcare reform and the next generation: United States medical student attitudes toward the Patient Protection and Affordable Care Act.

    Directory of Open Access Journals (Sweden)

    Kristin M Huntoon

    Full Text Available CONTEXT: Over one year after passage of the Patient Protection and Affordable Care Act (PPACA, legislators, healthcare experts, physicians, and the general public continue to debate the implications of the law and its repeal. The PPACA will have a significant impact on future physicians, yet medical student perspectives on the legislation have not been well documented. OBJECTIVE: To evaluate medical students' understanding of and attitudes toward healthcare reform and the PPACA including issues of quality, access and cost. DESIGN, SETTING, AND PARTICIPANTS: An anonymous electronic survey was sent to medical students at 10 medical schools (total of 6982 students between October-December 2010, with 1232 students responding and a response rate of 18%. MAIN OUTCOME MEASURES: Medical students' views and attitudes regarding the PPACA and related topics, measured with Likert scale and open response items. RESULTS: Of medical students surveyed, 94.8% agreed that the existing United States healthcare system needs to be reformed, 31.4% believed the PPACA will improve healthcare quality, while 20.9% disagreed and almost half (47.7% were unsure if quality will be improved. Two thirds (67.6% believed that the PPACA will increase access, 6.5% disagreed and the remaining 25.9% were unsure. With regard to containing healthcare costs, 45.4% of participants indicated that they are unsure if the provisions of the PPACA will do so. Overall, 80.1% of respondents indicated that they support the PPACA, and 78.3% also indicated that they did not feel that reform efforts had gone far enough. A majority of respondents (58.8% opposed repeal of the PPACA, while 15.0% supported repeal, and 26.1% were undecided. CONCLUSION: The overwhelming majority of medical students recognized healthcare reform is needed and expressed support for the PPACA but echoed concerns about whether it will address issues of quality or cost containment.

  1. Summary of research results 2012. Foundation 'Natuur en Milieu'. Factsheet; Samenvatting onderzoeksresultaten 2012. Stichting Natuur en Milieu. Factsheet

    Energy Technology Data Exchange (ETDEWEB)

    Vegter, F.; Van der Lelij, B.

    2012-06-08

    A summary is given of a survey among 1.246 Dutch people between 16 and 70 years old on their attitude towards the environment. The following subjects were investigated: attitude towards nature and environment, ways to solve problems, tasks of environmental organizations, sustainable solutions, green reputation of politicians, well-known Dutch people and businesses [Dutch] Een samenvatting is gegeven van een enquete onder 1.246 Nederlanders tussen 16 en 70 jaar inzake hun houding tegenover natuur en milieu. De volgende onderwerpen komen aan de orde: Houding tegenover het thema natuur en milieu; Oplossingsrichtingen; Taken van milieuorganisaties; Oplossingen op het gebied van duurzaamheid; Groen imago politici, bekende Nederlanders en bedrijven.

  2. 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

  3. Radiation protection dosimetry in medicine - Report of the working group n.9 of the European radiation dosimetry group (EURADOS) - coordinated network for radiation dosimetry (CONRAD - contract EC N) fp6-12684; Dosimetrie pour la radioprotection en milieu medical - rapport du groupe de travail n. 9 du European radiation dosimetry group (EURADOS) - coordinated netword for radiation dosimetry (CONRAD - contrat CE fp6-12684)

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2009-07-01

    This report present the results achieved within the frame of the work the WP 7 (Radiation Protection Dosimetry of Medical Staff) of the coordination action CONRAD (Coordinated Network for Radiation Dosimetry) funded through the 6. EU Framework Program. This action was coordinated by EURADOS (European Radiation Dosimetry Group). EURADOS is an organization founded in 1981 to advance the scientific understanding and the technical development of the dosimetry of ionising radiation in the fields of radiation protection, radiobiology, radiation therapy and medical diagnosis by promoting collaboration between European laboratories. WP7 coordinates and promotes European research for the assessment of occupational exposures to staff in therapeutic and diagnostic radiology workplaces. Research is coordinated through sub-groups covering three specific areas: 1. Extremity dosimetry in nuclear medicine and interventional radiology: this sub-group coordinates investigations in the specific fields of the hospitals and studies of doses to different parts of the hands, arms, legs and feet; 2. Practice of double dosimetry: this sub-group reviews and evaluates the different methods and algorithms for the use of dosemeters placed above and below lead aprons in large exposure during interventional radiology procedures, especially to determine effective doses to cardiologists during cardiac catheterization; and 3. Use of electronic personal dosemeters in interventional radiology: this sub-group coordinates investigations in laboratories and hospitals, and intercomparisons with passive dosemeters with the aim to enable the formulation of standards. (authors)

  4. Medical professionalism in China and the United States: a transcultural interpretation.

    Science.gov (United States)

    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.

  5. United States medical school graduate interest in radiology residency programs as depicted by online search tools.

    Science.gov (United States)

    Haney, Nora M; Kinsella, Stuart D; Morey, José M

    2014-02-01

    Recent media publications have indicated a tough job market in medical specialty positions for medical school graduates, specifically in the field of radiology. Internet search tools, such as Google Trends, have proved useful in the prediction of certain diseases on the basis of the search volume index for a specific term. The authors hypothesized that online search tools might be useful in the prediction of US medical school graduates' interest in residency positions in radiology. Google Trends indicated an increase over time in searches for "radiology salary" and a decrease over time in searches for "radiology residency." National Resident Matching Program results for diagnostic radiology showed an increase from 2004 to 2009 in the percentage of US graduates entering radiology but a dramatic drop from 2010 to 2013. This occurred even while the total number of US graduates active in the National Resident Matching Program increased. This finding might have been foretold on the basis of online query result trends. Online search data may be a useful insight into the interests of US medical school graduates and may be predictive of unfilled radiology residency positions and eventual increased shortages of community radiologists coming from US medical schools.

  6. 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.

  7. Mental ill health in the elderly: medical students’ social representations in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Bruno Medeiros

    2014-12-01

    Full Text Available Objective This study aims to explore medical students’ social representations of mental ill health in older adults. Method It comprises an exploratory and qualitative investigation based on the theory of social representations. Two focus groups with pre-clinical medics (group 1, N=4; group 2, N=4 and 10 individual interviews with clinical medical students were conducted. Thematic analysis at a latent level explored meanings and differences between groups. Results Three overarching themes reflect participants’ representations of mental health problems in later life – mental ill health in old age, polarisation of care, and challenges to care. Primary health care appears as an important strategy to overcome barriers to mental health care in the community. Nevertheless, disqualifying representations, stigma and organization of services constitute the main challenges to quality mental health care in later life. Conclusion This paper highlights the need to address cultural and organizational barriers to promote quality care.

  8. Comprehensive geriatric assessment on an acute medical unit: a qualitative study of older people's and informal carer's perspectives of the care and treatment received.

    Science.gov (United States)

    Darby, Janet; Williamson, Tracey; Logan, Pip; Gladman, John

    2017-01-01

    This qualitative study was imbedded in a randomized controlled trial evaluating the addition of geriatricians to usual care to enable the comprehensive geriatric assessment process with older patients on acute medical units. The qualitative study explored the perspectives of intervention participants on their care and treatment. A constructivist study incorporating semi-structured interviews that were conducted in patients' homes within six weeks of discharge from the acute medical unit. These interviews were recorded, transcribed, and analysed using thematic analysis. An acute medical unit in the United Kingdom. Older patients ( n = 18) and their informal carers ( n = 6) discharged directly home from an acute medical unit, who had been in the intervention group of the randomized controlled trial. Three core themes were constructed: (1) perceived lack of treatment on the acute medical unit; (2) nebulous grasp of the role of the geriatrician; and (3) on-going health and activities of daily living needs postdischarge. These needs impacted upon the informal carers, who either took over, or helped the patients to complete their activities of daily living. Despite the help received with activities of daily living, a lot of the patients voiced a desire to complete these activities themselves. The participants perceived they were just monitored and observed on the acute medical unit, rather than receiving active treatment, and spoke of on-going unresolved health and activity of daily living needs following discharge, despite receiving the additional intervention of a geriatrician.

  9. Race/Ethnicity in Medical Education: An Analysis of a Question Bank for Step 1 of the United States Medical Licensing Examination.

    Science.gov (United States)

    Ripp, Kelsey; Braun, Lundy

    2017-01-01

    Phenomenon: There is growing concern over racial/ethnic bias in clinical care, yet how best to reduce bias remains challenging, in part because the sources of bias in medical education are poorly understood. One possible source is the routinized use of race/ethnicity in lectures, assessment, and preparatory materials, including question banks for licensing examinations. Because students worldwide use question banks to prepare for the United States Medical Licensing Examination, we examined how race/ethnicity was used in one of the most commonly recommended question banks. We analyzed the use of race/ethnicity in all 2,211 questions in a question bank for Step 1 of the United States Medical Licensing Examination for the following: the frequency of mentions of racial/ethnic groups, whether the use of race/ethnicity was merely descriptive or was central to any part of the question, and whether the question associated race/ethnicity with genetic difference. In sum, 455 of the 2,011 (20.6%) of the questions in the question bank referred to race/ethnicity in the question stem, answer, or educational objective. The frequency of mentions of racial/ethnicity was disproportionate to the U.S. 85.8% referred to White/Caucasians, 9.70% to Black/African Americans, 3.16% to Asian, 0.633% to Hispanics, and 0.633% to Native Americans. No cases referred to Native Hawaiians/Pacific Islanders. The proportion of mentions of race/ethnicity classified as either a routine descriptor or central to the case varied by racial/ethnic category. The association between genetics and disease in cases also varied by racial/ethnic category. Insights. The routinized use of race/ethnicity with no specific goal in preparation materials, such as question banks, risks contributing to racial bias. The implications of routinized use extend to assessment in medical education. Race/ethnicity should be used only when referring to social experiences of groups relevant to their health, not as a proxy for

  10. Subterranean medicine: an inquiry into underground medical treatment protocols in cave rescue situations in national parks in the United States.

    Science.gov (United States)

    Hooker, K; Shalit, M

    2000-01-01

    Caving and spelunking have become increasingly popular over the years, with hundreds of thousands of amateur spelunkers across the country visiting caves. National parks in the United States offer hundreds of caves for all levels of spelunkers and, in fact, many national parks boast caves as either their main or major attraction. In an effort to increase visitor safety and establish subterranean medical treatment protocols, we began an investigation into cave rescue, medical protocols, previously published recommendations concerning cave safety, and visitor and rescue statistics in the national parks. Our inquiry provided little guidance from either the literature or the present US National Parks database for treating underground injuries. However, 2 predominant trends did appear. First, despite the nearly 2 million visitors to the caves in the 14 parks surveyed, there were only about 200 total calls for medical care. The vast number of those calls were for minor injuries. Second, no strict evidence-based treatment protocols for underground injuries exist, probably because they are not feasible. A caving incident database for the national parks would facilitate suggestions for preventative measures for the minor injuries and would help catalog the creative solutions for the rare serious subterranean medical incident.

  11. Unmet Needs for Ancillary Services Among Hispanics/Latinos Receiving HIV Medical Care - United States, 2013-2014.

    Science.gov (United States)

    Korhonen, Lauren C; DeGroote, Nicholas P; Shouse, R Luke; Valleroy, Linda A; Prejean, Joseph; Bradley, Heather

    2016-10-14

    The prevalence of diagnosed human immunodeficiency virus (HIV) infection in Hispanics/Latinos in the United States is more than twice as high as the prevalence among non-Hispanic whites (1). Services that support retention in HIV medical care and assist with day-to-day living, referred to here as ancillary services, help persons living with HIV access HIV medical care, adhere to HIV treatment, and attain HIV viral suppression. The needs for these ancillary services among Hispanics/Latinos are not well described (2). To obtain nationally representative estimates of and reasons for unmet needs for such services among Hispanic/Latino adults receiving outpatient HIV medical care during 2013-2014, CDC analyzed data from the Medical Monitoring Project (MMP). The analysis found that Hispanics/Latinos in all age and sexual orientation/behavior subgroups reported substantial unmet needs, including 24% needing dental care, 21% needing eye or vision care, 15% needing food and nutrition services, and 9% needing transportation assistance. Addressing unmet needs for ancillary services among Hispanics/Latinos living with HIV might help increase access to HIV care, improve health outcomes, and reduce health disparities.

  12. Medical and Family Leave: Benefits Available to Female Workers in the United States.

    Science.gov (United States)

    National Council of Jewish Women, New York, NY. Center for the Child.

    This paper discusses a national survey of employee benefits designed to investigate the extent to which employers have independently implemented basic components of a comprehensive maternity plan. Components include: (1) standard policies that set the period of leave; (2) job-protected medical leave for maternity; (3) employer contributions to…

  13. Strategies for safe medication use in ambulatory care settings in the United States.

    Science.gov (United States)

    Sorensen, Asta V; Bernard, Shulamit L

    2009-09-01

    This study aims to identify strategies for safe medication use practices in ambulatory care settings, with a special focus on clinical pharmacy services. We conducted case studies on 34 organizations, more than half of which were safety net providers. Data included discussions with 186 key informants, 3 interim debriefings, and a technical expert panel. We analyzed qualitative data using inductive analysis techniques and grounded theory approach. Ambulatory care organizations practice a broad range of safe medication use strategies. The inclusion of clinical pharmacy services is a culture change that supports efforts to improve patient safety and patient-centered care. Organizations integrated clinical pharmacy services when they introduced such services in a purposefully paced and gradual manner. Organizations sustained such services when they collected and reported data demonstrating improvements in patient outcomes and cost savings. Clinical pharmacy services were generally accompanied by strategies that helped organizations to provide patient-centered care; collect and measure process, safety, and clinical outcomes; promote leadership commitment; and integrate care delivery processes. These strategies interacted within organizations in synergistic rather than hierarchical or linear way. Organizational ability to provide safe, patient-centered, and efficient care that is supported by measurable data largely depends on leadership commitment and ability to integrate care processes. Ambulatory care organizations use multiple strategies for safe medication use systems. Understanding processes that promote such strategies will provide a helpful road map for other organizations in implementation and sustainability of safe medication use systems.

  14. National survey of clinical communication assessment in medical education in the United Kingdom (UK)

    Science.gov (United States)

    2014-01-01

    Background All medical schools in the UK are required to be able to provide evidence of competence in clinical communication in their graduates. This is usually provided by summative assessment of clinical communication, but there is considerable variation in how this is carried out. This study aimed to gain insight into the current assessment of clinical communication in UK medical schools. Methods The survey was sent via e-mail to communication leads who then were asked to consult with all staff within their medical school involved in the assessment of communication. Results Results were obtained from 27 out of 33 schools (response rate 82%) and a total of 34 courses. The average number of assessments per year was 2.4 (minimum 0, maximum 10). The Objective Structured Clinical Exam (OSCE) was the most commonly used method of assessment (53%). Other assessments included MCQ and workplace based assessments. Only nine courses used a single method of assessment. Issues raised included, logistics and costs of assessing mainly by OSCE, the robustness and reliability of such exams and integration with other clinical skills. Conclusions It is encouraging that a variety of assessment methods are being used within UK medical schools and that these methods target different components of clinical communication skills acquisition. PMID:24417939

  15. Medical Entomology in the United States Department of Defense: Challenging and Rewarding

    Science.gov (United States)

    2011-06-01

    insect and vector control programs. In 2003, the Republic of Palau requested US assist- ance in conducting surveillance for Aedes aegypti , a primary...preventive medi- cine teams remain vigilant on a global basis. Military medical entomologists have a long and proud history of ‘serving those who

  16. Medical Diplomacy in the United States Army: A Concept Whose Time Has Come

    Science.gov (United States)

    2008-06-13

    medical diplomacy, comparing the five million dollars spent refurbishing the Rabia Balkhi hospital in Kabul Afghanistan with the eight billion dollars...tat once saw nearly one in five children die at birth”, Mr. Thompson pointed out. Those patients being born and treated today in the Rabia Balkhi

  17. Training Groups and Foreign-Born Psychiatric Medical Residents in the United States.

    Science.gov (United States)

    Greenberg, Andrea; Juthani, Nalini

    1991-01-01

    About two-thirds of all psychiatry residents are foreign-born medical graduates. Discusses the operation, content, focus, challenges, and benefits of a training group experience for the psychiatry residents at Bronx Lebanon Hospital. The goals are to aid acculturation, improve group psychotherapeutic skills, encourage self-awareness, and promote…

  18. The United States Army Medical Department Journal. April-June 2010

    Science.gov (United States)

    2010-06-01

    deep breathing, journaling, tai chi, meditation , guided imagery, and biofeedback, just to name a few. These are techniques that most medical...doubled as a classroom . The clinic could accommodate instruction of up to 6 hearing technician students who not only used the training systems

  19. [Initiation to military medical corps activity modalities: a teaching unit providing a new approach to recruiting reserve pharmacists].

    Science.gov (United States)

    Labrude, P

    2004-07-01

    During the last ten Years, major reforms have been implemented in the French armies due to discontinuation of mandatory enlistment. For the medical corps, recruitment and training for reservists has ceased since the national school for reserve officers in Libourne was closed. During this same time, the number of foreign engagements of the French armies has revealed the need for available young reserve officers in the medical corps. Reserve training of students in medicine, pharmacy, odontology, or nursing has been considered and different possibilities considered. One option is to develop a teaching unit during the third Year of the curriculum allowing volunteer students to become junior officers. For pharmacy students, specific training on drug supply, nuclear, biological and chemical weapons and terrorism as well as clinical chemistry, toxicology, and hygiene are also organized.

  20. 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.

  1. Introducing geriatric health in medical training in Ajman, United Arab Emirates: A co-curricular approach

    Directory of Open Access Journals (Sweden)

    Mathew E

    2011-06-01

    Full Text Available BackgroundMedical students’ knowledge and understanding of theelderly will affect the quality of care to the rising populationof older adults which points to a need to identify geriatrichealth training methods appropriate for the region andcurriculum. Therefore the study assessed the effect of a cocurricularintroductory workshop on knowledge regardinggeriatric health and attitude towards the elderly amongfourth year medical students in a medical universityMethodA quasi-experimental before-after study, with control wasconducted at Gulf Medical College among 60 medicalstudents from discipline-based curriculum in year IV duringMay–June 2010 of whom 16 had opted (attendees toundergo the introductory course, a five day workshop of 10hours duration. Pre- and post-testing used self-administeredquestionnaires for demographic variables: age, gender,nationality, close contact with older people; a quiz on oldpeople’s health, and Kogan’s Old People Scale (KOPS forattitude. The difference in scores on quiz and KOPS werecompared for the attendees and 26 non-attendees whoparticipated in both pre and post testing.ResultsThe attendees group had 38% male and 62% femaleparticipants and the non-attendees group had 21% and 79%respectively. The groups were not significantly different inage, sex, nationality and close contact with the elderly. Thescores on the quiz and KOPS showed no statisticallysignificant difference between the two groups before orafter the workshop. Almost all the participants evaluatedthe workshop very positively especially the interaction withhealthy elderly and inmates of old people’s home.ConclusionA 10-hour introductory co-curricular workshop made nosignificant change in the knowledge on geriatric health orattitude of fourth year medical students though theyreported it as a very enriching experience. A reflectivereport may have been a better assessment tool and theimpact on their clinical practice cannot be predicted.

  2. Vital signs: health burden and medical costs of nonfatal injuries to motor vehicle occupants - United States, 2012.

    Science.gov (United States)

    Bergen, Gwen; Peterson, Cora; Ederer, David; Florence, Curtis; Haileyesus, Tadesse; Kresnow, Marcie-jo; Xu, Likang

    2014-10-10

    Motor vehicle crashes are a leading cause of death and injury in the United States. The purpose of this study was to describe the current health burden and medical and work loss costs of nonfatal crash injuries among vehicle occupants in the United States. CDC analyzed data on emergency department (ED) visits resulting from nonfatal crash injuries among vehicle occupants in 2012 using the National Electronic Injury Surveillance System – All Injury Program (NEISS-AIP) and the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS). The number and rate of all ED visits for the treatment of crash injuries that resulted in the patient being released and the number and rate of hospitalizations for the treatment of crash injuries were estimated, as were the associated number of hospital days and lifetime medical and work loss costs. In 2012, an estimated 2,519,471 ED visits resulted from nonfatal crash injuries, with an estimated lifetime medical cost of $18.4 billion (2012 U.S. dollars). Approximately 7.5% of these visits resulted in hospitalizations that required an estimated 1,057,465 hospital days in 2012. Nonfatal crash injuries occur frequently and result in substantial costs to individuals, employers, and society. For each motor vehicle crash death in 2012, eight persons were hospitalized, and 100 were treated and released from the ED. Public health practices and laws, such as primary seat belt laws, child passenger restraint laws, ignition interlocks to prevent alcohol impaired driving, sobriety checkpoints, and graduated driver licensing systems have demonstrated effectiveness for reducing motor vehicle crashes and injuries. They might also substantially reduce associated ED visits, hospitalizations, and medical costs.

  3. Republished paper: Improving safety culture on adult medical units through multidisciplinary teamwork and communication interventions: the TOPS Project.

    Science.gov (United States)

    Blegen, M A; Sehgal, N L; Alldredge, B K; Gearhart, S; Auerbach, A A; Wachter, R M

    2010-12-01

    The goal of this project was to improve unit-based safety culture through implementation of a multidisciplinary (pharmacy, nursing, medicine) teamwork and communication intervention. The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture was used to determine the impact of the training with a before-after design. Surveys were returned from 454 healthcare staff before the training and 368 staff 1 year later. Five of eleven safety culture subscales showed significant improvement. Nurses perceived a stronger safety culture than physicians or pharmacists. While it is difficult to isolate the effects of the team training intervention from other events occurring during the year between training and postevaluation, overall the intervention seems to have improved the safety culture on these medical units.

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

    2017-01-01

    textabstractBackground: 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 reduced by usi

  5. [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.

  6. The Association between Non-Medical Prescription Drug Use and Suicidal Behavior among United States Adolescents

    Directory of Open Access Journals (Sweden)

    Amanda L. Divin

    2014-11-01

    Full Text Available Adolescence represents a vulnerable time for the development of both drug use/abuse and mental illness. Although previous research has substantiated a relationship between drug use and suicidal behavior, little research has examined this relationship with non-medical prescription drug use. Given the growing prevalence of non-medical prescription drug use (NMPDU among adolescents, this study explored the association between NMPDU and suicidal behavior. Nationally representative data were derived from 16, 410 adolescents who completed the 2009 National Youth Risk Behavior Survey. Approximately 19.8% of participants reported lifetime NMPDU. NMPDU was associated with significantly increased odds of suicidal behavior (P < 0.01, with seriously considering attempting suicide and making a plan about attempting suicide representing the strongest correlates for males and females. Results suggest the importance of 1 continued reinforcement of drug education programs in high school begun at earlier ages and 2 mental health care and screenings among adolescents.

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

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    Balmer JT

    2013-09-01

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

  8. Impact of Endotracheal Intubation on Interventional Endoscopy Unit Efficiency Metrics at a Tertiary Academic Medical Center.

    Science.gov (United States)

    Perbtani, Yaseen B; Summerlee, Robert J; Yang, Dennis; An, Qi; Suarez, Alejandro; Williamson, J Blair; Shrode, Charles W; Gupte, Anand R; Chauhan, Shailendra S; Draganov, Peter V; Forsmark, Chris E; Chang, Myron; Wagh, Mihir S

    2016-06-01

    Measures for evaluating interventional endoscopy unit efficiency have not been adequately validated, especially in reference to the involvement of anesthesia services for endoscopy. Primary aim was to compare process measures/metrics of interventional endoscopy unit efficiency between intubated and non-intubated patients. Secondary aim was to assess variables associated with the need for endotracheal intubation. The prospectively collected endoscopy unit metrics database at UF Health was reviewed for procedures performed in the interventional endoscopy unit for 6 months. Parameters included hospital-mandated metrics available from the database. A total of 1,421 patients underwent 1,635 interventional endoscopic procedures and 271/1,421 patients (19.1%) were intubated. There was no significant difference between intubated and non-intubated cohorts with respect to age, gender, BMI, ASA Score, Mallampati Score, or the Charlson Comorbidity Index. Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) were more frequently intubated than those undergoing non-ERCP procedures (41.3 vs. 12.4%, Pintubated patients, whereas only 29.2% of non-intubated patients were inpatients (Pintubated per anesthesiologist preference. All process efficiency metrics were significantly prolonged in the intubated compared with the non-intubated patient cohort, except the time interval between successive procedures. Multivariate analysis revealed that patients with an anesthesiologist who had performed a greater number of total endoscopic sedations were less likely to be intubated than patients with an anesthesiologist who had performed fewer total procedures (P=0.0066). Endotracheal intubation negatively impacts efficiency metrics in an interventional endoscopy unit. Careful assessment for the need for intubation should be emphasized.

  9. How Does Medical Device Regulation Perform in the United States and the European Union? A Systematic Review

    Science.gov (United States)

    Kramer, Daniel B.; Xu, Shuai; Kesselheim, Aaron S.

    2012-01-01

    Background Policymakers and regulators in the United States (US) and the European Union (EU) are weighing reforms to their medical device approval and post-market surveillance systems. Data may be available that identify strengths and weakness of the approaches to medical device regulation in these settings. Methods and Findings We performed a systematic review to find empirical studies evaluating medical device regulation in the US or EU. We searched Medline using two nested categories that included medical devices and glossary terms attributable to the US Food and Drug Administration and the EU, following PRISMA guidelines for systematic reviews. We supplemented this search with a review of the US Government Accountability Office online database for reports on US Food and Drug Administration device regulation, consultations with local experts in the field, manual reference mining of selected articles, and Google searches using the same key terms used in the Medline search. We found studies of premarket evaluation and timing (n = 9), studies of device recalls (n = 8), and surveys of device manufacturers (n = 3). These studies provide evidence of quality problems in pre-market submissions in the US, provide conflicting views of device safety based largely on recall data, and relay perceptions of some industry leaders from self-surveys. Conclusions Few studies have quantitatively assessed medical device regulation in either the US or EU. Existing studies of US and EU device approval and post-market evaluation performance suggest that policy reforms are necessary for both systems, including improving classification of devices in the US and promoting transparency and post-market oversight in the EU. Assessment of regulatory performance in both settings is limited by lack of data on post-approval safety outcomes. Changes to these device approval and post-marketing systems must be accompanied by ongoing research to ensure that there is better assessment of

  10. How does medical device regulation perform in the United States and the European union? A systematic review.

    Directory of Open Access Journals (Sweden)

    Daniel B Kramer

    Full Text Available BACKGROUND: Policymakers and regulators in the United States (US and the European Union (EU are weighing reforms to their medical device approval and post-market surveillance systems. Data may be available that identify strengths and weakness of the approaches to medical device regulation in these settings. METHODS AND FINDINGS: We performed a systematic review to find empirical studies evaluating medical device regulation in the US or EU. We searched Medline using two nested categories that included medical devices and glossary terms attributable to the US Food and Drug Administration and the EU, following PRISMA guidelines for systematic reviews. We supplemented this search with a review of the US Government Accountability Office online database for reports on US Food and Drug Administration device regulation, consultations with local experts in the field, manual reference mining of selected articles, and Google searches using the same key terms used in the Medline search. We found studies of premarket evaluation and timing (n = 9, studies of device recalls (n = 8, and surveys of device manufacturers (n = 3. These studies provide evidence of quality problems in pre-market submissions in the US, provide conflicting views of device safety based largely on recall data, and relay perceptions of some industry leaders from self-surveys. CONCLUSIONS: Few studies have quantitatively assessed medical device regulation in either the US or EU. Existing studies of US and EU device approval and post-market evaluation performance suggest that policy reforms are necessary for both systems, including improving classification of devices in the US and promoting transparency and post-market oversight in the EU. Assessment of regulatory performance in both settings is limited by lack of data on post-approval safety outcomes. Changes to these device approval and post-marketing systems must be accompanied by ongoing research to ensure that there is

  11. Use of Curricular and Extracurricular Assessments to Predict Performance on the United States Medical Licensing Examination (USMLE) Step 1: A Multi-Year Study

    Science.gov (United States)

    Gandy, Robyn A.; Herial, Nabeel A.; Khuder, Sadik A.; Metting, Patricia J.

    2008-01-01

    This paper studies student performance predictions based on the United States Medical Licensure Exam (USMLE) Step 1. Subjects were second-year medical students from academic years of 2002 through 2006 (n = 711). Three measures of basic science knowledge (two curricular and one extracurricular) were evaluated as predictors of USMLE Step 1 scores.…

  12. Blood Program in World War II. Medical Department, United States Army

    Science.gov (United States)

    1964-01-01

    fowl malaria at the Naval Medical School had indicated that this variety of Pl43modium does not survive in dried plasma. Recent observations in Puerto ...1)4 )11 Ivs prm Idell shill)III1,111 . I I V \\1 VP A :14 I’ll I )FIFF It \\1 I N \\’III( JINS :opper SidlIkalle Falling- I )rojo Tesi A .1111...Pacific airlift, 602-603 in fractionation of plasma, 343 Puerperal hemorrhage, transfusion for, I in gelatin, 375, 376 Puerto Rico, 143 in intravenous

  13. 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.

  14. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  16. The study of life change unit as stressor agents among Tehran University of Medical Sciences Hospitals' employees.

    Science.gov (United States)

    Dargahi, Hossein; Sharifiy Yazdi, Mohammad Kazem

    2010-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. Receipt of HIV/STD Prevention Counseling by HIV-Infected Adults Receiving Medical Care in the United States

    Science.gov (United States)

    MIZUNO, Yuko; ZHU, Julia; CREPAZ, Nicole; BEER, Linda; PURCELL, David W.; JOHNSON, Christopher H.; VALVERDE, Eduardo E.; SKARBINSKI, Jacek

    2015-01-01

    Objective Guidelines recommend risk-reduction counseling by HIV providers to all HIV-infected persons. Among HIV-infected adults receiving medical care in the United States, we estimated prevalence of exposure to three types of HIV/sexually transmitted disease (STD) risk-reduction interventions and described the characteristics of persons who received these interventions. Design Data were from the Medical Monitoring Project (MMP), a supplemental HIV surveillance system designed to produce nationally representative estimates of behavioral and clinical characteristics of HIV-infected adults receiving medical care in the United States. Methods Descriptive analyses were conducted to estimate the exposure to each type of HIV/STD risk-reduction intervention. Bivariate and multivariable analyses were conducted to assess associations between the selected correlates with each exposure variable. Results About 44% of participants reported a one-on-one conversation with a health care provider about HIV/STD prevention, 30% with a prevention program worker, 16% reported participation in a small group risk-reduction intervention, and 52% reported receiving at least one of the three interventions in the past 12 months. Minority race/ethnicity, low income, and risky sexual behavior consistently predicted greater intervention exposure. However, 39% of persons who reported risky sex did not receive any HIV/STD risk-reduction interventions. Conclusions HIV-infected persons in care with fewer resources or those who engaged in risk behaviors were more likely to receive HIV/STD risk-reduction interventions. However, less than half of HIV-infected persons in care received HIV/STD prevention counseling from their provider, an intervention that has been shown to be effective and is supported by guidelines. PMID:24056066

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

    Directory of Open Access Journals (Sweden)

    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

  20. Medical conditions among Iraqi refugees in Jordan: data from the United Nations Refugee Assistance Information System

    Science.gov (United States)

    Carone, Marco; Al-Saedy, Huda; Nyce, Sayre; Ghosn, Jad; Mutuerandu, Timothy; Black, Robert E

    2012-01-01

    Abstract Objective To determine the range and burden of health services utilization among Iraqi refugees receiving health assistance in Jordan, a country of first asylum. Methods Medical conditions, diagnosed in accordance with the tenth revision of the International classification of diseases, were actively monitored from 1January to 31December 2010 using a pilot centralized database in Jordan called the Refugee Assistance Information System. Findings There were 27 166 medical visits by 7642 Iraqi refugees (mean age: 37.4 years; 49% male; 70% from Baghdad; 6% disabled; 3% with a history of torture). Chronic diseases were common, including essential hypertension (22% of refugees), visual disturbances (12%), joint disorders (11%) and type II diabetes mellitus (11%). The most common reasons for seeking acute care were upper respiratory tract infection (11%), supervision of normal pregnancy (4%) and urinary disorders (3%). The conditions requiring the highest number of visits per refugee were cerebrovascular disease (1.46 visits), senile cataract (1.46) and glaucoma (1.44). Sponsored care included 31 747 referrals or consultations to a specialty service, 18 432 drug dispensations, 2307 laboratory studies and 1090 X-rays. The specialties most commonly required were ophthalmology, dentistry, gynaecology and orthopaedic surgery. Conclusion Iraqi refugees in countries of first asylum and resettlement require targeted health services, health education and sustainable prevention and control strategies for predominantly chronic diseases. PMID:22690034

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

    Science.gov (United States)

    Okoniewska, Barbara; Santana, Maria Jose; Groshaus, Horacio; Stajkovic, Svetlana; Cowles, Jennifer; Chakrovorty, David; Ghali, William A

    2015-01-01

    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. 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. 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. 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 teaching unit and occurred on a daily basis between the multidisciplinary team. To help facilitate provider-patient communication, electronic transfer of care summaries were suggested as a potential solution. To help role clarity, a discharge coordinator and/or liaison was suggested. Communication can be enhanced through use of electronic discharge summaries, bullet rounds, and implementation of a discharge coordinator(s). The findings from this study can be used to aid future researchers in devising appropriate

  2. Association of nursing overtime, nurse staffing and unit occupancy with medical incidents and outcomes of very preterm infants.

    Science.gov (United States)

    Beltempo, M; Lacroix, G; Cabot, M; Blais, R; Piedboeuf, B

    2017-09-21

    To examine the association of nursing overtime, nursing provision and unit occupancy rate with medical incident rates in the neonatal intensive care unit (NICU) and the risk of mortality or major morbidity among very preterm infants. Single center retrospective cohort study of infants born within 23 to 29 weeks of gestational age or birth weight bed, level III NICU. Nursing overtime ratios (nursing overtime hours/total nursing hours), nursing provision ratios (nursing hours/recommended nursing hours based on patient dependency categories) and unit occupancy rates were pooled for all shifts during NICU hospitalization of each infant. Log-binomial models assessed their association with the composite outcome (mortality or major morbidity). Of the 257 infants that met the inclusion criteria, 131 (51%) developed the composite outcome. In the adjusted multivariable analyses, high (>3.4%) relative to low nursing overtime ratios (⩽3.4%) were not associated with the composite outcome (relative risk (RR): 0.93; 95% confidence interval (CI): 0.86 to 1.02). High nursing provision ratios (>1) were associated with a lower risk of the composite outcome relative to low ones (⩽1) (RR: 0.81; 95% CI: 0.74 to 0.90). NICU occupancy rates were not associated with the composite outcome (RR: 0.98; 95% CI: 0.89 to 1.07, high (>100%) vs low (⩽100%)). Days with high nursing provision ratios (>1) were also associated with lower risk of having medical incidents (RR: 0.91; 95% CI: 0.82 to 0.99). High nursing provision ratio during NICU hospitalization is associated with a lower risk of a composite adverse outcome in very preterm infants.Journal of Perinatology advance online publication, 21 September 2017; doi:10.1038/jp.2017.146.

  3. Does HIV Exploit the Inflammatory Milieu of the Male Genital Tract for Successful Infection?

    Science.gov (United States)

    Esra, Rachel T.; Olivier, Abraham J.; Passmore, Jo-Ann S.; Jaspan, Heather B.; Harryparsad, Rushil; Gray, Clive M.

    2016-01-01

    In many parts of the World, medical male circumcision (MMC) is used as standard prevention of care against HIV infection. This is based on seminal reports made over 10 years ago that removal of the foreskin provides up to 60% protection against HIV infection in males and seems currently the best antiretroviral-free prevention strategy yet against the global epidemic. We explore the potential mechanisms by which MMC protects against HIV-1 acquisition and that one of the oldest, albeit re-invented, rituals of removing a foreskin underscores the exploitative nature of HIV on the anatomy and tissue of the uncircumcised penis. Furthermore, foreskin removal also reveals how males acquire HIV, and in reality, the underlying mechanisms of MMC are not known. We argue that the normal sequelae of inflammation in the male genital tract (MGT) for protection from sexually transmitted infections (STI)-induced pathology represents a perfect immune and microbial ecosystem for HIV acquisition. The accumulation of HIV-1 target cells in foreskin tissue and within the urethra in response to STIs, both during and after resolution of infection, suggests that acquisition of HIV-1, through sexual contact, makes use of the natural immune milieu of the MGT. Understanding immunity in the MGT, the movement of HIV-1 target cells to the urethra and foreskin tissue upon encounter with microbial signals would provide more insight into viral acquisition and lay the foundation for further prevention strategies in males that would be critical to curb the epidemic in all sexual partners at risk of infection. The global female-centric focus of HIV-1 transmission and acquisition research has tended to leave gaps in our knowledge of what determines HIV-1 acquisition in men and such understanding would provide a more balanced and complete view of viral acquisition. PMID:27446076

  4. 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.

  5. Multimethod and Interpersonal Assessment in Medical Settings: A Case Study from the Dermatology Unit

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    Chiara Vari

    2014-01-01

    Full Text Available Psoriasis is a chronic skin disease with multifactorial aetiology. The psychological impact of skin diseases is increasingly recognised, but only scant attention has been given to the possible role of couple relationships as protective factors for dermatology patients. This article presents a multimethod assessment conducted along with physical examination at a Dermatology Unit. Specifically, the assessment includes measures of emotion regulation and attachment. The first aim of the article is to support an integrated assessment of dermatological and psychological factors together. The second aim is to highlight the possible role of couple relationships in the management of skin diseases.

  6. Web-based, virtual course units as a didactic concept for medical teaching.

    Science.gov (United States)

    Schultze-Mosgau, Stefan; Zielinski, Thomas; Lochner, Jürgen

    2004-06-01

    The objective was to develop a web-based, virtual series of lectures for evidence-based, standardized knowledge transfer independent of location and time with possibilities for interactive participation and a concluding web-based online examination. Within the framework of a research project, specific Intranet and Internet capable course modules were developed together with a concluding examination. The concept of integrating digital and analogue course units supported by sound was based on FlashCam (Nexus Concepts), Flash MX (Macromedia), HTML and JavaScript. A Web server/SGI Indigo Unix server was used as a platform by the course provider. A variety of independent formats (swf, avi, mpeg, DivX, etc.) were integrated in the individual swf modules. An online examination was developed to monitor the learning effect. The examination papers are automatically forwarded by email after completion. The results are also returned to the user automatically after they have been processed by a key program and an evaluation program. The system requirements for the user PC have deliberately been kept low (Internet Explorer 5.0, Flash-Player 6, 56 kbit/s modem, 200 MHz PC). Navigation is intuitive. Users were provided with a technical online introduction and a FAQ list. Eighty-two students of dentistry in their 3rd to 5th years of study completed a questionnaire to assess the course content and the user friendliness (SPSS V11) with grades 1 to 6 (1 = 'excellent' and 6 = 'unsatisfactory'). The course units can be viewed under the URL: http://giga.rrze.uni-erlangen.de/movies/MKG/trailer and URL: http://giga.rrze.uni-erlangen.de/movies/MKG/demo/index. Some 89% of the students gave grades 1 (excellent) and 2 (good) for accessibility independent of time and 83% for access independent of location. Grades 1 and 2 were allocated for an objectivization of the knowledge transfer by 67% of the students and for the use of video sequences for demonstrating surgical techniques by 91% of the

  7. 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.

  8. Complementary and alternative medical therapies for interstitial cystitis: an update from the United States.

    Science.gov (United States)

    Atchley, Megan Danielle; Shah, Nima M; Whitmore, Kristene E

    2015-12-01

    The diagnosis and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) has shifted from organ-specific to a multifactorial, multidisciplinary and individualized approach. Patients with refractory and debilitating symptoms may respond to complementary and alternative medical treatments (CAM). Through CAM therapies, practitioners assist the patient to be at the center of their care, empowering them to be emotionally and physically involved. Multi-disciplinary care, including urology, gynecology, gastroenterology, neurology, psychology, physiotherapy and pain medicine, is also identified to be the crux of adequate management of patients with chronic pelvic pain because of its variable etiology. The purpose of this review is to emphasize these changes and discuss management strategies.

  9. [Practice and research into multi-unit teaching of Medical Genetics.].

    Science.gov (United States)

    Du, Shao-Ling; Xu, Si-Bin; Gong, Lei; Zhu, Xiao-Lei; Wang, Ping; Lin, Ai-Qin

    2010-10-01

    In order to fully arise the enthusiasm of students in active learning and promote their development, we attempted such multiple class teaching methods in teaching medical science of genetics as elaboration of the basic theory of genetics, synopsis on the advance of this field, application of multimedia teaching, case-based teaching, role-play change in class teaching, instructions on writing of reviewing articles and academic assessment by diverse examination. The results suggest that multiple teaching methods can greatly enhance the efficiency of class teaching and comprehensively cultivate the academic ability of the students as well as improve the quality of teachers. Compared with the conventional class teaching, students are much interested in giving lessons by case-based study, CAI teaching and role change of teachers and students in class teaching, which resulted in improvement of self-disciplined study of students, problem settlement, class performance, awareness of the importance of scientific research and reinforcement of team work.

  10. Web Implementation of Quality Assurance (QA) for X-ray Units in Balkanic Medical Institutions.

    Science.gov (United States)

    Urošević, Vlade; Ristić, Olga; Milošević, Danijela; Košutić, Duško

    2015-08-01

    Diagnostic radiology is the major contributor to the total dose of the population from all artificial sources. In order to reduce radiation exposure and optimize diagnostic x-ray image quality, it is necessary to increase the quality and efficiency of quality assurance (QA) and audit programs. This work presents a web application providing completely new QA solutions for x-ray modalities and facilities. The software gives complete online information (using European standards) with which the corresponding institutions and individuals can evaluate and control a facility's Radiation Safety and QA program. The software enables storage of all data in one place and sharing the same information (data), regardless of whether the measured data is used by an individual user or by an authorized institution. The software overcomes the distance and time separation of institutions and individuals who take part in QA. Upgrading the software will enable assessment of the medical exposure level to ionizing radiation.

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

    Directory of Open Access Journals (Sweden)

    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

  12. 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

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

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    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

  14. Involvement of consumers in studies run by the Medical Research Council Clinical Trials Unit: Results of a survey

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    Vale Claire L

    2012-01-01

    Full Text Available Abstract Background We aimed to establish levels of consumer involvement in randomised controlled trials (RCTs, meta-analyses and other studies carried out by the UK Medical Research Council (MRC Clinical Trials Unit across the range of research programs, predominantly in cancer and HIV. Methods Staff responsible for studies that were included in a Unit Progress Report (MRC CTU, April 2009 were asked to complete a semi-structured questionnaire survey regarding consumer involvement. This was defined as active involvement of consumers as partners in the research process and not as subjects of that research. The electronic questionnaires combined open and closed questions, intended to capture quantitative and qualitative information on whether studies had involved consumers; types of activities undertaken; recruitment and support; advantages and disadvantages of involvement and its perceived impact on aspects of the research. Results Between October 2009 and April 2010, 138 completed questionnaires (86% were returned. Studies had been conducted over a 20 year period from 1989, and around half were in cancer; 30% in HIV and 20% were in other disease areas including arthritis, tuberculosis and blood transfusion medicine. Forty-three studies (31% had some consumer involvement, most commonly as members of trial management groups (TMG [88%]. A number of positive impacts on both the research and the researcher were identified. Researchers generally felt involvement was worthwhile and some felt that consumer involvement had improved the credibility of the research. Benefits in design and quality, trial recruitment, dissemination and decision making were also perceived. Researchers felt they learned from consumer involvement, albeit that there were some barriers. Conclusions Whilst most researchers identified benefits of involving consumers, most of studies included in the survey had no involvement. Information from this survey will inform the development

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

    Science.gov (United States)

    Ekerstad, Niklas; Karlson, Björn W; Dahlin Ivanoff, Synneve; Landahl, Sten; Andersson, David; Heintz, Emelie; Husberg, Magnus; Alwin, Jenny

    2017-01-01

    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 regression analysis, patients in the intervention group were less likely to present with decline in HRQoL after 3 months for the following dimensions: vision (odds ratio [OR] =0.33, 95% confidence interval [CI] =0.14–0.79), ambulation (OR =0.19, 95% CI =0.1–0.37), dexterity (OR =0.38, 95% CI =0.19–0.75), emotion (OR =0.43, 95% CI =0.22–0.84), cognition (OR = 0.076, 95% CI =0.033–0.18) and pain (OR =0.28, 95% CI =0.15–0.50). Treatment in a CGA unit was independently associated with lower 3-month mortality adjusted by Cox regression analysis (hazard ratio [HR] =0.55, 95% CI =0.32–0.96), and the two groups did not differ significantly in terms of hospital care costs (P>0.05). Conclusion Patients in an acute CGA unit were less likely to present with decline in HRQoL after 3 months, and the care in a CGA unit was also independently associated with lower mortality

  16. Trends in use of medical abortion in the United States: reanalysis of surveillance data from the Centers for Disease Control and Prevention, 2001-2008.

    Science.gov (United States)

    Pazol, Karen; Creanga, Andreea A; Zane, Suzanne B

    2012-12-01

    With changing patterns and increasing use of medical abortion in the United States, it is important to have accurate statistics on the use of this method regularly available. This study assesses the accuracy of medical abortion data reported annually to the Centers for Disease Control and Prevention (CDC) and describes trends over time in the use of medical abortion relative to other methods. This analysis included data reported to CDC for 2001-2008. Year-specific analyses included all states that monitored medical abortion for a given year, while trend analyses were restricted to states that monitored medical abortion continuously from 2001 to 2008. Data quality and completeness were assessed by (a) examining abortions reported with an unspecified method type within the gestational age limit for medical abortion (med-eligible abortions) and (b) comparing the percentage of all abortions and med-eligible abortions reported to CDC as medical abortions with estimates based on published mifepristone sales data for the United States from 2001 to 2007. During 2001-2008, the percentage of med-eligible abortions reported to CDC with an unspecified method type remained low (1.0%-2.2%); CDC data and mifepristone sales estimates for 2001-2007 demonstrated strong agreement [all abortions: intraclass correlation coefficient (ICC)=0.983; med-eligible abortions: ICC=0.988]. During 2001-2008, the percentage of abortions reported to CDC as medical abortions increased (pabortions and for med-eligible abortions). Among states that reported medical abortions for 2008, 15% of all abortions and 23% of med-eligible abortions were reported as medical abortions. CDC's Abortion Surveillance System provides an important annual data source that accurately describes the use of medical abortion relative to other methods in the United States. Published by Elsevier Inc.

  17. Health disparities among highly vulnerable populations in the United States: a call to action for medical and oral health care

    Directory of Open Access Journals (Sweden)

    Allison A. Vanderbilt

    2013-03-01

    Full Text Available Healthcare in the United States (US is burdened with enormous healthcare disparities associated with a variety of factors including insurance status, income, and race. Highly vulnerable populations, classified as those with complex medical problems and/or social needs, are one of the fastest growing segments within the US. Over a decade ago, the US Surgeon General publically challenged the nation to realize the importance of oral health and its relationship to general health and well-being, yet oral health disparities continue to plague the US healthcare system. Interprofessional education and teamwork has been demonstrated to improve patient outcomes and provide benefits to participating health professionals. We propose the implementation of interprofessional education and teamwork as a solution to meet the increasing oral and systemic healthcare demands of highly vulnerable US populations.

  18. Health disparities among highly vulnerable populations in the United States: a call to action for medical and oral health care.

    Science.gov (United States)

    Vanderbilt, Allison A; Isringhausen, Kim T; VanderWielen, Lynn M; Wright, Marcie S; Slashcheva, Lyubov D; Madden, Molly A

    2013-01-01

    Healthcare in the United States (US) is burdened with enormous healthcare disparities associated with a variety of factors including insurance status, income, and race. Highly vulnerable populations, classified as those with complex medical problems and/or social needs, are one of the fastest growing segments within the US. Over a decade ago, the US Surgeon General publically challenged the nation to realize the importance of oral health and its relationship to general health and well-being, yet oral health disparities continue to plague the US healthcare system. Interprofessional education and teamwork has been demonstrated to improve patient outcomes and provide benefits to participating health professionals. We propose the implementation of interprofessional education and teamwork as a solution to meet the increasing oral and systemic healthcare demands of highly vulnerable US populations.

  19. A UK wide survey on attitudes to point of care ultrasound training amongst clinicians working on the Acute Medical Unit.

    Science.gov (United States)

    Smallwood, Nicholas; Matsa, Ramprasad; Lawrenson, Philip; Messenger, Jenny; Walden, Andrew

    2015-01-01

    The use of point of care ultrasound (POCU) is increasing across a number of specialties, becoming mandatory within some specialist training programmes (for example respiratory and emergency medicine). Despite this, there are few data looking at the prevalence of use or the training clinicians have undertaken; this survey sought to address this. It shows that the majority of POCU undertaken on the Acute Medical Unit (AMU) is without formal accreditation, with significant arriers to training highlighted including a lack of supervision, time and equipment. For those who undertook POCU, it was shown to regularly speed up clinical decision making, while 76.3% respondents believed a lack of access to POCU out of hours may affect patient safety. The data provide support to the concept of developing AMU specific POCU accreditation, to ensure robust and safe use of this modality on the AMU.

  20. Medical exposure assessment: the global approach of the United Nations Scientific Committee on the Effects of Atomic Radiation.

    Science.gov (United States)

    Shannoun, F

    2015-07-01

    The United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) was established in 1955 to systematically collect, evaluate, publish and share data on the global levels and effects of ionizing radiation from natural and artificial sources. Regular surveys have been conducted to determinate the frequencies of medical radiological procedure, the number of equipment and staffing and the level of global exposure using the health care level (HCL) extrapolation model. UNSCEAR surveys revealed a range of issues relating to participation, survey process, data quality and analysis. Thus, UNSCEAR developed an improvement strategy to address the existing deficiencies in data quality and collection. The major element of this strategy is the introduction of an on-line platform to facilitate the data collection and archiving process. It is anticipated that the number of countries participating in UNSCEAR's surveys will increase in the future, particularly from HCL II-IV countries.

  1. 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

    -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......BACKGROUND: The use of mechanical restraint (MR) is controversial, and large differences regarding the use of MR are often found among countries. In an earlier study, we observed that MR was used twice as frequently in Denmark than Norway. AIMS: To examine how presumed MR preventive factors of non......-staff ratio (- 11%), and the identification of the patient's crisis triggers (- 10%). CONCLUSIONS: These six MR preventive factors might partially explain the difference in the frequency of MR episodes observed in the two countries, i.e. higher numbers in Denmark than Norway. One MR preventive factor...

  2. Commercial support of continuing medical education in the United States: the politics of doubt, the value of studies.

    Science.gov (United States)

    Mazmanian, Paul E

    2009-01-01

    The continuing medical education (CME) system of the United States is being questioned for its integrity. Leaders in medicine and in government are asking about the effectiveness of CME, the influence of commercial support, and the value of CME credit and accreditation in assuring CME courses offer valid content, free of commercial bias. Nationally accredited CME organizations received $1.2B in commercial support during 2007, much of it associated with CME in formats shown to be less effective for improving clinical behavior and patient outcomes. There are few reliable data to respond to careful criticism. In 2007, U.S. expenditures for health exceed $2.2 trillion, with physicians responsible for clinical decisions that account for a large part of the spending. Approximately $4013 was spent per physician on CME. Rigorous studies are required to describe and explain relationships of CME accreditation and credit to better education and improved patient outcomes.

  3. Screening difficult-to-reach populations for tuberculosis using a mobile medical unit, Punjab India.

    Science.gov (United States)

    Binepal, G; Agarwal, P; Kaur, N; Singh, B; Bhagat, V; Verma, R P; Satyanarayana, S; Oeltmann, J E; Moonan, P K

    2015-12-21

    Contexte : En Inde, la Mission nationale santé a fourni une unité médicale mobile (MMU) par district dans l'état du Penjab afin d'offrir des services de soins de santé primaires aux populations difficilement accessibles.Objectifs : Déterminer le nombre de patients présumés atteints de la tuberculose (TB) et le nombre de cas de TB détectés et traités parmi les patients qui ont utilisé les services de la MMU de mai à décembre 2012 dans le district de Mohali de l'état du Penjab, Inde.Méthodes : Une étude transversale a été réalisée et l'étude des registres des consultations, du laboratoire, de la radiologie et des services de TB de la MMU a permis de compter le nombre de personnes présumées atteintes de TB et le nombre de personnes ayant eu un diagnostic de TB.Résultats : Un total de 8346 patients ont fréquenté la MMU, dont 663 (8%) avaient des symptômes suggérant une TB. Parmi ces derniers, 540 (81%) ont bénéficié d'une recherche de TB pulmonaire grâce à un examen de l'expectoration ou à une radiographie pulmonaire. Au total, 58 (11%) patients ont eu des preuves cliniques ou biologiques de TB pulmonaire, dont 21 (36%) ont mis en route un traitement de la tuberculose.Conclusion : Comme les MMU font partie intégrante du système de santé publique général, ces unités ont le potentiel de détecter les cas de TB parmi les populations « difficiles à atteindre ». De plus amples recherches sont requises afin d'optimiser le diagnostic de la TB dans les MMU pour accélérer la mise en route du traitement de la TB.

  4. Interprofessional nursing education: a pilot study in the medical intensive care unit and internal medicine outpatient clinics

    Directory of Open Access Journals (Sweden)

    Ann Hagstrom

    2015-07-01

    Full Text Available Background: Healthcare requires frequent interactions among nurses, physicians, and other healthcare professionals.  Healthcare students frequently have little or no interaction with other disciplines during their education. Methods: The nursing students in our health sciences center do not have any formal interaction during their education with physicians in the hospital or clinics.  This pilot project allowed senior nursing students to directly observe physicians working in the medical intensive care unit and in the internal medicine clinics.  We used pre-and post-intervention surveys and post-intervention interviews to determine their satisfaction with this clinical experience and to determine any changes in their attitudes or understanding following their observations in the work site. Results: Twenty-two nursing students completed this pilot project.  There were no difficulties with the organization or scheduling of these students, and they found this experience useful and educational.  There were significant changes on two survey questions.  Nursing students thought that physicians had more need for collaboration with other healthcare workers following their observations but also thought that physicians spent less time with patients and family than expected.  During the interviews after the experience, the nursing students indicated that this intervention increased their understanding of the need for communication, collaboration, and planning during patient care. Conclusions: This pilot project demonstrates that it is relatively easy to increase the interprofessional education of nurses by allowing them to observe physicians during routine clinical work in the medical intensive care unit and in the internal medicine clinics.  This did not require significant organization or introduce difficult scheduling problems.  Nursing students found this activity educational and did have important changes in their understanding of physicians

  5. Telemedicine: socio-ethical considerations in the Indian milieu.

    Science.gov (United States)

    Sharma, Luv K; Rajput, Meena

    2009-01-01

    Telemedicine is the rapidly developing application of clinical medicine by telephone, the internet or other networks for the purpose of consulting, and on occasions carrying out examinations or medical procedures. Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between medical specialists in two different countries. Telemedicine offers real benefits in a country as vast as India where the majority of the population lives in remote areas with no access to even the most basic healthcare. As the practice of telemedicine spreads, maintaining standards, security and privacy, will be a challenge especially with regard to legal and regulatory measures and who will be held responsible if telemedicine-assisted surgery fails due to failure in connectivity? Is it the surgeon, the satellite provider or the software/hardware engineer? What is the legal status of telemedicine-based diagnosis and treatment? Other legal issues involve conflicting national laws and information piracy, the dangers of prescription drugs that are banned in one country but not in another and quacks who offer medical advice and prescribe drugs over the internet. This paper discusses some of the legal, ethical and social considerations in the Indian context.

  6. Mapping Antimicrobial Stewardship in Undergraduate Medical, Dental, Pharmacy, Nursing and Veterinary Education in the United Kingdom.

    Directory of Open Access Journals (Sweden)

    Enrique Castro-Sánchez

    Full Text Available To investigate the teaching of antimicrobial stewardship (AS in undergraduate healthcare educational degree programmes in the United Kingdom (UK.Cross-sectional survey of undergraduate programmes in human and veterinary medicine, dentistry, pharmacy and nursing in the UK. The main outcome measures included prevalence of AS teaching; stewardship principles taught; estimated hours apportioned; mode of content delivery and teaching strategies; evaluation methodologies; and frequency of multidisciplinary learning.80% (112/140 of programmes responded adequately. The majority of programmes teach AS principles (88/109, 80.7%. 'Adopting necessary infection prevention and control precautions' was the most frequently taught principle (83/88, 94.3%, followed by 'timely collection of microbiological samples for microscopy, culture and sensitivity' (73/88, 82.9% and 'minimisation of unnecessary antimicrobial prescribing' (72/88, 81.8%. The 'use of intravenous administration only to patients who are severely ill, or unable to tolerate oral treatment' was reported in ~50% of courses. Only 32/88 (36.3% programmes included all recommended principles.Antimicrobial stewardship principles are included in most undergraduate healthcare and veterinary degree programmes in the UK. However, future professionals responsible for using antimicrobials receive disparate education. Education may be boosted by standardisation and strengthening of less frequently discussed principles.

  7. Intrinsic component of resilience among entry level medical students in the United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Mehzabin Ahmed

    2011-10-01

    Full Text Available BackgroundResilience is the capacity to recover and to cope successfullywith everyday challenges. Resilience has intrinsic andextrinsic components and an effort has been made to studythe intrinsic component and its association with sociodemographicfactors, among the entry level students of theIntegrated Bachelor of Medicine and Bachelor of Surgery(MBBS course.MethodThe present study was conducted in Gulf MedicalUniversity, using a self-administered questionnaire,comprising of two parts, distributed to all the students whoconsented to participate. The first part contained questionson socio-demographic details while the second partcontained questions on the intrinsic and extrinsiccomponents of resilience of the students. The datacollected was analysed using Predictive Analytic Software(PASW 18.0 using frequency, mean, SD and median.ResultsAmong the 58 students who participated 24 (41.4% weremales and 34 (58.6% females, of which 70.7% were 20years. The mean score for the intrinsiccomponent of resilience was 48.9 (SD, 5 and range 35–60.The median scores showed no significant variation (p<0.05with age, gender, religion, nationality, family structure,highest education among parents, the person they sharetheir feelings with or the number of friends. However,minimally higher scores were noted in the median scores ofstudents from nuclear families, with Western nationalityand those whose parents had a university level education,who shared their feelings with people of their owngeneration or outside their family and who have 5–9friends.ConclusionThe intrinsic component of resilience was found to bealmost uniform for the study group and the level is high. Astudy has to further look into its effect on coping with thestresses encountered during the academic year.

  8. Professional experiences of international medical graduates practicing primary care in the United States.

    Science.gov (United States)

    Chen, Peggy Guey-Chi; Nunez-Smith, Marcella; Bernheim, Susannah May; Berg, David; Gozu, Aysegul; Curry, Leslie Ann

    2010-09-01

    International medical graduates (IMGs) comprise approximately 25% of the US physician workforce, with significant representation in primary care and care of vulnerable populations. Despite the central role of IMGs in the US healthcare system, understanding of their professional experiences is limited. To characterize the professional experiences of non-US born IMGs from limited-resource nations practicing primary care in the US. Qualitative study based on in-depth in-person interviews. Purposeful sample of IMGs (n = 25) diverse in country of origin, length of practice in the US, specialty (internal medicine, family medicine and pediatrics), age and gender. Participants were currently practicing primary care physicians in New York, New Jersey or Connecticut. A standardized interview guide was used to explore professional experiences of IMGs. Four recurrent and unifying themes characterize these experiences: 1) IMGs experience both overt and subtle forms of workplace bias and discrimination; 2) IMGs recognize professional limitations as part of "the deal"; 3) IMGs describe challenges in the transition to the culture and practice of medicine in the US; 4) IMGs bring unique skills and advantages to the workplace. Our data reveal that IMGs face workplace challenges throughout their careers. Despite diversity in professional background and demographic characteristics, IMGs in our study reported common experiences in the transition to and practice of medicine in the US. Findings suggest that both workforce and workplace interventions are needed to enable IMG physicians to sustain their essential and growing role in the US healthcare system. Finally, commonalities with experiences of other minority groups within the US healthcare system suggest that optimizing IMGs' experiences may also improve the experiences of an increasingly diverse healthcare workforce.

  9. Potential drug-drug interactions in medical intensive care unit of a tertiary care hospital in Pakistan.

    Science.gov (United States)

    Ismail, Mohammad; Khan, Farmanullah; Noor, Sidra; Haider, Iqbal; Haq, Inam-Ul; Ali, Zahid; Shah, Zahir; Hassam, Mohsin

    2016-10-01

    Background Patients admitted to intensive care unit (ICU) present with severe and life-threatening illnesses. Most of them suffer from various comorbidities. They usually receive complex pharmacotherapy with large number of medicines which increase the risk of drug-drug interactions (DDIs). Objective The present report aimed to investigate prevalence and levels of potential DDIs (pDDIs) in medical ICU. Methods Medications profiles of 416 patients were checked for pDDIs using Micromedex Drug-Reax(®). Prevalence, levels of severity and levels of documentation were reported. Results Of total 416 patients, 310 were exposed to pDDIs (overall prevalence = 74.5 %). Likewise, a prevalence rate of 13.9 % was recorded for contraindicated pDDIs, 52.2 % for major pDDI and 58.4 % for moderate pDDI. This study reported 740 interacting drug pairs that were presented in total 1686 pDDIs. Of 1686 pDDIs, 4.3 % were of contraindicated severity, 33.8 % of major severity and 49.6 % of moderate severity, whereas 45.5 % were of fair scientific evidence and 41.4 % of good scientific evidence. Conclusion In this study, pDDIs were found highly prevalent in ICU patients at a rate of 74.5 %. Most of the pDDIs had moderate severity; however, substantial number of interactions (38.1 %) had major and contraindicated severity.

  10. Performing 'pragmatic holism': Professionalisation and the holistic discourse of non-medically qualified acupuncturists and homeopaths in the United Kingdom.

    Science.gov (United States)

    Givati, Assaf

    2015-01-01

    Complementary and alternative medicine practitioners have often utilised 'holism' as a key identification mark of their practice, distancing themselves from 'the reductionist biomedicine'. However, the past couple of decades have witnessed increased engagement of several complementary and alternative medicines in professionalisation, which includes a degree of biomedical alignment while 'reducing' holistic claims in order to provide practice with a 'credible outlook' and move closer to the mainstream, a development which challenges the role of holism in complementary and alternative medicine practices. This article explores the strategies by which two groups of complementary and alternative medicine practitioners, namely, non-medically qualified acupuncturists and homeopaths in the United Kingdom, pragmatically accommodate holistic notions as a professional resource, a process of negotiation between maintaining their holistic premise, on the one hand, and the drive to professionalise and enhance their societal status, on the other. Based on in-depth interviews with non-medically qualified acupuncture and homeopathy practitioners and school principals, textual analysis of practitioners' web sites and observation of practice, the findings demonstrate the dynamic approach to 'holism' in complementary and alternative medicine practice. This discourse, through which practitioners use a range of strategies in order to 'narrow' or 'expand' their holistic expression, can be described as 'pragmatic holism', by which they try to make gains from the formalisation/standardisation processes, without losing the therapies' holistic outlook and appeal.

  11. Successful introduction of a daily checklist to enhance compliance with accepted standards of care in the medical intensive care unit.

    Science.gov (United States)

    Nama, A; Sviri, S; Abutbul, A; Stav, I; van Heerden, P V

    2016-07-01

    We introduced a simple checklist to act as an aid to memory for our junior medical staff to ensure that every patient in the intensive care unit (ICU) received every appropriate element of a bundle of care every day. The checklist was developed in consultation with our junior doctors and was designed to be completed every morning for every patient by the junior doctor reviewing the patient. The completed checklist was then checked again by the attending intensivist on the main daily ward round to ensure all the appropriate elements of the checklist had been applied to the patient. It was also noted each day which of the elements of the checklist had been forgotten and was therefore prompted to be completed by use of the checklist. Of the 75 patients surveyed there were 99 occasions, in 48 patients, when the checklist detected a forgotten element of the bundle of care (i.e. in 64% of patients). There was a decrease in the incidence of missed elements of the bundle of care the longer the patient stayed in the ICU. Types of missed elements varied with the duration of the ICU stay. We found that the introduction of a simple checklist, developed in collaboration with the junior medical staff who would be using the checklist every day in the ICU, resulted in the detection and correction of missed elements of a bundle of care we had previously introduced in the ICU.

  12. Deaths and medical visits attributable to environmental pollution in the United Arab Emirates.

    Directory of Open Access Journals (Sweden)

    Jacqueline MacDonald Gibson

    Full Text Available BACKGROUND: This study estimates the potential health gains achievable in the United Arab Emirates (UAE with improved controls on environmental pollution. The UAE is an emerging economy in which population health risks have shifted rapidly from infectious diseases to chronic conditions observed in developed nations. The UAE government commissioned this work as part of an environmental health strategic planning project intended to address this shift in the nature of the country's disease burden. METHODS AND FINDINGS: We assessed the burden of disease attributable to six environmental exposure routes outdoor air, indoor air, drinking water, coastal water, occupational environments, and climate change. For every exposure route, we integrated UAE environmental monitoring and public health data in a spatially resolved Monte Carlo simulation model to estimate the annual disease burden attributable to selected pollutants. The assessment included the entire UAE population (4.5 million for the year of analysis. The study found that outdoor air pollution was the leading contributor to mortality, with 651 attributable deaths (95% confidence interval [CI] 143-1,440, or 7.3% of all deaths. Indoor air pollution and occupational exposures were the second and third leading contributors to mortality, with 153 (95% CI 85-216 and 46 attributable deaths (95% CI 26-72, respectively. The leading contributor to health-care facility visits was drinking water pollution, to which 46,600 (95% CI 15,300-61,400 health-care facility visits were attributed (about 15% of the visits for all the diseases considered in this study. Major study limitations included (1 a lack of information needed to translate health-care facility visits to quality-adjusted-life-year estimates and (2 insufficient spatial coverage of environmental data. CONCLUSIONS: Based on international comparisons, the UAE's environmental disease burden is low for all factors except outdoor air pollution. From a

  13. The United States twenty-year experience with bombing incidents: implications for terrorism preparedness and medical response.

    Science.gov (United States)

    Kapur, G Bobby; Hutson, H Range; Davis, Mark A; Rice, Phillip L

    2005-12-01

    Terrorist bombings remain a significant threat in the United States. However, minimal longitudinal data exists regarding the medical and public health impact because of bombings. We conducted a retrospective analysis of the number of incidents, injuries, and deaths because of explosive, incendiary, premature, and attempted bombings from January 1983 to December 2002. Morbidity and mortality by motives, target locations, and materials used were evaluated. In the United States, 36,110 bombing incidents, 5,931 injuries, and 699 deaths were reported. There were 21,237 (58.8%) explosive bombings, 6,185 (17.1%) incendiary bombings, 1,107 (3.1%) premature bombings, and 7,581 (21.0%) attempted bombings. For explosive bombings with known motives, 72.9% of injuries and 73.8% of deaths were because of homicide. For incendiary bombings with known motives, 68.2% of injuries were because of extortion and revenge, and 53.5% of deaths were due to homicide. Private residences accounted for 29.0% of incidents, 31.5% of injuries, and 55.5% of deaths. Government installations accounted for 4.4% of incidents but were the site of 12.7% of injuries and 25.5% of deaths. In bombings with known materials, nitrate-based fertilizers accounted for 36.2% of injuries and 30.4% of deaths, and smokeless powder and black powder accounted for 33.2% of injuries and 27.1% of deaths. Illegal bombings and related injuries commonly occur in the United States. Because of the easy availability of bombing materials, government agencies and healthcare providers should prepare for potential mass-casualty bombings.

  14. Correlation between antibiotic use and changes in susceptibility patterns of Pseudomonas aeruginosa in a medical-surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Kallel Hatem

    2008-01-01

    Full Text Available Context: Multiple surveillance programmes have reported a decline in antibiotic susceptibility of P. aeruginosa. Aim: Our study aimed to study the relationship between the use of antipseudomonal drugs and the development of resistance of P. aerogenosa to these drugs. Setting and Design: Our study is retrospective. It was conducted in a medical surgical intensive care unit during a five-year period (January 1 st , 1999 to December 31, 2003, which was divided into 20 quarters. We had monitored the use of antipseudomonal agents and the resistance rates of P. aeruginosa to these drugs. Statistical Methods: The associations between use and resistance were quantified using non-partial and partial correlation coefficients according to Pearson and Spearman. Results: Over the study period, the most frequently used antipseudomonal agent was Imipenem (152 ± 46 DDD/1000 patients-day and the resistance rate of P. aeruginosa to Imipenem was 44.3 ± 9.5% (range, 30 and 60%. In addition, Imipenem use correlated significantly with development of resistance to Imipenem in the same ( P < 0.05 and in the following quarter (P < 0.05; and Ciprofloxacin use correlated significantly with resistance to Ciprofloxacin in the following quarter ( P < 0.05. However, use of Ceftazidime or Amikacine had no apparent association with development of resistance. Conclusion: We conclude that the extensive use of imipenem or ciprofloxacin in intensive care units may lead to the emergence of imipenem- and ciprofloxacin-resistant strains of P. aeruginosa and that antibiotic prescription policy has a significant impact on P. aeruginosa resistance rates in an intensive care unit.

  15. Experience with using second life for medical education in a family and community medicine education unit

    Directory of Open Access Journals (Sweden)

    Melús-Palazón Elena

    2012-05-01

    Full Text Available Abstract Background The application of new technologies to the education of health professionals is both a challenge and a necessity. Virtual worlds are increasingly being explored as a support for education. Aim: The aim of this work is to study the suitability of Second Life (SL as an educational tool for primary healthcare professionals. Methods Design: Qualitative study of accredited clinical sessions in SL included in a continuing professional development (CPD programme for primary healthcare professionals. Location: Zaragoza I Zone Family and Community Medicine Education Unit (EU and 9 health centres operated by the Aragonese Health Service, Aragon, Spain. Method: The EU held two training workshops in SL for 16 healthcare professionals from 9 health centres by means of two workshops, and requested them to facilitate clinical sessions in SL. Attendance was open to all personnel from the EU and the 9 health centres. After a trail period of clinical sessions held at 5 health centres between May and November 2010, the CPD-accredited clinical sessions were held at 9 health centres between February and April 2011. Participants: 76 healthcare professionals attended the CPD-accredited clinical sessions in SL. Main measurements: Questionnaire on completion of the clinical sessions. Results Response rate: 42-100%. Questionnaire completed by each health centre on completion of the CPD-accredited clinical sessions: Access to SL: 2 centres were unable to gain access. Sound problems: 0% (0/9. Image problems: 0% (0/9. Voice/text chat: used in 100% (10/9; 0 incidents. Questionnaire completed by participants in the CPD-accredited clinical sessions: Preference for SL as a tool: 100% (76/76. Strengths of this method: 74% (56/76 considered it eliminated the need to travel; 68% (52/76 believed it made more effective use of educational resources; and 47% (36/76 considered it improved accessibility. Weaknesses: 91% (69/76 experienced technical problems, while; 9

  16. Deaths and Medical Visits Attributable to Environmental Pollution in the United Arab Emirates

    Science.gov (United States)

    MacDonald Gibson, Jacqueline; Thomsen, Jens; Launay, Frederic; Harder, Elizabeth; DeFelice, Nicholas

    2013-01-01

    Background This study estimates the potential health gains achievable in the United Arab Emirates (UAE) with improved controls on environmental pollution. The UAE is an emerging economy in which population health risks have shifted rapidly from infectious diseases to chronic conditions observed in developed nations. The UAE government commissioned this work as part of an environmental health strategic planning project intended to address this shift in the nature of the country’s disease burden. Methods and Findings We assessed the burden of disease attributable to six environmental exposure routes outdoor air, indoor air, drinking water, coastal water, occupational environments, and climate change. For every exposure route, we integrated UAE environmental monitoring and public health data in a spatially resolved Monte Carlo simulation model to estimate the annual disease burden attributable to selected pollutants. The assessment included the entire UAE population (4.5 million for the year of analysis). The study found that outdoor air pollution was the leading contributor to mortality, with 651 attributable deaths (95% confidence interval [CI] 143–1,440), or 7.3% of all deaths. Indoor air pollution and occupational exposures were the second and third leading contributors to mortality, with 153 (95% CI 85–216) and 46 attributable deaths (95% CI 26–72), respectively. The leading contributor to health-care facility visits was drinking water pollution, to which 46,600 (95% CI 15,300–61,400) health-care facility visits were attributed (about 15% of the visits for all the diseases considered in this study). Major study limitations included (1) a lack of information needed to translate health-care facility visits to quality-adjusted-life-year estimates and (2) insufficient spatial coverage of environmental data. Conclusions Based on international comparisons, the UAE’s environmental disease burden is low for all factors except outdoor air pollution. From a

  17. Self-Determination in Medical Education: Encouraging Medical Educators to Be More like Blues Artists and Poets

    Science.gov (United States)

    Patrick, Heather; Williams, Geoffrey C.

    2009-01-01

    Historically, medical education has focused largely on medical students' intellectual development, mostly ignoring the broader psychological milieu of medical practice. This chasm can result in practitioners who are less likely to process their emotions and/or support their patient's needs, and more likely to experience burnout. Self-determination…

  18. Non-medical use of prescription drugs and HIV risk behaviour in transgender women in the Mid-Atlantic region of the United States.

    Science.gov (United States)

    Benotsch, Eric G; Zimmerman, Rick S; Cathers, Laurie; Pierce, Juan; McNulty, Shawn; Heck, Ted; Perrin, Paul B; Snipes, Daniel J

    2016-08-01

    Male-to-female transgender women (TGW) experience high rates of substance use and HIV. A recent substance use trend is the use of prescription medication without a doctor's consent. No research to date has examined the associations between this non-medical use of prescription drugs and HIV risk behaviour in TGW. In the present study, TGW recruited from community venues (N = 104) in the Mid-Atlantic region of the United States completed surveys assessing demographic information, non-medical use of prescription drugs, other substance use, injection practices and sexual risk behaviour. Twenty-four per cent of the sample reported lifetime non-medical use of prescription drugs across the following categories: analgesics (21.2%), anxiolytics (14.4%), stimulants (12.5%) and sedatives (8.7%). Participants reporting non-medical use of prescription drugs were more likely to report other substance use, needle use to inject drugs, injecting silicone and sharing needles. In multivariable analyses, non-medical use of prescription drugs was associated with unprotected sex, sex after engaging in substance use, and commercial sex work, after controlling for demographic factors. Self-esteem and social support from family served as protective factors for non-medical use of prescription drugs. HIV-prevention programmes focused on TGW in the United States may wish to expand their assessment of substance use to include the use of prescription medications without a physician's consent.

  19. Use of Medication Prescribed for Emotional or Behavioral Difficulties among Children Aged 6-17 Years in the United ...

    Science.gov (United States)

    ... the National Technical Information Service NCHS Use of Medication Prescribed for Emotional or Behavioral Difficulties Among Children ... prescription medication, mental health treatment Use of prescribed medication during the past 6 months for emotional or ...

  20. Fostering Biliteracy in a Monolingual Milieu: Reflections on Two Counter-Hegemonic English Immersion Classes

    Science.gov (United States)

    Manyak, Patrick C.

    2006-01-01

    This article presents data from two yearlong ethnographic studies of the biliteracy instruction and development of young Latina/o children in two counter-hegemonic English immersion classes in the English-only milieu established by California's Proposition 227. The author first describes the struggle that the teachers engaged in as they sought to…

  1. 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

    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...

  2. The spiritual Tolkien milieu : a study of fiction‐based religion

    NARCIS (Netherlands)

    Davidsen, Markus Altena

    2014-01-01

    This book offers a comprehensive analysis of the organisation and development of the spiritual Tolkien milieu, a largely online-situated network of individuals and groups that draw on J.R.R. Tolkien’s literary mythology for spiritual inspiration. It is the first academic treatment of Tolkien spiritu

  3. 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…

  4. 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…

  5. 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…

  6. 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…

  7. Parent-Implemented Enhanced Milieu Teaching with Preschool Children Who Have Intellectual Disabilities

    Science.gov (United States)

    Kaiser, Ann P.; Roberts, Megan Y.

    2013-01-01

    Purpose: The purpose of this study was to compare the effects of enhanced milieu teaching (EMT) implemented by parents and therapists versus therapists only on the language skills of preschool children with intellectual disabilities (IDs), including children with Down syndrome and children with autism spectrum disorders. Method: Seventy-seven…

  8. [Analysis of the use of field medical units in the armies of NATO and Russian Armed Forces].

    Science.gov (United States)

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

    2011-12-01

    An analysis of medical services of NATO and the Medical Service of the Armed Forces of the Russian Federation of modern technology deployment stages of medical evacuation (tents, inflatable structures, shelters, containers, medical armored vehicles, cars, etc.) is presented. Examples of their usage in isolated employment, usage in the group as a mobile medical stations and field hospitals in various conditions, the prospects and directions of development of technical means deployment of medical service are given.

  9. Exploration and Consideration on Medical Ethics Education Mode of Uniting Knowledge and Action in Internship Medical Students%实习生医德知行合一教育模式的探索

    Institute of Scientific and Technical Information of China (English)

    廖生武

    2013-01-01

    医德教育是医疗卫生领域精神文明建设的一个重要部分,实习是临床医学生认知医学专业技能的重要时期,是其医德形成的关键时期,也是医学教育的重要阶段.通过正式课程、课外教育、心理咨询、社会实践、卫生服务等医学职业道德教育环节,借鉴先进医德培育经验,提高实习医学生的职业道德素质.%Medical ethics education is an important part of spiritual civilization construction,iuternship is an important period of clinical medical students medical professional skills,is the key period of forming medical ethics,also an important stage of medical education.Under the current circumstances,medical students'medical ethics education has some problems such as the separation between teaching and learning,learning and doing,knoeledge and action,which need to build a scientific and rational education system of uniting knowledge and action.It has the vital significance in improving the quality of the practice of medical students' professional ethics,cultivating qualified medical teams with good skills and morals,prompting noble medical ethics of medical personnel through formal courses,extracurricular education,psychological counseling,social practice,health services such as medical ethics education,using the experience of advanced medical ethics cultivation.

  10. United States Medical Licensing Examination and Its Illumination to Chinese Medical Schools and Examinations%中美两国医师执业考试述评及对中国医学教育的启示

    Institute of Scientific and Technical Information of China (English)

    陈梁

    2012-01-01

    从美国医师执照考试,展现美国医师培养的优势,对中国大陆的医学教育引起思考,获得启示。将美国医师执照考试和中国医师资格考试进行一定程度的比较,从而指出两者的不同之处和差距,以利于改进我国执业医师考试。%To demonstrate the advantage of the deep thoughts of medical education of China, examination of United States to China, to find out training system of so that to gain ill American umination physicians from USMLE, to induce the differences between them, so compare the medical licensing that we can improve the medical licensing examination and medical education of Chinese medical schools.

  11. A study of Thai patients with systemic lupus erythematosus in the medical intensive care unit: epidemiology and predictors of mortality.

    Science.gov (United States)

    Siripaitoon, B; Lertwises, S; Uea-Areewongsa, P; Khwannimit, B

    2015-01-01

    In this retrospective study, we described demographic information, reasons for admission, APACHE II severity scores, complications, mortality rate, causes of death and prognostic factors in 61 Thai patients with systemic lupus erythematosus (SLE) who were admitted to the medical intensive care unit (ICU) over a six-year period. The overall mortality rate during ICU hospitalization was 57% and the most common cause of death was infection, especially in the lower respiratory tract. The mean (SD) APACHE II score was 24.8 (10.8). SLE patients who had an APACHE II score of 20 or more were up to 65% of the patient population and had a significantly lower probability of survival based on Kaplan-Meier results (p = 0.004). The need for vasopressor therapy was significantly higher in patients who did not survive (OR = 6.98, 95% CI = 1.91-25.49). The patients who developed ventilator-associated pneumonia had a numerically higher mortality, which was not statistically significant (OR = 4.17, 95% CI = 0.91-19.03). The use of azathioprine as a steroid-sparing agent for SLE was associated with lower mortality rates (OR = 0.08, 95% CI = 0.01-0.58). Our findings emphasize that Thai SLE patients admitted to the medical ICU has a high mortality rate and early aggressive treatments are warranted. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  12. Men victim of sexual assault of concern into the first Emergency Medical Unit for Victims of Assaults in France.

    Science.gov (United States)

    Hiquet, J; Gromb-Monnoyeur, S

    2013-10-01

    Although it accounts for only a small part of activity in the field of victimology, the provision of support for male victims of sexual assault is regularly discussed in the literature. Authors, English-speaking for the most part, all agree that this phenomenon has been largely underestimated, owing to the stigmatization victims suffer after the facts have been disclosed. The same authors agree that this type of assault is far from being inconsequential, from both a physical and a psychological perspective. The following retrospective and descriptive study, conducted at the Bordeaux CHU (Bordeaux University Hospital), aims to draw a comparison between the distinctive characteristics of male sexual assault victims treated at the CAUVA (Centre d'Accueil en Urgence des Victimes d'Agression - Emergency Medical Unit for Victims of Assaults) on the one hand, and, on the other hand, those identified in the existing scientific literature. The victims are predominantly young men, unconnected with their attackers, and more often than not the attacks take place on the public highway. Forensic treatment is provided within the seven days following the assault, which raises the question of the assessment of infection risks, including HIV transmission. Most of the time, the victims will not undergo a full psychological appraisal, though authors are unanimous that such assaults do indeed have heavy repercussions. Improving our services for such victims will require suitable training for staff, covering initial reception, general assessment and the drafting of the forensic medical report, as well as encouragement to lodge a complaint. This process should give priority to multidisciplinary centers, especially dedicated to shelter-providing, information, counseling and victim support. This will also entail information and awareness campaigns for the general population, and the homosexual community in particular. Finally, we should not be afraid to envisage an investigation into this

  13. Recreational use of erectile dysfunction medications in undergraduate men in the United States: characteristics and associated risk factors.

    Science.gov (United States)

    Harte, Christopher B; Meston, Cindy M

    2011-06-01

    Mounting evidence indicates that erectile dysfunction medications (EDMs) have become increasingly used as a sexual enhancement aid among men without a medical indication. Recreational EDM use has been associated with increased sexual risk behaviors, an increased risk for STIs, including incident HIV infection, and high rates of concomitant illicit drug use. The aim of the present study was to investigate the characteristics and associated risk factors for recreational EDM use among young, healthy, undergraduate men. A cross-sectional sample of 1,944 men were recruited from 497 undergraduate institutions within the Unites States between January 2006 and May 2007. The survey assessed patterns of EDM use, as well as demographic, substance use, and sexual behavior characteristics. Four percent of participants had recreationally used an EDM at some point in their lives, with 1.4% reporting current use. The majority of recreational EDM users reported mixing EDMs with illicit drugs and particularly during risky sexual behaviors. Recreational EDM use was independently associated with increased age, gay, or bisexual sexual orientation, drug abuse, lifetime number of sex partners, and lifetime number of "one-night stands." Recreational EDM users also reported a 2.5-fold rate of erectile difficulties compared to nonusers. Overall, recreational use of EDMs was associated with sexual risk behaviors and substance abuse; however, a relatively small proportion of undergraduates reported using EDMs. Results also suggest that a sizable portion of recreational EDM users are heterosexual men, and that use does not solely occur within the environments of venues that cater to men having sex with men.

  14. End-of-life attitudes in the Intensive Care Unit (ICU) amongst final year medical students at International Medical University, Malaysia

    OpenAIRE

    Sangeetha Poovaneswaran; Anuradha Poovaneswaran; hiruselvi Subramaniam

    2014-01-01

    With recent medical advances and the availability of newer sophisticated technologies, critically ill patients tend to survive longer.1 Thus, decisions to forgo life-sustaining medical treatment generate challenging issues that all doctors must face. The aim of this pilot study was to assess attitudes towards end-of-life care in ICU which included futile therapy (withholding and withdrawing therapy) among final year medical students who had received the same degr...

  15. Investigation and management of multidrug-resistant Acinetobacter baumannii spread in a French medical intensive care unit: one outbreak may hide another.

    Science.gov (United States)

    Bourigault, Céline; Corvec, Stéphane; Bretonnière, Cédric; Guillouzouic, Aurélie; Crémet, Lise; Marraillac, Julie; Juvin, Marie-Emmanuelle; Bemer, Pascale; Le Gallou, Florence; Reynaud, Alain; Boutoille, David; Villers, Daniel; Lepelletier, Didier

    2013-07-01

    An outbreak in a medical intensive care unit was due to an OXA-23-producing Acinetobacter baumannii strain imported from a repatriate hospitalized in Singapore. This outbreak revealed another multidrug resistant epidemic strain that had been present in the hospital for 2 years. Both outbreaks were controlled after 9 months of an extensive infection control program.

  16. Medical Treatment for Minor Children: The Roles of Parents, the State, the Child, and the Supreme Court of the United States, and Responses.

    Science.gov (United States)

    Crutchfield, Charles F.; And Others

    1981-01-01

    The roles of the state, the parent, the United States Supreme Court, and the child in the decision-making process relating to medical treatment of minor children are outlined and analyzed in four articles. Several case studies, recommendations and opposing viewpoints are presented. (Author/JAC)

  17. Faculty and Students’ Perceptions of Student Experiences in a Medical School Undergoing Curricular Transition in the United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Syed I Shehnaz

    2012-02-01

    Full Text Available Objectives: In 2008, the Gulf Medical College in the United Arab Emirates underwent a curricular change from a discipline-based to an organ-system-based integrated curriculum. In this context, this study aimed to compare the faculty and students’ perceptions of the student experiences with the new curriculum. Methods: Data were collected from faculty and second-year students in the integrated curriculum using the Dundee Ready Education Environment Measure (DREEM. Data collected were transferred to Predictive Analytics Software, Version 18. Global and domain scores were assessed with the Wilcoxon Rank-Sum Test. Percentage agreement, disagreement and uncertainty were assessed by the z-test for proportion. Results: There were no significant differences between the total DREEM scores of faculty (139/200 and students (135/200. The faculty perceived that the students were experiencing significantly more positive learning as indicated by the domain score of “Students' Perceptions of Learning”. Proportions of agreement between faculty and students showed that more faculty members than students perceived the need for increased feedback to students and a greater emphasis on long term learning. Conclusion: The study showed that the faculty and students had similar perceptions about the student experiences in the integrated curriculum. Areas necessitating remedial measures were the need for faculty to learn constructive feedback techniques and an emphasis on long term learning in the new curriculum.

  18. 疗医合编单位技术建设发展探析%Technology Construction and Development in the Unit Combining Recuperating and Medical Works

    Institute of Scientific and Technical Information of China (English)

    斯友良; 过贵元; 施文兴; 阮英轶; 宋启哲; 孙清华

    2013-01-01

    Combining with the practice in the units combining recuperating and medical works, the article introduces some considerations on the technology development from four aspects, including the medical special center, special key discipline, medical technology innovations and the building of specialized talented persons. It affords a useful lesson for the technology development in such units.%结合疗医合编单位实际,从医学专科中心、特色重点学科、疗养医疗技术创新和专业人才队伍建设四个方面探讨技术建设的思路,为疗医合编单位技术建设发展提供借鉴.

  19. 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.

  20. The Association between Medical Education Accreditation and Examination Performance of Internationally Educated Physicians Seeking Certification in the United States

    Science.gov (United States)

    van Zanten, Marta; Boulet, John R.

    2013-01-01

    The purposes of this research were to examine medical education accreditation practices around the world, with special focus on the Caribbean, and to explore the association between medical school accreditation and graduates' examination performance. In addition to other requirements, graduates of international medical schools seeking to…

  1. 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......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...

  2. Local Milieu in Developing China's Cultural and Creative Industry: The Case of Nanluoguxiang in Beijing

    OpenAIRE

    Jici Wang; Chun Zhang; Ching-Ning Wang; Ping Chen

    2010-01-01

    This paper examines the role of creative milieu and cultural heritages in the development of Chinese cultural industry. Through case study of Beijing’s Nanluoguxiang, where several arts institutions and theaters concentrate, it depicts the birth and growth of a creative place for free artists in the institutional changing of Chinese cultural setting. Based on field survey data from artists, managers and visitors, it shows the spouting and growth of local creativities in a transitional econo...

  3. A Social Milieu Approach to the Online Participation Divides in Germany

    Directory of Open Access Journals (Sweden)

    Christoph Lutz

    2016-01-01

    Full Text Available Research on digital divides has been helpful in advancing our understanding of the social structuration of Internet access, motivations to go online, digital skills, and Internet (non-use, including participatory uses. However, digital divide research has been criticized for oversimplifying the relationship between demographic characteristics and Internet use and for its under-theorization. A social milieu approach, inspired by Pierre Bourdieu’s sociological theory, presents an excellent set of concepts to address these criticisms and thus advance digital divide research. This article uses the social milieu approach for an empirical investigation of the participation divides in Germany. Focus groups and online communities with 96 participants from seven distinct Internet milieus serve to differentiate online participation along social lines. The results show that German citizens are strongly segregated into distinct Internet milieus that differ in their intensity, variety, understanding, and attitudes toward online participation. Each milieu displays specific participatory patterns and some of the findings challenge existing research on digital and participation divides. Implications are derived and limitations of the approach carved out.

  4. Psychological Health of First-Year Health Professional Students in a Medical University in the United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Kadayam G Gomathi

    2012-05-01

    Full Text Available Objectives: The aim of this study was to assess the psychological health of first-year health professional students and to study sources of student stress. Methods: All first-year students (N = 125 of the Gulf Medical University (GMU in Ajman, United Arab Emirates (UAE, were invited to participate in a voluntary, anonymous, self-administered, questionnaire-based survey in January 2011. Psychological health was assessed using the 12-item General Health Questionnaire. A 24-item questionnaire, with items related to academic, psychosocial and health domains was used to identify sources of stress. Pearson’s chi-squared test and the Mann-Whitney U-test were used for testing the association between psychological morbidity and sources of stress. Results: A total of 112 students (89.6% completed the survey and the overall prevalence of psychological morbidity was found to be 33.6%. The main academic-related sources of stress were ‘frequency of exams’, ‘academic workload’, and ‘time management’. Major psychosocial stressors were ‘worries regarding future’, ‘high parental expectations’, ‘anxiety’, and ‘dealing with members of the opposite sex’. Health-related issues were ‘irregular eating habits’, ‘lack of exercise’, and ‘sleep-related problems’. Psychological morbidity was not significantly associated with any of the demographic factors studied. However, total stress scores and academics-related domain scores were significantly associated with psychological morbidity. Conclusion: Psychological morbidity was seen in one in three first-year students attending GMU. While worries regarding the future and parental expectations were sources of stress for many students, psychological morbidity was found to be significantly associated with only the total stress and the academic-related domain scores.

  5. HIVAN and medication use in chronic dialysis patients in the United States: analysis of the USRDS DMMS Wave 2 study

    Directory of Open Access Journals (Sweden)

    Agodoa Lawrence Y

    2003-07-01

    Full Text Available Abstract Background The use and possible effects of factors known to improve outcomes in patients with human immunodeficiency virus associated nephropathy (HIVAN, namely of angiotensin converting enzyme inhibitors (ACE and antiretroviral therapy, has not been reported for a national sample of dialysis patients. Methods We conducted a historical cohort study of the United States Renal Data System (USRDS Dialysis Morbidity and Mortality Study (DMMS Wave 2 to identify risk factors associated with increased mortality in these patients. Data were available for 3374 patients who started dialysis and were followed until March 2000. Cox Regression analysis was used to model adjusted hazard ratios (AHR with HIVAN as a cause of end stage renal disease (ESRD and its impact on mortality during the study period, adjusted for potential confounders. Results Of the 3374 patients who started dialysis, 36 (1.1% had ESRD as a result of HIVAN. Only 22 (61% of patients with HIVAN received antiretroviral agents, and only nine patients (25% received combination antiretroviral therapy, and only 14% received ACE inhibitors. Neither the use of multiple antiretroviral drugs (AHR, 0.62, 95% CI, 0.10, 3.86, p = 0.60, or ACE inhibitors were associated with a survival advantage. Patients with HIVAN had an increased risk of mortality (adjusted hazard ratio, 4.74, 95% Confidence Interval, 3.12, 7.32, p Conclusions Medications known to improve outcomes in HIV infected patients were underutilized in patients with HIVAN. Adjusted for other factors, a primary diagnosis of HIVAN was associated with increased mortality compared with other causes of ESRD.

  6. Recent trends in the probability of high out-of-pocket medical expenses in the United States

    Directory of Open Access Journals (Sweden)

    Katherine E Baird

    2016-09-01

    Full Text Available Objective: This article measures the probability that out-of-pocket expenses in the United States exceed a threshold share of income. It calculates this probability separately by individuals’ health condition, income, and elderly status and estimates changes occurring in these probabilities between 2010 and 2013. Data and Method: This article uses nationally representative household survey data on 344,000 individuals. Logistic regressions estimate the probabilities that out-of-pocket expenses exceed 5% and alternatively 10% of income in the two study years. These probabilities are calculated for individuals based on their income, health status, and elderly status. Results: Despite favorable changes in both health policy and the economy, large numbers of Americans continue to be exposed to high out-of-pocket expenditures. For instance, the results indicate that in 2013 over a quarter of nonelderly low-income citizens in poor health spent 10% or more of their income on out-of-pocket expenses, and over 40% of this group spent more than 5%. Moreover, for Americans as a whole, the probability of spending in excess of 5% of income on out-of-pocket costs increased by 1.4 percentage points between 2010 and 2013, with the largest increases occurring among low-income Americans; the probability of Americans spending more than 10% of income grew from 9.3% to 9.6%, with the largest increases also occurring among the poor. Conclusion: The magnitude of out-of-pocket’s financial burden and the most recent upward trends in it underscore a need to develop good measures of the degree to which health care policy exposes individuals to financial risk, and to closely monitor the Affordable Care Act’s success in reducing Americans’ exposure to large medical bills.

  7. Recent trends in the probability of high out-of-pocket medical expenses in the United States

    Science.gov (United States)

    Baird, Katherine E

    2016-01-01

    Objective: This article measures the probability that out-of-pocket expenses in the United States exceed a threshold share of income. It calculates this probability separately by individuals’ health condition, income, and elderly status and estimates changes occurring in these probabilities between 2010 and 2013. Data and Method: This article uses nationally representative household survey data on 344,000 individuals. Logistic regressions estimate the probabilities that out-of-pocket expenses exceed 5% and alternatively 10% of income in the two study years. These probabilities are calculated for individuals based on their income, health status, and elderly status. Results: Despite favorable changes in both health policy and the economy, large numbers of Americans continue to be exposed to high out-of-pocket expenditures. For instance, the results indicate that in 2013 over a quarter of nonelderly low-income citizens in poor health spent 10% or more of their income on out-of-pocket expenses, and over 40% of this group spent more than 5%. Moreover, for Americans as a whole, the probability of spending in excess of 5% of income on out-of-pocket costs increased by 1.4 percentage points between 2010 and 2013, with the largest increases occurring among low-income Americans; the probability of Americans spending more than 10% of income grew from 9.3% to 9.6%, with the largest increases also occurring among the poor. Conclusion: The magnitude of out-of-pocket’s financial burden and the most recent upward trends in it underscore a need to develop good measures of the degree to which health care policy exposes individuals to financial risk, and to closely monitor the Affordable Care Act’s success in reducing Americans’ exposure to large medical bills. PMID:27651901

  8. Predictive value of SAPS II and APACHE II scoring systems for patient outcome in a medical intensive care unit

    Directory of Open Access Journals (Sweden)

    Amina Godinjak

    2016-11-01

    Full Text Available Objective. The aim is to determine SAPS II and APACHE II scores in medical intensive care unit (MICU patients, to compare them for prediction of patient outcome, and to compare with actual hospital mortality rates for different subgroups of patients. Methods. One hundred and seventy-four patients were included in this analysis over a oneyear period in the MICU, Clinical Center, University of Sarajevo. The following patient data were obtained: demographics, admission diagnosis, SAPS II, APACHE II scores and final outcome. Results. Out of 174 patients, 70 patients (40.2% died. Mean SAPS II and APACHE II scores in all patients were 48.4±17.0 and 21.6±10.3 respectively, and they were significantly different between survivors and non-survivors. SAPS II >50.5 and APACHE II >27.5 can predict the risk of mortality in these patients. There was no statistically significant difference in the clinical values of SAPS II vs APACHE II (p=0.501. A statistically significant positive correlation was established between the values of SAPS II and APACHE II (r=0.708; p=0.001. Patients with an admission diagnosis of sepsis/septic shock had the highest values of both SAPS II and APACHE II scores, and also the highest hospital mortality rate of 55.1%. Conclusion. Both APACHE II and SAPS II had an excellent ability to discriminate between survivors and non-survivors. There was no significant difference in the clinical values of SAPS II and APACHE II. A positive correlation was established between them. Sepsis/septic shock patients had the highest predicted and observed hospital mortality rate.

  9. An antibiotic decision-making tool for patients with pneumonia admitted to a medical intensive care unit.

    Science.gov (United States)

    Huang, Sheng-Feng; Chang, Jung-San; Sheu, Chau-Chyun; Liu, Yu-Ting; Lin, Ying-Chi

    2016-09-01

    Pneumonia is a leading cause of death in medical intensive care units (MICUs). Delayed or inappropriate antibiotic therapy largely increases morbidity and mortality. Multidrug-resistant (MDR) micro-organisms are major reasons for inappropriate antibiotic use. Currently there is no good antibiotic decision-making tool designed for critically ill patients. The objective of this study was to develop a convenient MDR prediction scoring system for patients admitted to MICUs with pneumonia. A retrospective cohort study was conducted using databases and chart reviews of pneumonia patients admitted to a 30-bed MICU from 2012 to 2013. Forward logistic regression was applied to identify independent MDR risk factors for prediction tool development. A total of 283 pneumonia episodes from 263 patients with positive cultures from blood or respiratory secretions were recruited, of which 154 (54.4%) were MDR episodes. Long-term ventilation (OR = 11.09; P = 0.026), residence in a long-term care facility (OR = 2.50; P = 0.005), MDR infection/colonisation during the preceding 90 days (OR = 2.08; P = 0.041), current hospitalisation ≥2 days (OR = 1.98; P = 0.019) and stroke (OR = 1.81; P = 0.035) were identified as independent predictors for MDR pneumonia. The area under the ROC curve of this prediction tool was much higher than that of ATS/IDSA classification (0.69 vs. 0.54; P <0.001). The prediction accuracy of this tool with risk score ≥1 for MDR infections was 63.7%. This simple five-item, one-step scoring tool for critically ill patients admitted to the MICU could help physicians provide timely appropriate empirical antibiotics.

  10. [Prenatal diagnosis. I: Prenatal diagnosis program at the Medical Genetics Unit of the Universidad de Zulia, Maracaibo, Venezuela].

    Science.gov (United States)

    Prieto-Carrasquero, M; Molero, A; Carrasquero, N; Paz, V; González, S; Pineda-Del Villar, L; Del Villar, A; Rojas-Atencio, A; Quintero, M; Fulcado, W; Mena, R; Morales-Machin, A

    1998-06-01

    The Prenatal Diagnosis Program of the Medical Genetic Unit of University of Zulia has the following objectives: Identification of Genetic Risk Factors (GRF) in those couples who attend to the Prenatal Genetic Clinic, application of different prenatal diagnostic procedures (PDP), and providing adequate genetic counseling. The goal of this paper is to show preliminary results obtained between January 1993 and December 1996. Three hundred and twenty one pregnant women were analyzed by determining the GRF and taking into account the genetic clinical history. The GRF analyzed were: Advanced maternal age (AMA), congenital malformation history (CMH), previous child with chromosomic anomalies (PCCA), defects of neural tube history (DNTH), congenital heart disease history (CHDH), any parent carrier of chromosomic anomaly (PCA), habitual abortion (HA), abnormal fetal echography (AFE), altered maternal serum levels of alpha-feto-protein (AMSAFP) and OTHERS: exposure to teratogenic agents, history of Mendelian diseases, maternal systemic diseases and anxiety in the mother or in her partner. The PDP was designed according to the GRF, which included fetal echography (FE), fetal echocardiography (FEc), amniocentesis (AMN), chordocentesis (CCT) and AMSAFP. Results showed that 58.4% of the expectant mothers asked for counseling during the 2nd trimester, 70% of the total showed only one GRF, and AMA was the most frequent GRF found (40.3%), followed by PCCA, AFE, CHDH, HA, DNTH, PCA, and OTHERS in that order. The specific PDP applied to the identified GRF allowed a health evaluation of the fetus. The GRF identification gave the opportunity of establishing a Prenatal Diagnostic Program producing a response to the couple's needs and showed the utility of an integral and multidisciplinary management directed to any expecting mother in order to identify any high GRF.

  11. 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.

  12. Mental Health and Well-Being across the Military Spectrum (Bien-etre et sante mentale dans le milieu militaire)

    Science.gov (United States)

    2011-04-01

    Apr 2011 Mental Health and Well-Being across the Military Spectrum ( Bien -être et santé mentale dans le milieu militaire) Research and Technology...Spectrum ( Bien -être et santé mentale dans le milieu militaire) Papers presented at the RTO Human Factors and Medicine Panel (HFM) Symposium held in...research be conducted to demonstrate the usability of these technologies in real world settings. ES - 2 RTO-MP-HFM-205 Bien -être et santé

  13. Preventability of death in a medical intensive care unit at a university hospital in a developing country

    OpenAIRE

    Amine Ali Zeggwagh; Houda Mouad; Tarek Dendane; Khalid Abidi; Jihane Belayachi; Naoufel Madani; Redouane Abouqal

    2014-01-01

    Objective: To determine the incidence and characteristics of preventable in-ICU deaths. Materials and Methods: A one-year observational study was conducted in a medical ICU of a teaching hospital. All patients who died in medical ICU beyond 24 h were analyzed and reviewed during daily medical meeting. A death was considered preventable when it would not have occurred if the patient had received ordinary standards of care appropriate for the time of study. Preventability of death was classifie...

  14. 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.

  15. Le passage du milieu francophone minoritaire au milieu francophone majoritaire : étude d’une expérience d’enseignants en formation pour comprendre l’influence du milieu sur le développement professionnel

    Directory of Open Access Journals (Sweden)

    Fadila Boutouchent

    2016-06-01

    Full Text Available Résumé Le programme de formation des maîtres en français langue première et seconde de l’Université de Regina en Saskatchewan exige un niveau linguistique avancé et astreint ses étudiants à passer leur deuxième année à l’Université Laval, au Québec. Au cours de leur première année, ces étudiants vivent parfois leur premier contact entre francophiles et Fransaskois et apprennent à collaborer dans la langue minoritaire. Leurs croyances, leurs perceptions individuelles et leurs relations d’amitié sont renégociées au cours de la deuxième année, loin de leur province d’origine et de leurs réseaux habituels de contact. Durant une année, ils vivent en milieu francophone majoritaire, développent de nouvelles stratégies et de nouvelles perspectives. Dans cette recherche qualitative exploratoire, des entrevues semi-dirigées ont permis d’explorer le changement de perceptions de sept participants après leur expérience en milieu francophone majoritaire. Dès leur retour, ils étaient plus motivés à utiliser le français, déploraient le manque de ressources et d’opportunités dans leur région et pensaient apporter une contribution à leur environnement. Les participants, francophones de l’immersion ou d’origine, ont affirmé à quel point le contact avec le français « partout » avait aidé leur développement linguistique. Les résultats concordent avec ceux obtenus par d’autres recherches en milieu francophone minoritaire. Abstract The teacher education program for teaching French as a first and second language at the University of Regina in Saskatchewan demands advanced language skills, and requires students to spend their second year at Laval University in Quebec. During their first year, these students may experience their first contacts between Francophiles and Fransaskois learning the French minority language. Their beliefs, individual perceptions, and friendships are renegotiated during the second

  16. 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.

  17. 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

    Directory of Open Access Journals (Sweden)

    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

  18. Analysis of the discrepancies identified during medication reconciliation on patient admission in cardiology units: a descriptive study.

    Science.gov (United States)

    Lombardi, Natália Fracaro; Mendes, Antonio Eduardo Matoso; Lucchetta, Rosa Camila; Reis, Wálleri Christini Torelli; Fávero, Maria Luiza Drechsel; Correr, Cassyano Januário

    2016-08-15

    this observational study aimed to describe the discrepancies identified during medication reconciliation on patient admission to cardiology units in a large hospital. the medication history of patients was collected within 48 hours after admission, and intentional and unintentional discrepancies were classified as omission, duplication, dose, frequency, timing, and route of drug administration. most of the patients evaluated were women (58.0%) with a mean age of 59 years, and 75.5% of the patients had a Charlson comorbidity index score between 1 and 3. Of the 117 discrepancies found, 50.4% were unintentional. Of these, 61.0% involved omission, 18.6% involved dosage, 18.6% involved timing, and 1.7% involved the route of drug administration. this study revealed a high prevalence of discrepancies, most of which were related to omissions, and 50% were unintentional. These results reveal the number of drugs that are not reincorporated into the treatment of patients, which can have important clinical consequences. este estudo observacional teve como objetivo descrever discrepâncias encontradas na realização de conciliação medicamentosa de pacientes admitidos em unidades de cardiologia de um hospital de grande porte. a história de medicação dos pacientes foi coletada dentro de 48h após a admissão, e as discrepâncias, identificadas como intencionais ou não intencionais, foram classificadas como de: omissão, duplicidade, dose, frequência, intervalo e via. a maioria dos pacientes incluídos pertençia ao sexo feminino (58,0%), com idade média de 59 anos, e com índice de comorbidades de Charlson entre 1 e 3 (75,5% dos casos). Das 117 discrepâncias encontradas, 50,4% foram não intencionais. Dessas, 61,0% foram de omissão, 18,6% de dose, 18,6% de intervalo e 1,7% de via de administração. o estudo mostra a alta prevalência de discrepâncias, principalmente de omissão, sendo quase metade não intencionais. Esse dado remete ao número de medicamentos que n

  19. Development of a mortality prediction formula due to sepsis/severe sepsis in a medical intensive care unit

    Directory of Open Access Journals (Sweden)

    Anant Mohan

    2015-01-01

    Full Text Available Background: Although sepsis is one of the leading causes of mortality in hospitalized patients, information regarding early predictive factors for mortality and morbidity is limited. Materials and Methods: Patients fulfilling the Infectious Disease Society of America criteria of sepsis within the medical intensive care unit (ICU were included over two years. Apart from baseline hematological, biochemical, and metabolic parameters, Acute Physiology and Chronic Health Evaluation II (APACHE II, Simplified Acute Physiology Score II and III (SAPS II and SAPS III, and Sequential Organ Function Assessment (SOFA scores were calculated on day 1 of admission. Patients were followed till death or discharge from the ICU. Results: One hundred patients were enrolled over two years (54% males. The overall mortality was 53%, (69.5% in females, 38.8% in males (P < 0.01. Mortality was 65.7%, 55.7%, and 33.3% in patients with septic shock, severe sepsis, and sepsis, respectively. Patients who died were significantly older than the survivors (mean age, 57.37 ± 20.42 years and 44.29 ± 15.53 years respectively, P < 0.01. Nonsurvivors were significantly more anemic and had higher APACHE II, SAPS II, SAPS III, and SOFA scores. The presence of acute respiratory distress syndrome and renal dysfunction were associated with higher mortality (75% and 70.2%, respectively. There was no significant difference in the duration of mechanical ventilation or ICU stay between survivors and nonsurvivors. On multivariate analysis, significant predictors of mortality with odds ratio greater than 2 included the presence of anemia, SAPS II score greater than 35, SAPS III score greater than 47, and SOFA score greater than 6 at day 1 of admission. Conclusion: Several demographic and laboratory parameters as well as composite critical illness scoring systems are reliable early predictors of mortality in sepsis. A sepsis mortality prediction formula (AIIMS Sepsis Score based on SAPS II

  20. Mass fatality preparedness among medical examiners/coroners in the United States: a cross-sectional study.

    Science.gov (United States)

    Gershon, Robyn R M; Orr, Mark G; Zhi, Qi; Merrill, Jacqueline A; Chen, Daniel Y; Riley, Halley E M; Sherman, Martin F

    2014-12-15

    In the United States (US), Medical Examiners and Coroners (ME/Cs) have the legal authority for the management of mass fatality incidents (MFI). Yet, preparedness and operational capabilities in this sector remain largely unknown. The purpose of this study was twofold; first, to identify appropriate measures of preparedness, and second, to assess preparedness levels and factors significantly associated with preparedness. Three separate checklists were developed to measure different aspects of preparedness: MFI Plan Elements, Operational Capabilities, and Pre-existing Resource Networks. Using a cross-sectional study design, data on these and other variables of interest were collected in 2014 from a national convenience sample of ME/C using an internet-based, anonymous survey. Preparedness levels were determined and compared across Federal Regions and in relation to the number of Presidential Disaster Declarations, also by Federal Region. Bivariate logistic and multivariable models estimated the associations between organizational characteristics and relative preparedness. A large proportion (42%) of respondents reported that less than 25 additional fatalities over a 48-hour period would exceed their response capacities. The preparedness constructs measured three related, yet distinct, aspects of preparedness, with scores highly variable and generally suboptimal. Median scores for the three preparedness measures also varied across Federal Regions and as compared to the number of Presidential Declared Disasters, also by Federal Region. Capacity was especially limited for activating missing persons call centers, launching public communications, especially via social media, and identifying temporary interment sites. The provision of staff training was the only factor studied that was significantly (positively) associated (p < .05) with all three preparedness measures. Although ME/Cs ranked local partners, such as Offices of Emergency Management, first responders, and

  1. Racial and Ethnic Disparities in Influenza Vaccination among Adults with Chronic Medical Conditions Vary by Age in the United States

    Science.gov (United States)

    Lu, Degan; Qiao, Yanru; Brown, Natalie E.; Wang, Junling

    2017-01-01

    Background People living with chronic health conditions exhibit higher risk for developing severe complications from influenza according to the Centers for Diseases Control and Prevention. Although racial and ethnic disparities in influenza vaccination have been documented, it has not been comprehensively determined whether similar disparities are present among the adult population with at least one such condition. Objective To study if racial and ethnic disparities in relation to influenza vaccination are present in adults suffering from at least one chronic condition and if such inequalities differ between age groups. Methods The Medical Expenditure Panel Survey (2011–2012) was used to study the adult population (age ≥18) who had at least one chronic health condition. Baseline differences in population traits across racial and ethnic groups were identified using a chi-square test. This was conducted among various age groups. In addition, survey logistic regression was utilized to produce odds ratios of receiving influenza vaccination annually between racial and ethnic groups. Results The total sample consisted of 15,499 adults living with at least one chronic health condition. The numbers of non-Hispanic whites (whites), non-Hispanic blacks (blacks), and Hispanics were 8,658, 3,585, and 3,256, respectively. Whites (59.93%) were found to have a higher likelihood of self-reporting their receipt of the influenza vaccine in comparison to the black (48.54%) and Hispanic (48.65%) groups (Pinfluenza vaccine coverage than the white population (59.22%, 77.89) (both P0.05). After controlling for patient characteristics, the difference in influenza vaccine coverage between whites and the minority groups were no longer significant for adults aged 50–64 years. However, the difference were still statistically significant for those aged ≥65 years. Conclusions In the United States, there are significant disparities in influenza vaccination by race and ethnicity for

  2. 20 CFR 404.462 - Nonpayment of hospital and medical insurance benefits of alien outside United States for more...

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Nonpayment of hospital and medical insurance... SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Deductions; Reductions; and Nonpayments of Benefits § 404.462 Nonpayment of hospital and medical insurance benefits of...

  3. Words Can Be Deceiving: A Review of Variation Among Legally Effective Medical Marijuana Laws in the United States.

    Science.gov (United States)

    Pacula, Rosalie Liccardo; Hunt, Priscillia; Boustead, Anne

    2014-12-01

    When voters in two US states approved the recreational use of marijuana in 2012, public debates for how best to promote and protect public health and safety started drawing implications from states' medical marijuana laws. However, many of the discussions were simplified to the notion that states either have a medical marijuana law or do not; little reference was made to the fact that legal provisions differ across states. This study seeks to clarify the characteristics of medical marijuana laws in place since 1990 that are most relevant to consumers/patients and categorizes those aspects most likely to affect the prevalence of use, and consequently the intensity of public health and welfare effects. Evidence shows treating medical marijuana laws as homogeneous across states is misleading and does not reflect the reality of medical marijuana lawmaking. This variation likely has implications for use and health outcomes, and thus states' public health.

  4. [An a priori risk analysis study. Securisation of transfusion of blood product in a hospital: from the reception in the medical unit to its administration].

    Science.gov (United States)

    Bertrand, E; Lévy, R; Boyeldieu, D

    2013-12-01

    Following an ABO accident after transfusion of red blood cells, an a priori risk analysis study is being performed in a hospital. The scope of this analysis covers from the reception of the blood product in the medical unit to its administration. The risk analysis enables to identify the potentially dangerous situations and the evaluation of the risks in order to propose corrective measures (precautionary or protective) and bring the system back to an acceptable risk level. The innovative concept of an a priori risk analysis in the medical field allows the extension of the analysis of this transfusion risk to other hospitals. In addition, it allows the extension of the use of this approach to other medical fields.

  5. [The concept of the organ, as a hierarchal unit of human body, and its place in teaching histology at the medical university and medical college].

    Science.gov (United States)

    Miadelets, O D; Miadelets, N Ia; Miadelets, V O

    2011-01-01

    This paper deals with the methodological aspects of teaching histology at the medical university and medical college. The authors raise the issue of the necessity of teaching of the topic "Introduction to Special Histology" and the inclusion of the appropriate chapter into the textbooks. This is important for the students, as the formation of the general concepts of organ structure and function, components, and classification will aid in the further study of specific organs during the course of Special Histology. The authors describe their own experience in teaching of the section, dedicated to the general regularities of organ structure, present some definitions and classifications that are used by them for a number of years.

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

    Directory of Open Access Journals (Sweden)

    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

  7. Feeling “overloaded” and “shortcomings”: milieu therapists’ experiences of vulnerability in caring for severely mentally ill patients

    Science.gov (United States)

    Bachmann, Liv; Michaelsen, Ragnhild A; Vatne, Solfrid

    2016-01-01

    Background Milieu therapists’ relationships with patients with severe mental illnesses are viewed as challenging. Elucidating vulnerability from their perspective in daily face-to-face encounters with patients might contribute to extending our knowledge about milieu therapists’ vulnerability and the dynamics of the interaction between patients in mental health services and expertise in building caring and therapeutic relationships. The aim of this project was to study educated milieu therapists’ experiences of their own vulnerability in their interactions with patients in mental health services. Materials and methods The data collection method was focus-group interviews. Thirteen part-time master’s in mental health students (eight nurses, three social workers, two social educators) participated. All participants had experience with community or specialized mental health services (2–8 years). Results The milieu therapists mainly related their experiences of vulnerability to negative feelings elicited by challenging work conditions, disclosed as two main themes: 1) “overloaded”, by the possibility of being physically and mentally hurt and the burdens of long-lasting close relationships; milieu therapists were extremely vulnerable because of their difficulty in protecting themselves; and 2) “shortcomings”, connected to feelings of despair associated with not acting in concordance with their professional standards and insecurity about their skills to handle challenging situations, which was a threat to their professional integrity. There seemed to be coherence between vulnerability and professional inauthenticity. A misunderstanding that professionalism refers to altruism seems to increase milieu therapist vulnerability. Conclusion Vulnerability in health care is of interest to multiple disciplines, and is of relevance for knowledge development in higher education. Extended knowledge and understanding about milieu therapists’ vulnerability might

  8. 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

    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...... 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...... reported significant reductions in levels of anxiety and depressive symptoms (p dual diagnosis populations and warrants further...

  9. Unit 1001: The Nature of Meaning in Language.

    Science.gov (United States)

    Minnesota Univ., Minneapolis. Center for Curriculum Development in English.

    This 10th-grade unit in Minnesota's "language-centered" curriculum introduces the complexity of linguistic meaning by demonstrating the relationships among linguistic symbols, their referents, their interpreters, and the social milieu. The unit begins with a discussion of Ray Bradbury's "The Kilimanjaro Machine," which…

  10. 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.

    Science.gov (United States)

    Bosma, Bertha Elizabeth; Meuwese, Edmé; Tan, Siok Swan; van Bommel, Jasper; Melief, Piet Herman Gerard Jan; Hunfeld, Nicole Geertruida Maria; van den Bemt, Patricia Maria Lucia Adriana

    2017-02-10

    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 reduced by using the Transfer ICU and Medication reconciliation (TIM) program. This prospective 8-month observational study with a pre- and post-design will assess the effects of the TIM program compared with usual care in two Dutch hospitals. Patients will be included if they are using at least one drug before hospital admission and will stay in the ICU for at least 24 h. They are excluded if they are transferred to another hospital, admitted and discharged in the same weekend or unable to communicate in Dutch or English. In the TIM program, a clinical pharmacist reconciles patient's medication history within 24 h after ICU admission, resulting in a "best possible" medication history and presents it to the ICU doctor. At ICU discharge the clinical pharmacist reconciles the prescribed ICU medication and the medication history with the ICU doctor, resulting in an ICU discharge medication list with medication prescription recommendations for the general ward doctor. Primary outcome measures are the proportions of patients with one or more medication transfer errors 24 h after ICU admission and 24 h after ICU discharge. Secondary outcome measures are the proportion of patients with potential adverse drug events, the severity of potential adverse drug events and the associated costs. For the primary outcome relative risks and 95% confidence intervals will be calculated. Strengths of this study are the tailor-made design of the TIM program and two participating hospitals. This study also has some limitations: A potential selection bias since this program is not performed during the weekends, collecting of potential rather than actual adverse drug events and finally a relatively short study period. Nevertheless

  11. Reason-Giving and Medical Futility: Contrasting Legal and Social Discourse in the United States With the United Kingdom and Ontario, Canada.

    Science.gov (United States)

    Bosslet, Gabriel T; Baker, Mary; Pope, Thaddeus M

    2016-09-01

    Disputes regarding life-prolonging treatments are stressful for all parties involved. These disagreements are appropriately almost always resolved with intensive communication and negotiation. Those rare cases that are not require a resolution process that ensures fairness and due process. We describe three recent cases from different countries (the United States, United Kingdom, and Ontario, Canada) to qualitatively contrast the legal responses to intractable, policy-level disputes regarding end-of-life care in each of these countries. In so doing, we define the continuum of clinical and social utility among different types of dispute resolution processes and emphasize the importance of public reason-giving in the societal discussion regarding policy-level solutions to end-of-life treatment disputes. We argue that precedential, publicly available, written rulings for these decisions most effectively help to move the social debate forward in a way that is beneficial to clinicians, patients, and citizens. This analysis highlights the lack of such rulings within the United States.

  12. Neutral Caregivers or Military Support? The British Red Cross, the Friends’ Ambulance Unit, and the Problems of Voluntary Medical Aid in Wartime

    Science.gov (United States)

    2015-01-01

    During the First World War the British Red Cross Society (BRCS) served as the coordinating body for voluntary medical aid giving in Britain. Among the many units which came within its purview was the Friends’ Ambulance Unit (FAU), formed by a group of young men whose desire to serve their nation in wartime conflicted with their pacifist principles. Both the BRCS and the FAU were wracked by ideological conflicts in the years which preceded and throughout the war. These struggles over voluntarist identity highlight the contested meanings of service and conscience in wartime. Through a critical examination of the language of official histories and biographies, this article will argue that the war formed a key moment in the relationship between the British state and voluntary medical aid, with the state’s increasing role in the work of such organizations raising questions about the voluntarist principles to which aid organizations laid claim. The struggles that both organizations and individuals within them faced in reconciling the competing pressures that this new relationship created form a legacy of the war which continues to have important implications for the place of medical voluntarism in wartime today. PMID:26213442

  13. Neutral Caregivers or Military Support? The British Red Cross, the Friends' Ambulance Unit, and the Problems of Voluntary Medical Aid in Wartime.

    Science.gov (United States)

    Meyer, Jessica

    2015-05-01

    During the First World War the British Red Cross Society (BRCS) served as the coordinating body for voluntary medical aid giving in Britain. Among the many units which came within its purview was the Friends' Ambulance Unit (FAU), formed by a group of young men whose desire to serve their nation in wartime conflicted with their pacifist principles. Both the BRCS and the FAU were wracked by ideological conflicts in the years which preceded and throughout the war. These struggles over voluntarist identity highlight the contested meanings of service and conscience in wartime. Through a critical examination of the language of official histories and biographies, this article will argue that the war formed a key moment in the relationship between the British state and voluntary medical aid, with the state's increasing role in the work of such organizations raising questions about the voluntarist principles to which aid organizations laid claim. The struggles that both organizations and individuals within them faced in reconciling the competing pressures that this new relationship created form a legacy of the war which continues to have important implications for the place of medical voluntarism in wartime today.

  14. A murine model of obesity implicates the adipokine milieu in the pathogenesis of severe acute pancreatitis.

    Science.gov (United States)

    Zyromski, Nicholas J; Mathur, Abhishek; Pitt, Henry A; Lu, Debao; Gripe, John T; Walker, Julia J; Yancey, Kyle; Wade, Terence E; Swartz-Basile, Deborah A

    2008-09-01

    Obesity is clearly an independent risk factor for increased severity of acute pancreatitis (AP), although the mechanisms underlying this association are unknown. Adipokines (including leptin and adiponectin) are pleiotropic molecules produced by adipocytes that are important regulators of the inflammatory response. We hypothesized that the altered adipokine milieu observed in obesity contributes to the increased severity of pancreatitis. Lean (C57BL/6J), obese leptin-deficient (LepOb), and obese hyperleptinemic (LepDb) mice were subjected to AP by six hourly intraperitoneal injections of cerulein (50 microg/kg). Severity of AP was assessed by histology and by measuring pancreatic concentration of the proinflammatory cytokines IL-1beta and IL-6, the chemokine MCP-1, and the marker of neutrophil activation MPO. Both congenitally obese strains of mice developed significantly more severe AP than wild-type lean animals. Severity of AP was not solely related to adipose tissue volume: LepOb mice were heaviest; however, LepDb mice developed the most severe AP both histologically and biochemically. Circulating adiponectin concentrations inversely mirrored the severity of pancreatitis. These data demonstrate that congenitally obese mice develop more severe AP than lean animals when challenged by cerulein hyperstimulation and suggest that alteration of the adipokine milieu exacerbates the severity of AP in obesity.

  15. Adaptive endoplasmic reticulum stress alters cellular responses to the extracellular milieu.

    Science.gov (United States)

    Liu, Yiting; Neely, Elizabeth; Simmons, Zachary; Connor, James R

    2015-05-01

    The ability to respond to perturbations in endoplasmic reticulum (ER) function is a critical property for all cells. In the presence of chronic ER stress, the cell must adapt so that cell survival is favored or the stress may promote apoptosis. In some pathological processes, such as neurodengeneration, persistent ER stress can be tolerated for an extended period, but eventually cell death occurs. It is not known how an adaptive response converts from survival into apoptosis. To gain a better understanding of the role of adaptive ER stress in neurodegeneration, in this study, with a neuronal cell line SH-SY5Y and primary motor neuron-glia cell mixed cultures, we induced adaptive ER stress and modified the extracellular environment with physiologically relevant changes that alone did not activate ER stress. Our data demonstrate that an adaptive ER stress favored neuronal cell survival, but when cells were exposed to additional physiological insults the level of ER stress was increased, followed by activation of the caspase pathway. Our results indicate that an adaptive ER stress response could be converted to apoptosis when the external cellular milieu changed, suggesting that the conversion from prosurvival to proapoptotic pathways can be driven by the external milieu. This conversion was due at least partially to an increased level of ER stress. © 2015 Wiley Periodicals, Inc.

  16. Aphid Gel Saliva: Sheath Structure, Protein Composition and Secretory Dependence on Stylet-Tip Milieu

    Science.gov (United States)

    Will, Torsten; Steckbauer, Kathrin; Hardt, Martin; van Bel, Aart J. E.

    2012-01-01

    In order to separate and analyze saliva types secreted during stylet propagation and feeding, aphids were fed on artificial diets. Gel saliva was deposited as chains of droplets onto Parafilm membranes covering the diets into which watery saliva was secreted. Saliva compounds collected from the diet fluid were separated by SDS-PAGE, while non-soluble gel saliva deposits were processed in a novel manner prior to protein separation by SDS-PAGE. Soluble (watery saliva) and non-soluble (gel saliva) protein fractions were significantly different. To test the effect of the stylet milieu on saliva secretion, aphids were fed on various diets. Hardening of gel saliva is strongly oxygen-dependent, probably owing to formation of sulfide bridges by oxidation of sulphydryl groups. Surface texture of gel saliva deposits is less pronounced under low-oxygen conditions and disappears in dithiothreitol containing diet. Using diets mimicking sieve-element sap and cell-wall fluid respectively showed that the soluble protein fraction was almost exclusively secreted in sieve elements while non-soluble fraction was preferentially secreted at cell wall conditions. This indicates that aphids are able to adapt salivary secretion in dependence of the stylet milieu. PMID:23056521

  17. 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.

  18. Family medicine: its core principles and impact on patient care and medical education in the United States.

    Science.gov (United States)

    Jimbo, Masahito

    2004-06-01

    The specialty of family medicine arose out of a combination of American public and professional concerns regarding fragmentation of health care and was intended to foster a type of physician with a scope of clinical competence that would allow the patient, not the disease, to be the focus. Family physicians serve as the patient's personal physician and provide entry to the health care system, provide comprehensive care, maintain continuing responsibility for the patient including necessary coordination of care and referral, and provide care appropriate to the patient's physical, emotional, and social needs in the context of family and community. The specialty is currently second only to internal medicine in size, and makes a significant contribution to patient care and medical education. As family medicine looks to the future, some of its challenges include continuing to attract medical students to the specialty, refine research themes, and gain further acceptance in academic medical centers.

  19. The medical officer of health, the social worker, and the problem family, 1943 to 1968: the case of family service units.

    Science.gov (United States)

    Starkey, P

    1998-12-01

    It has sometimes been assumed that the Report of the Seebohm Committee on the Local Authority and Allied Personal Social Services of 1968 and subsequent Local Authority (Social Services) Reorganization signalled a reduction in the influence of Medical Officers of Health in the care of poor and disorganized families and an increase in that of social workers. This article considers the role of Medical Officers of Health in the care of such families in the period after the Second World War, and their relationship with one of the key voluntary social work agencies in the field, Pacifist Service Units/Family Service Units. By examining the shift in responsibility from public health doctors to social workers and using the Bristol Family Service Unit as a case study, it argues that in many areas the Children and Young Persons Act of 1963 was used formally to transfer responsibility for such families to the Children's Departments and that the process was complete before the Seebohm Committee reported in 1968. It also suggests that those families in difficulty who remained the responsibility of the Public Health Department, and who were thought to have increased in number during the course of the 1960s, presented health visitors and public health doctors with a different range of problems, although they continued to be labelled problem families.

  20. Confidentiality of the medical records of HIV-positive patients in the United Kingdom – a medicolegal and ethical perspective

    Directory of Open Access Journals (Sweden)

    Mike Williams

    2011-01-01

    Full Text Available Mike WilliamsHead of Service, Cambridge University Dental Service, Cambridge, UKAbstract: This article examines the legal and ethical issues that surround the confidentiality of medical records, particularly in relation to patients who are HIV positive. It records some historical background of the HIV epidemic, and considers the relative risks of transmission of HIV from individual to individual. It explains the law as it pertains to confidentiality, and reports the professional guidance in these matters. It then considers how these relate to HIV-positive individuals in particular.Keywords: HIV/AIDS, confidentiality, medical records

  1. Patient need at the heart of workforce planning: the use of supply and demand analysis in a large teaching hospital's acute medical unit.

    Science.gov (United States)

    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.

  2. The American Medical Association's Section on Surgery: The Beginnings of the Organization, Professionalization, and Specialization of Surgery in the United States.

    Science.gov (United States)

    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.

  3. Evolving paradigm of illnesses presented to medical Intensive Care Unit in body builders: Cases from tertiary care center

    Directory of Open Access Journals (Sweden)

    Sunil Kumar Garg

    2015-01-01

    Full Text Available Bodybuilding is the use of progressive resistance exercise to control and develop one′s musculature. With the rise in number of persons adopting this activity, there is evolving paradigm of illnesses presented to intensive care in this population subset. Strict adherence to details of bodybuilding and avoidance of unsupervised medications are essential to prevent untoward effects.

  4. 42 CFR 435.1008 - FFP in expenditures for medical assistance for individuals who have declared United States...

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false FFP in expenditures for medical assistance for... ISLANDS, AND AMERICAN SAMOA Federal Financial Participation Limitations on Ffp § 435.1008 FFP in... identity. Except for individuals described in § 435.406(a)(1)(v), FFP will not be available to a State...

  5. Evolving paradigm of illnesses presented to medical Intensive Care Unit in body builders: Cases from tertiary care center.

    Science.gov (United States)

    Garg, Sunil Kumar

    2015-04-01

    Bodybuilding is the use of progressive resistance exercise to control and develop one's musculature. With the rise in number of persons adopting this activity, there is evolving paradigm of illnesses presented to intensive care in this population subset. Strict adherence to details of bodybuilding and avoidance of unsupervised medications are essential to prevent untoward effects.

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

    Directory of Open Access Journals (Sweden)

    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.

  7. Survey of Nurses\\' Viewpoints on Causes of Medicinal Errors and Barriers to Reporting in Pediatric Units in Hospitals of Mashhad University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Masoomeh Seidi

    2012-12-01

    Full Text Available Background and Objective: Patient safety is the principal concern of current health care delivery systems, and several recent studies initiated by the Institute of Medicine have reported a high incidence of medicinal errors. Of the approximately 44000-98000 patient deaths reported each year because of medical errors, 7000 are attributed to medicinal errors. The purpose of this study was to determine nurses' perceptions of causes of medicinal errors and barriers to reporting them in the pediatric wards of Mashhad University of Medical Sciences. Materials and Methods: This cross-sectional descriptive study recruited156 nurses working in general pediatric units via the convenience sample method. A questionnaire containing four sections was used: the first section on demographic information; the second on the reasons for medicinal errors; the third on the estimation of the percentage of medicinal errors occurring in the units; and the final section on the reasons for failing to report the medicinal errors. Results: The most important medicinal errors from the nurses' viewpoint were failure to check medicinal orders (73.9% and errors in the medication administration (64%. The nurses estimated that only 45% of all the medicinal errors were reported, and they cited a lack of knowledge about unit policies and routines (59.8% and negligence to report (59.8% as the most important reasons for the failure to report the errors. Conclusion: We need to improve the accuracy of medicinal error reporting by nurses and to provide a hospital environment conducive to preventing errors from occurring.

  8. The use of energy drinks, dietary supplements, and prescription medications by United States college students to enhance athletic performance.

    Science.gov (United States)

    Hoyte, Christopher O; Albert, Donald; Heard, Kennon J

    2013-06-01

    While the use of performance enhancing substances by professional, collegiate, and Olympic athletes is well described, the rate of use in the general population is not well studied. We explored the use of energy drinks, dietary supplements, and prescription medications for the enhancement of athletic performance among college students using an ongoing survey system. We conducted a multi-round online questionnaire collecting data from self-identified students at two-year colleges, four-year colleges, online courses, or technical schools at least part-time during the specified sampling period. The sample is obtained through the use of a survey panel company in which respondents voluntarily register. Survey data were collected from December, 2010 through August, 2011. Subjects who reported participating in athletics were asked if they used any of the following substances to enhance athletic performance (1) energy drinks (2) dietary supplements (3) prescription medications within the last year. Data were analyzed from October, 2011 through January, 2012. There were 462 college students who responded to the survey reporting they participate in sports at various levels. Of these, 397 (85.9 %) responded that within the last year they used energy drinks, dietary supplements, or prescription medications to enhance athletic performance. Energy drinks had the highest prevalence (80.1 %), followed by dietary supplements (64.1 %) and prescription medications (53.3 %). Use was most prevalent amongst intercollegiate athletes (89.4 %) followed by club (88.5 %) and intermural (82.1 %) participants. The vast majority of survey respondents reported using energy drinks, dietary supplements, and prescription medications within the last year for athletic performance enhancement.

  9. Preventability of death in a medical intensive care unit at a university hospital in a developing country.

    Science.gov (United States)

    Zeggwagh, Amine Ali; Mouad, Houda; Dendane, Tarek; Abidi, Khalid; Belayachi, Jihane; Madani, Naoufel; Abouqal, Redouane

    2014-02-01

    To determine the incidence and characteristics of preventable in-ICU deaths. A one-year observational study was conducted in a medical ICU of a teaching hospital. All patients who died in medical ICU beyond 24 h were analyzed and reviewed during daily medical meeting. A death was considered preventable when it would not have occurred if the patient had received ordinary standards of care appropriate for the time of study. Preventability of death was classified by using a 1-6 point preventability scale. The types of medical errors causing preventable in-ICU deaths and the contributory factors to deaths were identified. 120 deaths (47 ± 19 years, 57 months-63 weeks) were analyzed (mortality: 23%; 95% confidence interval (CI):15-31%). At admission, Acute Physiology and Chronic Health Evaluation (APACHE) II score was 18 ± 7.6 and Charlson comorbidity index was 1.3 ± 1.6. The main diagnosis was infectious disease (57%) and respiratory disease (23%). The median period between the ICU admission and death was 5 days. The rate of preventable in-ICU deaths was 14.1% (17/120). The most common medical errors related to occurrence of preventable in-ICU deaths were therapeutic error (52.9%) and inappropriate technical procedure (23.5%). The preventable in-ICU deaths were associated with inadequate training or supervision of clinical staff (58.8%), no protocol (47.1%), inadequate functioning of hospital departments (29.4%), unavailable equipment (23.5%), and inadequate communication (17.6%). According to our study, one to two in-ICU deaths would be preventable per month. Our results suggest that the implementation of supervision and protocols could improve outcomes for critically ill patients.

  10. Preventability of death in a medical intensive care unit at a university hospital in a developing country

    Directory of Open Access Journals (Sweden)

    Amine Ali Zeggwagh

    2014-01-01

    Full Text Available Objective: To determine the incidence and characteristics of preventable in-ICU deaths. Materials and Methods: A one-year observational study was conducted in a medical ICU of a teaching hospital. All patients who died in medical ICU beyond 24 h were analyzed and reviewed during daily medical meeting. A death was considered preventable when it would not have occurred if the patient had received ordinary standards of care appropriate for the time of study. Preventability of death was classified by using a 1-6 point preventability scale. The types of medical errors causing preventable in-ICU deaths and the contributory factors to deaths were identified. Results: 120 deaths (47 ± 19 years, 57 months-63 weeks were analyzed (mortality: 23%; 95% confidence interval (CI:15-31%. At admission, Acute Physiology and Chronic Health Evaluation (APACHE II score was 18 ± 7.6 and Charlson comorbidity index was 1.3 ± 1.6. The main diagnosis was infectious disease (57% and respiratory disease (23%. The median period between the ICU admission and death was 5 days. The rate of preventable in-ICU deaths was 14.1% (17/120. The most common medical errors related to occurrence of preventable in-ICU deaths were therapeutic error (52.9% and inappropriate technical procedure (23.5%. The preventable in-ICU deaths were associated with inadequate training or supervision of clinical staff (58.8%, no protocol (47.1%, inadequate functioning of hospital departments (29.4%, unavailable equipment (23.5%, and inadequate communication (17.6%. Conclusion: According to our study, one to two in-ICU deaths would be preventable per month. Our results suggest that the implementation of supervision and protocols could improve outcomes for critically ill patients.

  11. Determination of prevalence and causes of hyponatremia in patient's admitted in pediatric intensive care unit of the Children's Hospital Medical Center

    Directory of Open Access Journals (Sweden)

    Kadivar M

    1999-06-01

    Full Text Available Among the 708 patients who were admitted in the pediatric intensive care unit (PICU of the children's hospital medical center, there were 100 patients with hyponatermia (Na<130 mEq/L. 62% of these patients had hyponatermia at the beginning of admission and 38% during hospitalization in PICU. According to the classification of hyponatermia in comparison to body fluid, this study revealed 7% pseudohyponatermia, 40% euvolemic hyponatermia, 34% hypovolemic hyponatermia and 10% hypovolemic hyponatermia. In conclusion, the most perevalent causes of hyponatermia in this study were syndrome of inappropriate antidiuretic hormone secretion (SIADH (27%, water intoxication (22% and extrarenal losses (20%

  12. Case Based Metabolic Unit (CBMU: A Model for Better Understanding of Metabolic Pathways in the Second Year Extended Modular Program Medical Students

    Directory of Open Access Journals (Sweden)

    Sanaa Eissa

    2016-12-01

    Full Text Available We designed a case based metabolic unit (CBMU which is a  hybrid learning model using case based learning and interactive lectures for 2nd year EMP medical students (n:113 who firstly attended blood module (Classical model in learning metabolism and then locomotor module (CBMU. At the end of both modules, they were evaluated through MCQ exams and the results of both exams were compared. The Majority of students (97-100% opined that case based metabolic unit learning model was interesting, motivating, and better than the classical model in understanding metabolic pathways and making learning stick. 99% of them demanded the application of this learning model in future biochemistry courses. Improvement in student’s exam scores ensures that they grasped the knowledge by this model. In conclusion, CBMU is a useful learning tool for metabolic pathways using human cases to aid in connecting theory to practice which is positively reflected on student’s academic performance.

  13. [Perinatal mortality at the Medical Care Units of the IMSS (Mexico Social Security Institute), National Medical Center of Torreón].

    Science.gov (United States)

    Rodríguez y Enríquez de Rivera, F C; Velázquez Trejo, M L; Roís Hernández, J

    1998-07-01

    To describe the situation of perinatal mortality during 1994 year in General Hospitals with Family Medicine number 16 and 18 of IMSS (Social Security Mexican Institut) National Medical Center in Torreón Coah. It was realized a retrospective study, were included 199 files of perinatal deaths occurred from January 1st to December 31 of 1994. The variables obtained were number of death for step, period, age, sex, weight and the cause of the cause of the death. Were eliminated the files without data of interest. For the analysis our utilized descriptive statistics. The rate of perinatal mortality was 20.17 per 1000 live birth, fetal death rate 9.58 by 1000 and the rate of neonatal death 12.97 per 1,000 live birth, fetal death rate 8.68 and neonatal death rate 12.30. The majority were in the perinatal period one with a rate of 16.71 by 1,000 live birth. Were most common in a male sex (53%) in pregnancies from 28 to 32 weeks (33.91%) and in babies with less of 1000 gr of weight (33.86%). The causes more frequents of deaths were the respiratory difficult syndrome (41.77%), the anomalies (19.62%) and hypoxia (9.49%). The perinatal mortality in our study was similar that in the rest of the country and is acorde with the literature. The perinatal mortality were in the perinatal period one. Is important to conduce a prospective studies.

  14. Microbial evaluation of dental units waterlines at the department of operative dentistry, Tehran university of medical sciences in the year 2006

    Directory of Open Access Journals (Sweden)

    Memarian M.

    2008-10-01

    Full Text Available "nBackground and Aim: According to infection possibility in high risk patients, assessment of microbial contamination in water sources utilized at medico-dental units has become a recent concern. The purpose of this study was to evaluate the microbial contamination in dental units waterlines at the department of operative dentistry, Tehran university of medical sciences in the year 2006. "nMaterials and Methods: In this cross-sectional study, six dental units in the department of operative dentistry were selected to assess microbial contamination in water sources. Samples were taken on Saturdays (the first working day in a week and in the midweek, 64 and 16 hours respectively after turning the units off. Moreover, for investigating the effect of flushing, sampling was done at 30, 60, 90 and 120 seconds after flushing and were taken from three parts of each unit including air/water syringe, turbine handpiece and also cup filler water. Samples were transported in closed sterile containers to microbiology laboratory of the school pharmacy. Data were analyzed by Kruskal-Wallis and Dunn tests with p<0.05 as the level of significance. "nResults: E.coli was isolated from contaminated samples. Contamination decreased by flushing. In midweek after 90 seconds flushing, water contamination disappeared. On Saturdays 2 minutes flushing decreased contamination to lower that 200 cfu/ml (the rate recommended by ADA. Samples taken from turbine handpieces showed significantly higher contamination rate compared to air/water syringe and cup filler water (p<0.001. "nConclusion: According to the results of this study, dental units waterlines showed bacterial contamination which was eliminated after 120 seconds of flushing.

  15. The performance of customised APACHE II and SAPS II in predicting mortality of mixed critically ill patients in a Thai medical intensive care unit.

    Science.gov (United States)

    Khwannimit, B; Bhurayanontachai, R

    2009-09-01

    The aim of this study was to evaluate and compare the performance of customised Acute Physiology and Chronic Health Evaluation HII (APACHE II) and Simplified Acute Physiology Score HII (SAPS II) in predicting hospital mortality of mixed critically ill Thai patients in a medical intensive care unit. A prospective cohort study was conducted over a four-year period. The subjects were randomly divided into calibration and validation groups. Logistic regression analysis was used for customisation. The performance of the scores was evaluated by the discrimination, calibration and overall fit in the overall group and across subgroups in the validation group. Two thousand and forty consecutive intensive care unit admissions during the study period were split into two groups. Both customised models showed excellent discrimination. The area under the receiver operating characteristic curve of the customised APACHE II was greater than the customised SAPS II (0.925 and 0.892, P APACHE II in overall populations and various subgroups but insufficient calibration for the customised SAPS II. The customised SAPS II showed good calibration in only the younger, postoperative and sepsis patients subgroups. The overall performance of the customised APACHE II was better than the customised SAPS II (Brier score 0.089 and 0.109, respectively). Our results indicate that the customised APACHE II shows better performance than the customised SAPS II in predicting hospital mortality and could be used to predict mortality and quality assessment in our unit or other intensive care units with a similar case mix.

  16. The mare as a model for luteinized unruptured follicle syndrome: intrafollicular endocrine milieu.

    Science.gov (United States)

    Bashir, S T; Gastal, M O; Tazawa, S P; Tarso, S G S; Hales, D B; Cuervo-Arango, J; Baerwald, A R; Gastal, E L

    2016-03-01

    Luteinized unruptured follicle (LUF) syndrome is a recurrent anovulatory dysfunction that affects up to 23% of women with normal menstrual cycles and up to 73% with endometriosis. Mechanisms underlying the development of LUF syndrome in mares were studied to provide a potential model for human anovulation. The effect of extended increase in circulating LH achieved by administration of recombinant equine LH (reLH) or a short surge of LH and decrease in progesterone induced by prostaglandin F2α (PGF2α) on LUF formation (Experiment 1), identification of an optimal dose of COX-2 inhibitor (flunixin meglumine, FM; to block the effect of prostaglandins) for inducing LUFs (Experiment 2), and evaluation of intrafollicular endocrine milieu in LUFs (Experiment 3) were investigated. In Experiment 1, mares were treated with reLH from Day 7 to Day 15 (Day 0=ovulation), PGF2α on Day 7, or in combination. In Experiment 2, FM at doses of 2.0 or 3.0 mg/kg every 12 h and human chorionic gonadotropin (hCG) (1500 IU) were administered after a follicle ≥32 mm was detected. In Experiment 3, FM at a dose of 2.0 mg/kg every 12 h plus hCG was used to induce LUFs and investigate the intrafollicular endocrine milieu. No LUFs were induced by reLH or PGF2α treatment; however, LUFs were induced in 100% of mares using FM. Intrafollicular PGF2α metabolite, PGF2α, and PGE2 were lower and the ratio of PGE2:PGF2α was higher in the induced LUF group. Higher levels of intrafollicular E2 and total primary sex steroids were observed in the induced LUF group along with a tendency for higher levels of GH, cortisol, and T; however, LH, PRL, VEGF-A, and NO did not differ between groups. In conclusion, this study reveals part of the intrafollicular endocrine milieu and the association of prostaglandins in LUF formation, and indicates that the mare might be an appropriate model for studying the poorly understood LUF syndrome.

  17. Factors Influencing the Use of Psychotropic Medication for Challenging Behaviour in the United Kingdom: A Q Method Investigation

    Science.gov (United States)

    Wastell, Sarah; Skirrow, Paul; Hare, Dougal Julian

    2016-01-01

    Objectives: The use of pharmacological interventions to manage challenging behaviour displayed by adults with intellectual disabilities remains controversial, with current clinical guidelines in the United Kingdom advocating the use of less invasive psychological interventions. This exploratory study aimed to discover what views and beliefs are…

  18. The impact of a pre-hospital medical response unit on patient care and emergency department attendances.

    LENUS (Irish Health Repository)

    Deasy, C

    2012-02-03

    A rapid response team was instigated in Cork to improve prehospital care and reduce unnecessary Emergency Department (ED) visits. This consisted of a Specialist Registrar (SpR) in Emergency Medicine and a Paramedic who attended all "999" calls in a designated rapid response vehicle on the allotted study days. Two hundred and sixty-three patients were seen on designated days between Jan 2004 and March 2006. Presentations seen included; road traffic accident (23%) collapse (12%), fall (10%) and seizure (8%). The majority of calls were to houses (36%). The most common medical intervention was intravenous cannulation (25%). Intravenous medications were administered in 21% of these patients--morphine sulphate was the most common drug given. It was possible to safely discharge 31% of patients on scene. In our experience skilled Emergency Medicine doctors attending at scene could provide advanced care and reduce ambulance transportation and patient attendance.

  19. Narrative descriptions should replace grades and numerical ratings for clinical performance in medical education in the United States

    Directory of Open Access Journals (Sweden)

    Janice Lynn Hanson

    2013-11-01

    Full Text Available Background: In medical education, evaluation of clinical performance is based almost universally on rating scales for defined aspects of performance and scores on examinations and checklists. Unfortunately, scores and grades do not capture progress and competence among learners in the complex tasks and roles required to practice medicine. While the literature suggests serious problems with the validity and reliability of ratings of clinical performance based on numerical scores, the critical issue is not that judgments about what is observed vary from rater to rater but that these judgments are lost when translated into numbers on a scale. As the Next Accreditation System of the Accreditation Council on Graduate Medical Education (ACGME takes effect, medical educators have an opportunity to create new processes of evaluation to document and facilitate progress of medical learners in the required areas of competence.Proposal and initial experience: Narrative descriptions of learner performance in the clinical environment, gathered using a framework for observation that builds a shared understanding of competence among the faculty, promise to provide meaningful qualitative data closely linked to the work of physicians. With descriptions grouped in categories and matched to milestones, core faculty can place each learner along the milestones’ continua of progress. This provides the foundation for meaningful feedback to facilitate the progress of each learner as well as documentation of progress toward competence.Implications: This narrative evaluation system addresses educational needs as well as the goals of the Next Accreditation System for explicitly documented progress. Educators at other levels of education and in other professions experience similar needs for authentic assessment and, with meaningful frameworks that describe roles and tasks, may also find useful a system built on descriptions of learner performance in actual work settings

  20. The United States Army Medical Department Journal, April - June 2011. Prehospital combat casualty care; The starting point of battlefield survival

    Science.gov (United States)

    2011-04-01

    advanced since 1831. Highlighting the technologic advances in combat arms to the individual medic level, one only need look at the medic’s semiautomatic ...splenic laceration) in normal and coagulopathic pigs,31,32 but was ineffective against severe arterial (aortotomy injury22), venous ( grade V liver...swine model with a grade V liver injury. The results demonstrated the superior efficacy of this dressing over regular gauze for controlling venous

  1. Mental Health and Resilience: Soldiers’ Perceptions about Psychotherapy, Medications, and Barriers to Care in the United States Military

    Science.gov (United States)

    2014-08-01

    for anxiety and depression are highly addictive . Rate how each of the possible concerns might affect your decision to receive mental health counseling...anxiety and depression do not help a person cope better. 6. Most medications for anxiety and depression are highly addictive . Strongly Strongly DISAGREE...days after soldiers return home. After the soldier has been home for at least 90 days, a secure personal internet account (Army Knowledge On-line

  2. United States Air Force Personalized Medicine and Advanced Diagnostics Program Panel: Representative Research at the San Antonio Military Medical Center

    Science.gov (United States)

    2016-05-20

    DEPARTMENT OF THE AIR FORCE 59TH MEDICAL WING (AETC) LACKLAND AIR FORCE BASE TEXAS MEMORANDUMFORSGVT ATTN: DEBRA M NIEMEYER FROM: 59 MDW/SGVU... Dato of Mooting) 181 PLATFORM PRESENTATION (At c ivilian lnstitulionsfNamo of Meeting, State, Dato of Mooting) University of Texas at San Antonio...SAMHS & Universities Research Forum {SURF2016). TX, 05-20-2016 D OTHER (Describe: Name of Mooting, City, State, and Dato of Meeting) 6. WHAT IS THE

  3. Diversity by race, Hispanic ethnicity, and sex of the United States medical oncology physician workforce over the past quarter century.

    Science.gov (United States)

    Deville, Curtiland; Chapman, Christina H; Burgos, Ramon; Hwang, Wei-Ting; Both, Stefan; Thomas, Charles R

    2014-09-01

    To assess the medical oncology (MO) physician workforce diversity by race, Hispanic ethnicity, and sex, with attention to trainees. Public registries were used to assess 2010 differences among MO practicing physicians, academic faculty, and fellows; internal medicine (IM) residents; and the US population, using binomial tests with P diversity remains unchanged. For Blacks alone, representation as MO fellows is decreased compared with IM residents, suggesting greater disparity in MO training. Copyright © 2014 by American Society of Clinical Oncology.

  4. Transferable skills of incoming medical students and their development over the first academic year: The United Arab Emirates experience.

    Science.gov (United States)

    McLean, Michelle; Shaban, Sami; Murdoch-Eaton, Deborah

    2011-01-01

    Increasingly, it is being recognised in higher and medical education that learners should be adequately prepared for the unpredictable nature of professional practice. Several generic or transferable skills or capabilities (e.g., communication, information handling) that will enable graduates to function in an ever-changing professional world have been identified. Using a validated inventory comprising six categories of transferable skills, three cohorts of incoming male and female medical students at a Gulf university documented their level of practice and confidence for 31 skills. The exercise was repeated a year later. New medical students identified computer and organisational skills and the ability to manage their learning as strengths, but scores for technical and numeracy, information handling and presentation and communication skills suggested that learners generally required guidance. A year later, despite considerable self-reported information handling and communication skills development, learners generally did not consider themselves self-sufficient. A significant gender difference emerged, with incoming males reporting less experience and confidence in many skills. This gap was reduced but did not disappear over the first academic year. An audit such as this may be useful for identifying individual skills levels as well as providing insight into shortcomings in the academic programme in terms of opportunities for transferable skills development.

  5. Hands in medicine: understanding the impact of competency-based education on the formation of medical students’ identities in the United States

    Directory of Open Access Journals (Sweden)

    Catherine Gonsalves

    2016-08-01

    Full Text Available Purpose 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. Methods 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. Results 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. Conclusion 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.

  6. Hands in medicine: understanding the impact of competency-based education on the formation of medical students’ identities in the United States

    Directory of Open Access Journals (Sweden)

    Catherine Gonsalves

    2016-08-01

    Full Text Available Purpose 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. Methods 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. Results 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. Conclusion 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.

  7. 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)

    2016-01-01

    Purpose 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. Methods 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. Results 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. Conclusion 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. PMID:27572244

  8. Descriptive Analysis on ICU Medical Risk Management in United Kingdom, United States, Australia, Canada and Taiwan%英美澳加和中国台湾地区ICU医疗风险管理分析

    Institute of Scientific and Technical Information of China (English)

    孙纽云; 崔小花; 梁铭会; 王莉; 李幼平; 成岚; 李筱; 袁强

    2011-01-01

    Objective To analyze the policy and guideline, the institutional management and the operation mechanism of ICU medical risk management in the United Kingdom, the United States, Australia, Canada and Taiwan, so as to provide evidence and recommendations for health care risk management policy in China.Methods Such databases as PubMed, EMBASE, The Cochrane Library were searched to include the literatures such as the guideline documents and the research reports on ICU medical risk management in the United Kingdom, the United States, Australia, Canada and Taiwan; the institutional management and the operation mechanism of the risk management in the above four countries and one area were comprehensively analyzed, and especially the UK model was highly emphasized.Results A total of 31 literatures were included, including 1 guideline, 5 reviews, 2 investigative reports and 23 research documents.The United Kingdom guided the ICU risk management in forms of the standard and the guideline, formulated a clear tool of event classification and corresponding response mechanism.The United States learned from Australia's experience and established the ICU safety reporting system; both of them regarded ICU as one part of the medical risk management and set up a special management column.Conclusion The ICU risk management with the independent report system in the United Kingdom is brought into the scope of national patient safety management, and is regarded as the relative complete system at present.In Australia and the USA, the national institutions are in charge of setting up the research projects of ICU risk management; the industry associations and the non-governmental organizations lead the risk research; and the experimental units popularize gradually after self-application.%目的 通过分析四国一区ICU风险管理政策指南、机构管理和运行机制等,为我国ICU风险管理提供决策依据和政策建议.方法 计算机检索PubMed,、Embase,Cochrane Library

  9. 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.

  10. Le cancer en milieu chirurgical pédiatrique au Togo

    OpenAIRE

    Gnassingbe, Komla; Guedenon, Koffi Mawuse; Kanassoua, Kokou; Adabra, Komlan; Kpabi, Kagnimtassou; Akakpo-Numado, Gamedzi Komlatse; Napo-Koura, Gado; Tekou, Hubert

    2014-01-01

    Introduction Le but de ce travail était de relever les aspects épidémiologiques des cancers de l'enfant en milieu chirurgical, décrire les problèmes posés par ces cancers et évaluer les résultats de leur prise en charge Méthodes Il s'agit d'une étude rétrospective analytique sur dossiers de patients âgés de moins de 15 ans pris en charge dans le service de chirurgie pédiatrique pour cancer solide de preuve anatomopathologique entre janvier 1987 et décembre 2010. Jusqu'en 2010, les hôpitaux pu...

  11. [Prevalence of hip, femur and knee fractures at the High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes", Instituto Mexicano del Seguro Social].

    Science.gov (United States)

    Lovato-Salas, F; Luna-Pizarro, D; Oliva-Ramírez, S A; Flores-Lujano, J; Núñez-Enríquez, J C

    2015-01-01

    Lower limb fractures are more frequent among older patients with osteopenia after a low energy fall and/or among young patients who sustain a high energy trauma. The prevalence of hip, femur and knee fractures at the High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes" is unknown. Cross-sectional study, descriptive and retrospective design. Cases with low extremity fractures treated from January 1st, 2012 to December 31st, 2013 at the Hip, Femur and Knee Service, High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes", were reviewed. Most patients (52.2%) were females; 64.1% of patients were over 60 years of age. Fracture distribution according to the segment involved was as follows: 73.4% (n = 1,327) were femur fractures, 13.5% (n = 244) tibial plateau fractures, and 13.2% (n = 238) patellar fractures. 66.8% (n = 1,209) of patients had a long hospital stay (more than 10 days). According to the anatomical location of fractures, transtrochanteric fractures (49.1%) were the most frequent ones, followed by patellar fractures (13.2%), and femur shaft fractures (12.7%). The prevalence of lower limb fractures at our hospital corresponds to what has been reported internationally.

  12. 野战医疗队无线Mesh快速组网%Fast Construct Network for Wireless Mesh in Field Medical Unit

    Institute of Scientific and Technical Information of China (English)

    万任华; 林亚忠; 林村河; 王苓; 顾金库

    2011-01-01

    传统的联网方式容易受距离和复杂地形的影响,不适合野战医疗队所处的复杂地理环境.针对这一不足,本文提出一种基于无线Mesh网络技术的野战医疗临时组网方案,利用无线Mesh网络技术高带宽、健壮性、非视距传输和兼容性等优点,实现野战环境的组网,并对Mesh网络的性能特点和可能存在的问题进行探讨.%It is vulnerable to distance and complex terrain for the ways of traditional networking, which are not suitable to the complex geographical environment for field medical unit.In response to this deficiency, a temporary networking program based on wireless Mesh network for the field medical unit is proposed.The program takes the advantages of high - bandwidth, robustness, non - sight transmission and compatibility of the wireless Mesh network, and makes the temporary networking into realize under the field environment.At last, the performance and the potential problems of Mesh network are discussed.

  13. The United States cover-up of Japanese wartime medical atrocities: complicity committed in the national interest and two proposals for contemporary action.

    Science.gov (United States)

    Nie, Jing-Bao

    2006-01-01

    To monopolize the scientific data gained by Japanese physicians and researchers from vivisections and other barbarous experiments performed on living humans in biological warfare programs such as Unit 731, immediately after the war the United States (US) government secretly granted those involved immunity from war crimes prosecution, withdrew vital information from the International Military Tribunal for the Far East, and publicly denounced otherwise irrefutable evidence from other sources such as the Russian Khabarovsk trial. Acting in "the national interest" and for the security of the US, authorities in the US tramped justice and morality, and engaged in what the English common law tradition clearly defines as "complicity after the fact." To repair this historical injustice, the US government should issue an official apology and offer appropriate compensation for having covered up Japanese medical war crimes for six decades. To help prevent similar acts of aiding principal offender(s) in the future, international declarations or codes of human rights and medical ethics should include a clause banning any kind of complicity in any unethical medicine-whether before or after the fact-by any state or group for whatever reasons.

  14. 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.

    Science.gov (United States)

    Harwood, Rowan H; Goldberg, Sarah E; Whittamore, Kathy H; Russell, Catherine; Gladman, John Rf; Jones, Rob G; Porock, Davina; Lewis, Sarah A; Bradshaw, Lucy E; Elliot, Rachel A

    2011-05-13

    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. 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 life, cognitive function, disability, behavioural and

  15. 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

    Directory of Open Access Journals (Sweden)

    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

  16. Peculiarities of the Super-Folder GFP Folding in a Crowded Milieu

    Directory of Open Access Journals (Sweden)

    Olesya V. Stepanenko

    2016-10-01

    Full Text Available The natural cellular milieu is crowded by large quantities of various biological macromolecules. This complex environment is characterized by a limited amount of unoccupied space, limited amounts of free water, and changed solvent properties. Obviously, such a tightly packed cellular environment is poorly mimicked by traditional physiological conditions, where low concentrations of a protein of interest are analyzed in slightly salted aqueous solutions. An alternative is given by the use of a model crowded milieu, where a protein of interest is immersed in a solution containing high concentrations of various polymers that serve as model crowding agents. An expected outcome of the presence of such macromolecular crowding agents is their ability to increase conformational stability of a globular protein due to the excluded volume effects. In line with this hypothesis, the behavior of a query protein should be affected by the hydrodynamic size and concentration of an inert crowder (i.e., an agent that does not interact with the protein, whereas the chemical nature of a macromolecular crowder should not play a role in its ability to modulate conformational properties. In this study, the effects of different crowding agents (polyethylene glycols (PEGs of various molecular masses (PEG-600, PEG-8000, and PEG-12000, Dextran-70, and Ficoll-70 on the spectral properties and unfolding–refolding processes of the super-folder green fluorescent protein (sfGFP were investigated. sfGFP is differently affected by different crowders, suggesting that, in addition to the expected excluded volume effects, there are some changes in the solvent properties.

  17. Apoptosis and hormonal milieu in ductal system of normal prostate and benign prostatic hyperplasia

    Institute of Scientific and Technical Information of China (English)

    Shu-Jie XIA; Chun-Xiao XU; Xiao-Da TANG; Wan-Zhong WANG; De-Li DU

    2001-01-01

    Aim: To study theapoptotic rate (AR) and the androgen and estrogen milieu in the proximal and distal ductal sys tems of prostate, in order to help exploring the effects of these factors on prostatic growth and the pathogenesis of be nign prostatic hypertrophy (BPH). Methods: The proximal and distal ends of the ductal system were incised from 20 normal prostate as well as the hypertrophic prostate tissue from 20 patients with BPH. The AR was determined by the DNA end-labeling method and dihydrotestosterone (DHT) and estrodiol (E2), by radioimmunoassay. Results:There was no significant difference in DHT and E2 density between the proximal and distal ends of the ductal systems in normal prostate. E2 appeared to be higher in BPH than in normal prostatic tissues, but the difference was statistically in significant. In normal prostatic tissue, the AR was significantly higher in the distal than in the proximal ends of the ductal system ( P < 0.05), while the AR of the proximal ends was significantly higher ( P < 0.01) than that in the BPH tissue. No significant correlation was noted between the DHT and E2 density and the AR both in the normal prostate and BPH tissues. Conclusion: The paper is the first time describing a difference in AR in different regions of the ductal system of normal prostate, while the hormonal milieu is similar, indicating a functional inhomogeneity of these regions. A low AR in the proximal duct, where BPH originates, and an even lower AR in the BPH tissue, sug gesting the participation of apoptosis in the BPH pathogenesis.

  18. The Battle Stress Recovery Unit (BSRU) in UNIFIL: A Module of the Belgian Medical Treatment Facility (MTF) Role 2

    Science.gov (United States)

    2011-04-01

    be in charge of the protection of the Belgian and Luxemburg personnel of BELUFIL. The protection force will operate under direct Belgian command...for the collective (i.e. bullet-proof jackets, armoured vehicles, CBRN equipment...) Before departure and upon return, the participants will be...servicemen or their co-workers at the unit in Belgium. During these three years of effort, almost every employee of the CCP was directly involved in

  19. Estimated Lifetime Medical and Work-Loss Costs of Emergency Department-Treated Nonfatal Injuries--United States, 2013.

    Science.gov (United States)

    Florence, Curtis; Haegerich, Tamara; Simon, Thomas; Zhou, Chao; Luo, Feijun

    2015-10-02

    A large number of nonfatal injuries are treated in U.S. emergency departments (EDs) every year. CDC's National Center for Health Statistics estimates that approximately 29% of all ED visits in 2010 were for injuries. To assess the economic impact of ED-treated injuries, CDC examined injury data from the National Electronic Injury Surveillance System--All Injury Program (NEISS-AIP) for 2013, as well as injury-related lifetime medical and work-loss costs from the Web-Based Injury Statistics Query and Reporting System (WISQARS). NEISS-AIP collects data from a nationally representative sample of EDs, using specific guidelines for recording the primary diagnosis and mechanism of injury. Number of injuries, crude- and age-specific injury rates, and total lifetime work-loss costs and medical costs were calculated for ED-treated injuries, stratified by sex, age groups, and intent and mechanism of injury. ED-treated injuries were further classified as those that were subsequently hospitalized or treated and released. The rate of hospitalized injuries was 950.8 per 100,000, and the rate of treated and released injuries was 8,549.8 per 100,000. Combined medical and work-loss costs for all ED-treated injuries (both hospitalized and treated and released) were $456.9 billion, or approximately 68% of the total costs of $671 billion associated with all fatal and ED-treated injuries. The substantial economic burden associated with nonfatal injuries underscores the need for effective prevention strategies.

  20. Physical characterization and in vitro evaluation of some generic medications available in pharma market of United Arab Emirates (UAE)

    OpenAIRE

    Abdul Rasool, Bazigha K; Khan, Saeed A.; Shamsueldin, Eiman; Sadik, Raghad

    2011-01-01

    This study is the first attempt in UAE to prove the trustworthiness of the in vitro evaluation to assess the reliability of the generic medications comparing to the brand name. Five generic medicines, two Local (codes: L1, L2), three Arabic (codes: A1, A2 and A3) and the International brand (code: I1) of diclofenac sodium (DS) sustained release tablets, as a model product, was collected randomly from the UAE pharma market. The products were characterized by physical parameters including weigh...

  1. Disparities in HIV knowledge and attitudes toward biomedical interventions among the non-medical HIV workforce in the United States.

    Science.gov (United States)

    Copeland, Raniyah M; Wilson, Phill; Betancourt, Gabriela; Garcia, David; Penner, Murray; Abravanel, Rebecca; Wong, Eric Y; Parisi, Lori D

    2017-04-27

    Non-medical, community-based workers play a critical role in supporting people living with (or at risk of acquiring) HIV along the care continuum. The biomedical nature of promising advances in HIV prevention, such as pre-exposure prophylaxis and treatment-as-prevention, requires frontline workers to be knowledgeable about HIV science and treatment. This study was developed to: measure knowledge of HIV science and treatment within the HIV non-medical workforce, evaluate workers' familiarity with and attitudes toward recent biomedical interventions, and identify factors that may affect HIV knowledge and attitudes. A 62-question, web-based survey was completed in English or Spanish between 2012 and 2014 by 3663 US-based employees, contractors, and volunteers working in AIDS service organizations, state/local health departments, and other community-based organizations in a non-medical capacity. Survey items captured the following: respondent demographics, HIV science and treatment knowledge, and familiarity with and attitudes toward biomedical interventions. An average of 61% of HIV knowledge questions were answered correctly. Higher knowledge scores were associated with higher education levels, work at organizations that serve people living with HIV/AIDS or who are at a high risk of acquiring HIV, and longer tenure in the field. Lower knowledge scores were associated with non-Hispanic Black or Black race/ethnicity and taking the survey in Spanish. Similarly, subgroup analyses showed that respondents who were non-Hispanic Black or Hispanic (versus non-Hispanic white), as well as those located in the South (versus other regions) scored significantly lower. These subpopulations were also less familiar with and had less positive attitudes toward newer biomedical prevention interventions. Respondents who took the survey in Spanish (versus English) had lower knowledge scores and higher familiarity with, but generally less positive attitudes toward, biomedical interventions

  2. Progress for whose future? The impact of the Flexner Report on medical education for racial and ethnic minority physicians in the United States.

    Science.gov (United States)

    Steinecke, Ann; Terrell, Charles

    2010-02-01

    The publication of the Flexner Report in 1910 had an immediate and enduring impact on the training of African American physicians in the United States. The Flexner Report's thesis, "that the country needs fewer and better doctors," was intended to normalize medical education for the majority of physicians, but its implementation just 48 years after the Emancipation Proclamation obstructed opportunities for African Americans pursuing medical education and restricted the production of physicians capable of addressing the health needs of a nation that would grow increasingly diverse across the century.This article provides a working definition of structural racism within academic medicine, reviews the significant physician workforce diversity initiatives of the past four decades, and suggests the most successful of these possess strategies common to addressing structural racism (community empowerment, collaboration, clear and measurable goals, leadership, and durable resources). Stymied by popular ballot initiatives, relentless legal challenges, and dwindling funds, current and future efforts to increase diversity in medicine must maintain a focus on addressing the active remnants of structural racism while they build on the broad benefits of diversity in education and medicine. Despite creative and tireless efforts, no significant progress in expanding diversity within the U.S. physician workforce can be made absent a national effort to address this enduring barrier in the collective social, economic, and political institutions. The centennial of the Flexner Report is an opportunity for the academic medicine community to renew its commitment to dismantling the barriers to diversity and improving medical education for all future physicians.

  3. Investigation of the degree of organisational influence on patient experience scores in acute medical admission units in all acute hospitals in England using multilevel hierarchical regression modelling

    Science.gov (United States)

    Sullivan, Paul

    2017-01-01

    Objectives Previous studies found that hospital and specialty have limited influence on patient experience scores, and patient level factors are more important. This could be due to heterogeneity of experience delivery across subunits within organisations. We aimed to determine whether organisation level factors have greater impact if scores for the same subspecialty microsystem are analysed in each hospital. Setting Acute medical admission units in all NHS Acute Trusts in England. Participants We analysed patient experience data from the English Adult Inpatient Survey which is administered to 850 patients annually in each acute NHS Trusts in England. We selected all 8753 patients who returned the survey and who were emergency medical admissions and stayed in their admission unit for 1–2 nights, so as to isolate the experience delivered during the acute admission process. Primary and secondary outcome measures We used multilevel logistic regression to determine the apportioned influence of host organisation and of organisation level factors (size and teaching status), and patient level factors (demographics, presence of long-term conditions and disabilities). We selected ‘being treated with respect and dignity’ and ‘pain control’ as primary outcome parameters. Other Picker Domain question scores were analysed as secondary parameters. Results The proportion of overall variance attributable at organisational level was small; 0.5% (NS) for respect and dignity, 0.4% (NS) for pain control. Long-standing conditions and consequent disabilities were associated with low scores. Other item scores also showed that most influence was from patient level factors. Conclusions When a single microsystem, the acute medical admission process, is isolated, variance in experience scores is mainly explainable by patient level factors with limited organisational level influence. This has implications for the use of generic patient experience surveys for comparison between

  4. Popular apps on the medical category targeting patients and the general public in the United Kingdom: Do they conform to the Health On the Net Foundation principles?

    Science.gov (United States)

    Ben-Mussa, Ali; Paget, Anthony M

    2016-08-26

    Smartphones with their rising popularity and versatile software 'apps' have great potential for revolutionising healthcare services. However, this was soon overshadowed by concerns highlighted by many studies over quality. These were subject and/or discipline specific and mostly evaluated compliance with a limited number of information portrayal standards originally devised for health websites. Hence, this study aimed to take a broader approach by evaluating the most popular apps categorised as medical in the United Kingdom for compliance with all of those standards systematically using the Health On the Net (HON) Foundation principles.The study evaluated top 50 free and paid apps of the 'medical' category on both iTunes and Google stores for evidence of compliance with an app-adapted version of the HON Foundation code of conduct. The sample included 64 apps, 34/64 (53%) were on Google Play and 36/64 (56%) were free. None of the apps managed to comply with the entire eight principles. Compliance with seven principles was achieved by only one app (1.6%), and the rest were compliant with three, two, and one (14.7%, 27%, and 38%, respectively).In conclusion, this study demonstrated that most popular apps on the medical category that are available in the United Kingdom do not meet the standards for presenting health information to the public, and this is consistent with earlier studies. Improving the situation would require raising the public awareness, providing tools that would assist in quality evaluation, encouraging developers to use robust development process, and facilitating collaboration and engagement among the stakeholders. © The Author(s) 2016.

  5. Medical Students in the United States Reveal Their Ideal Expectations to Help Planners of a New Library

    Directory of Open Access Journals (Sweden)

    Aislinn Conway

    2017-09-01

    Full Text Available A Review of: Aronoff, N. (2016. Surveying medical students to gauge library use and plan for a new medical library. Medical Reference Services Quarterly, 35(2, 187-203. http://dx.doi.org/10.1080/02763869.2016.1152144 Abstract Objective – To help plan for a new library by exploring student use of existing library services and identifying their priorities for the new space. Design – Online survey, sent via email. Setting – Medical school at a university in New York. Subjects – 585 medical students. Methods – The researchers emailed a 45-item online survey to all medical students enrolled at the school. Responses were anonymised and all questions were non-mandatory. Main results – 27% of students (157 out of 585 took part in the survey by answering at least one question. The questions were categorised into the following six topic areas: 1. Use of space and expectations for the new library space: More than half of the participants (67% indicated that they rarely or never came to the library during the academic year in question. Of the students who reported frequenting the library on a daily, weekly, or monthly basis, the majority indicated that they preferred independent study to group study. The following resources were ranked as very important for an ideal library space: sufficient electrical outlets, strong wireless connectivity, printing facilities, individual and quiet study spaces, comfortable seating, online resources, computers, windows/natural light, and group study spaces. Open-ended responses indicated that students desire close proximity to food and beverage services, large study tables to accommodate reading materials and technology, improved opening hours, and satisfactory bathroom facilities. 2. Where medical students study: Of the participants, one third of students reported studying at home, 21% chose to describe the physical characteristics of their place of study rather than name a place, 18% of students studied in

  6. Non-targeted metabolomic evaluation of the uterine milieu during the transitional period of embryo elongation in the pig

    Science.gov (United States)

    Alterations in the signaling of critical molecular factors within the uterine milieu lead to deficiencies in embryo elongation. The objective of this study was to identify metabolites within the uterine environment that are present as porcine embryos transition between spherical, ovoid, and tubular ...

  7. Asking More than We Can Tell: Social Status, Social Milieu and Social Space in Explanations for Participation in Adult Education

    Science.gov (United States)

    Schemmann, Michael; Wittpoth, Jurgen

    2008-01-01

    This paper argues that even though there is continuous research work on participation in adult education, the current state of research is not satisfactory. It develops this assumption by discussing studies that focus on social status and social milieu as explanatory factors for adult education. The authors draw on findings from a research project…

  8. 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

    2015-01-01

    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…

  9. Mortality-related factors disparity among Iranian deceased children aged 1-59 months according to the medical activities in emergency units: National mortality surveillance system

    Directory of Open Access Journals (Sweden)

    Roya Kelishadi

    2012-01-01

    Full Text Available Background: To determine disparity in mortality-related factors in 1-59 months children across Iran using hospital records of emergency units. Materials and Methods: After designing and validating a national questionnaire for mortality data collection of children 1-59 months, all 40 medical universities has been asked to fill in the questionnaires and return to the main researcher in the Ministry of Health and Medical Education. Age and sex of deceased children, the type of health center, staying more than 2 h in emergency unit, the reason of prolonged stay in emergency, having emergency (risk signs, vaccination, need to blood transfusion, need to electroshock and so on have also been collected across the country. There was also a comparison of children based on their BMI. Chi-square test has been applied for nominal and ordinal variables. ANOVA and t-student test have been used for measuring the difference of continuous variables among groups. Results: Mortality in 1-59 months children was unequally distributed across Iran. The average month of entrance to hospital was June, the average day was 16 th of month, and the average hour of entrance to hospital was 14:00. The average of month, day and hour for discharge was July, 16, and 14:00, respectively. The hour of discharge was statistically significant between children with and without risk signs. More than half (54% of patients had referred to educational hospital emergency units. There were no statistically significant differences between children with and without emergency signs. There were statistically significant differences between children with and without emergency signs in age less than 24 months (0.034, nutrition situation ( P = 0.031, recommendation for referring ( P = 0.013, access to electroshock facilities ( P = 0.026, and having successful cardiopulmonary resuscitation ( P = 0.01. Conclusion: This study is one of the first to show the distribution of the disparity of early

  10. A Survey of Intravenous Remifentanil Use for Labor Analgesia at Academic Medical Centers in the United States.

    Science.gov (United States)

    Aaronson, Jaime; Abramovitz, Sharon; Smiley, Richard; Tangel, Virginia; Landau, Ruth

    2017-04-01

    Remifentanil is most commonly offered when neuraxial labor analgesia is contraindicated. There is no consensus regarding the optimal administration, dosing strategy, or requirements for maternal monitoring, which may pose a patient safety issue. This exploratory survey evaluated the current practices regarding remifentanil use for labor analgesia at academic centers in the United States. Of 126 obstetric anesthesia directors surveyed, 84 (67%) responded. In 2014 to 2015, an estimated 36% (95% confidence interval: 25.7-46.3) of centers used remifentanil, most of which did so less than 5 times. Some serious maternal and neonatal respiratory complications occurred, emphasizing that clinical protocols and adequate monitoring are key to ensure maternal and neonatal safety.

  11. A computer-assisted recording, diagnosis and management of the medically ill system for use in the intensive care unit: A preliminary report

    Directory of Open Access Journals (Sweden)

    John George

    2009-01-01

    Full Text Available Background: Computerized medical information systems have been popularized over the last two decades to improve quality and safety, and for decreasing medical errors. Aim: To develop a clinician-friendly computer-based support system in the intensive care unit (ICU that incorporates recording, reminders, alerts, checklists and diagnostic differentials for common conditions encountered in critical care. Materials and Methods: This project was carried out at the Medical ICU CMC Hospital, Vellore, in collaboration with the Computer Science Department, VIT University. The first phase was to design and develop monitoring and medication sheets. Terminologies such as checklists (intervention list that pops up at defined times for all patients, reminders (intervention unique to each patient and alerts (time-based, value-based, trend-based were defined. The diagnostic and intervention bundles were characterized in the second phase. The accuracy and reliability of the software to generate alerts, reminders and diagnoses was tested in the third phase. The fourth phase will be to integrate this with the hospital information system and the bedside monitors. Results: Alpha testing was performed using six scenarios written by intensivists. The software generated real-time alerts and reminders and provided diagnostic differentials relevant to critical care. Predefined interventions for each diagnostic possibility appeared as pop-ups. Problems identified during alpha testing were rectified prior to beta testing. Conclusions: The use of a computer-assisted monitoring, recording and diagnostic system appears promising. It is envisaged that further software refinements following beta testing would facilitate the improvement of quality and safety in the critical care environment.

  12. A Prospective, Descriptive Study to Determine the Rate and Characteristics of and Risk Factors for the Development of Medical Device-related Pressure Ulcers in Intensive Care Units.

    Science.gov (United States)

    Hanonu, Seval; Karadag, Ayise

    2016-02-01

    Pressure ulcers do not develop only in areas with bony prominences; they can develop in any tissue under pressure, including pressure exerted by medical devices. A prospective, descriptive study was conducted from December 15, 2013 to March 25, 2014 to determine the prevalence, risk factors, and characteristics of medical device-related hospitalacquired pressure ulcers (MDR HAPUs) among all patients (N = 175) in 5 adult intensive care units (ICUs) in a university hospital in Turkey. The previously established point prevalence of hospital-acquired pressure ulcers (HAPUs) in these ICUs was 15%. Patients were evaluated in the first 24 hours after admission and observed 6 times thereafter in intervals of 48 hours. Demographic (eg, age, gender, body mass index) and medical device-related pressure ulcer data (eg, location, device type, stage), and Braden Scale scores were collected and analyzed; frequencies and percentages were calculated and Mann-Whitney U Test, t-test, and odds ratios were applied. Twenty-seven (27) patients (15.4%) developed nonMDR HAPUs and 70 (40.0%) developed MDR HAPUs. MDR HAPUs occurred most frequently (45.0%) in patients with an endotracheal tube. The most frequent type (42.6%) was Stage II. The highest rates of MDR HAPUs were observed among internal medicine ICU patients (OR 7.041), patients who also had a nonMDR HAPU (OR 6.6), patients in the high Braden risk score group (OR 1.8), or patients who received enteral feeding (OR 2.12). Because of the high rate of MDR HAPUs noted, policies and procedures aimed at preventing medical device-related pressure ulcers are needed.

  13. [Access to medical appointments by men with sexually transmitted diseases at a health unit in Fortaleza, Ceará, Brazil].

    Science.gov (United States)

    Araújo, Maria Alix Leite; Leitão, Glória da Conceição Mesquita

    2005-01-01

    Access to healthcare services is one of the important aspects of the Unified National Health System in Brazil, and the supply and management of such services is the responsibility of municipalities. This study focuses on difficulties faced by men with sexually transmitted diseases (STDs) in accessing appointments for treatment. This was a qualitative study of men treated at an STD clinic in Fortaleza, Ceará State, Brazil, in November 2003, using content analysis technique and interpretation of interviews, focusing on access as the category. Men with STDs encountered extensive difficulty in accessing medical appointments, even when they used different strategies for this purpose. Scheduling of services is incompatible with patients' available time. At the primary care level, the supply of appointments for STDs scarcely exists. More investment is needed in the Unified National Health System in order to improve access to appointments for men with STDs, and the supply of services should take the population's demand into account.

  14. Enlightenment from United States medical licensing examination(USMLE) upon Chinese medical genetics education%美国医师执照考试对我国医学遗传学教学的启示

    Institute of Scientific and Technical Information of China (English)

    孙平楠; 周小玲; 刘戈飞; 黄天华

    2009-01-01

    介绍了美国医师执照(United States Medical Licensing Examination,USMLE)考试中与医学遗传学教学相关的大纲内容,并比较了我国医学遗传学教学范围与美国USMLE测试考点的异同.分析发现USMLE更加注重临床思维的培训以及临床案例的运用,启示国内医学遗传学教学工作应加强运用以问题为基础的教学模式(Problem-based learning,PBL),提出邀请临床医生参加教材编写,以及在中国执业医师考试中增加医学遗传内容等建议.

  15. Early Rehabilitation in the Medical and Surgical Intensive Care Units for Patients With and Without Mechanical Ventilation: An Interprofessional Performance Improvement Project.

    Science.gov (United States)

    Corcoran, John R; Herbsman, Jodi M; Bushnik, Tamara; Van Lew, Steve; Stolfi, Angela; Parkin, Kate; McKenzie, Alison; Hall, Geoffrey W; Joseph, Waveney; Whiteson, Jonathan; Flanagan, Steven R

    2017-02-01

    Most early mobility studies focus on patients on mechanical ventilation and the role of physical and occupational therapy. This Performance Improvement Project (PIP) project examined early mobility and increased intensity of therapy services on patients in the intensive care unit (ICU) with and without mechanical ventilation. In addition, speech-language pathology rehabilitation was added to the early mobilization program. We sought to assess the efficacy of early mobilization of patients with and without mechanical ventilation in the ICU on length of stay (LOS) and patient outcomes and to determine the financial viability of the program. PIP. Prospective data collection in 2014 (PIP) compared with a historical patient population in 2012 (pre-PIP). Medical and surgical ICUs of a Level 2 trauma hospital. There were 160 patients in the PIP and 123 in the pre-PIP. Interprofessional training to improve collaboration and increase intensity of rehabilitation therapy services in the medical and surgical intensive care units for medically appropriate patients. Demographics; intensity of service; ICU and hospital LOS; medications; pain; discharge disposition; functional mobility; and average cost per day were examined. Rehabilitation therapy services increased from 2012 to 2014 by approximately 60 minutes per patient. The average ICU LOS decreased by almost 20% from 4.6 days (pre-PIP) to 3.7 days (PIP) (P = .05). A decrease of over 40% was observed in the floor bed average LOS from 6.0 days (pre-PIP) to 3.4 days (PIP) (P ICU and floor bed decreased in the PIP group, resulting in an annualized net cost savings of $1.5 million. The results of the PIP indicate that enhanced rehabilitation services in the ICU is clinically feasible, results in improved patient outcomes, and is fiscally sound. Most early mobility studies focus on patients on mechanical ventilation. The results of this PIP project demonstrate that there are significant benefits to early mobility and increased

  16. Design and Construction of a Positron Emission Tomography (PET) Unit and Medical Applications with GEANT Detector Simulation Package

    Energy Technology Data Exchange (ETDEWEB)

    Karagoz, Muge [Bogazici Univ., Istanbul (Turkey)

    1998-01-01

    In order to investigate the possibility of the construction of a sample PET coincidence unit in our HEP laboratory, a setup with two face to face PMTs and two 2x8 Csi(Tl) scintillator matrices has been constructed. In this setup, 1-D projections of a pointlike 22 Na positron source at different angles have been measured. Using these projections a 2-D image has been formed. Monte Carlo studies of this setup have been implemented using the detector simulation tool in CERN program library, GEANT. Again with GEANT a sample human body is created to study the effects of proton therapy. Utilization of the simulation as a pretherapy tool is also investigated.

  17. Effect of auditory stimulation on traumatic coma duration in intensive care unit of Medical Sciences University of Mazandarn, Iran

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Heidari Gorji

    2014-01-01

    Full Text Available Background: Sensory deprivation is one of the common complications of coma patients in the intensive care unit (ICU. The purpose of this study was to investigate the impact of a familiar voice to consciousness level in coma patients. Methods: A total of 13 patients with traumatic coma (8 ≥ Glasgow′s coma scale [GCS] admitted in ICU ward were randomly assigned to control and experimental groups. The experimental group was treated twice a daily each time 15 min with a familiar recorded MP3 sound for 2 weeks. The control group received only natural voices of environment. GCS applied to evaluate patients′ level of consciousness. Finding: Findings showed that duration to reach GCS = 15 was significantly shorter in the experimental group (χ 2 = 12/96, P < 0/001. Conclusion: These findings imply that providing familiar auditory stimulation programs for coma patients in the ICU could be effective.

  18. Atrial Fibrillation on Intensive Care Unit Admission Independently Increases the Risk of Weaning Failure in Nonheart Failure Mechanically Ventilated Patients in a Medical Intensive Care Unit: A Retrospective Case-Control Study.

    Science.gov (United States)

    Tseng, Yen-Han; Ko, Hsin-Kuo; Tseng, Yen-Chiang; Lin, Yi-Hsuan; Kou, Yu Ru

    2016-05-01

    Atrial fibrillation (AF) is one of the most frequent arrhythmias in clinical practice. Previous studies have reported the influence of AF on patients with heart failure (HF). The effect of AF on the non-HF critically ill patients in a medical intensive care unit (ICU) remains largely unclear. The study aimed to investigate the impact of AF presenting on ICU admission on the weaning outcome of non-HF mechanically ventilated patients in a medical ICU.A retrospective observational case-control study was conducted over a 1-year period in a medical ICU at Taipei Veterans General Hospital, a tertiary medical center in north Taiwan. Non-HF mechanically ventilated patients who were successful in their spontaneous breathing trial and underwent ventilator discontinuation were enrolled. The primary outcome measure was the ventilator status after the first episode of ventilator discontinuation.A total of 285 non-HF patients enrolled were divided into AF (n = 62) and non-AF (n = 223) groups. Compared with the non-AF patients, the AF patients were significantly associated with old age (P = 0.002), a higher rate of acute respiratory distress syndrome causing respiratory failure (P = 0.015), a higher percentage of sepsis before liberation from mechanical ventilation (MV) (P = 0.004), and a higher serum level of blood urea nitrogen on the day of liberation from MV (P = 0.003). Multivariate logistic regression analysis demonstrated that AF independently increased the risk of weaning failure [adjusted odds ratio (AOR), 3.268; 95% confidence interval (CI), 1.254-8.517; P = 0.015]. Furthermore, the AF patients were found to be independently associated with a high rate of ventilator dependence (log rank test, P = 0.026), prolonged total ventilator use (AOR, 1.979; 95% CI, 1.032-3.794; P = 0.040), increased length of ICU stay (AOR, 2.256; 95% CI, 1.049-4.849; P = 0.037), increased length of hospital stay (AOR, 2.921; 95% CI, 1.363-6.260; P = 0

  19. [CASTOR-Radiology: software of management in a Unit of Medical Imaging: use in the CHU of Tours].

    Science.gov (United States)

    Bertrand, P; Rouleau, P; Alison, D; Bristeau, M; Minard, P; Saad, B

    1993-01-01

    Despite the large volume of information circulating in radiology departments, very few of them are currently computerised, although computer processing is developing rapidly in hospitals, encouraged by the installation of PMSI. This article illustrates the example of an imaging department management software: CASTOR-Radiologie, Computerisation of part of the Hospital Information System (HIS) must allow an improvement in the efficacy of the service rendered, must reliably reflect the department's activity and must be able to monitor the running costs. CASTOR-Radiologie was developed in conformity with standard national specifications defined by the Public Hospitals Department of the French Ministry of Health. The functions of this software are: unique patient identification, HIS base, management of examination requests, allowing a rapid reply to clinician's requests, "real-time" follow-up of patients in the department, saving time for secretaries and technicians, medical files and file analysis, allowing analysis of diagnostic strategies and quality control, edition of analytical tables of the department's activity compatible with the PMSI procedures catalogue, allowing optimisation of the use of limited resources, aid to the management of human, equipment and consumable resources. Links with other hospital computers raise organisational rather than technical problems, but have been planned for in the CASTOR-Radiologie software. This new tool was very well accepted by the personnel.

  20. Characteristics of child commercial sexual exploitation and sex trafficking victims presenting for medical care in the United States.

    Science.gov (United States)

    Varma, Selina; Gillespie, Scott; McCracken, Courtney; Greenbaum, V Jordan

    2015-06-01

    The objective of the study is to describe distinguishing characteristics of commercial sexual exploitation of children/child sex trafficking victims (CSEC) who present for health care in the pediatric setting. This is a retrospective study of patients aged 12-18 years who presented to any of three pediatric emergency departments or one child protection clinic, and who were identified as suspected victims of CSEC. The sample was compared with gender and age-matched patients with allegations of child sexual abuse/sexual assault (CSA) without evidence of CSEC on variables related to demographics, medical and reproductive history, high-risk behavior, injury history and exam findings. There were 84 study participants, 27 in the CSEC group and 57 in the CSA group. Average age was 15.7 years for CSEC patients and 15.2 years for CSA patients; 100% of the CSEC and 94.6% of the CSA patients were female. The two groups significantly differed in 11 evaluated areas with the CSEC patients more likely to have had experiences with violence, substance use, running away from home, and involvement with child protective services and/or law enforcement. CSEC patients also had a longer history of sexual activity. Adolescent CSEC victims differ from sexual abuse victims without evidence of CSEC in their reproductive history, high risk behavior, involvement with authorities, and history of violence.

  1. Evaluation of risk factors in acute myocardial infarction patients admitted to the coronary care unit, Tripoli Medical Centre, Libya.

    Science.gov (United States)

    Abduelkarem, A R; El-Shareif, H J; Sharif, S I

    2012-04-01

    The aim of this study was to provide an overview of the risk factors for acute myocardial infarction in patients attending Tripoli Medical Centre, Libya. Records were reviewed for 622 patients with a mean age of 58.3 (SD 12.9) years. Diabetes mellitus (48.2%), hypertension (35.7%) and smoking (50.6%) were among the risk factors reported. There were 110 patients (17.7%) who died during hospitalization, mainly suffering cardiogenic shock (48.0%). The rate of use of thrombolytic therapy was low in patients who were female (40.4% versus 58.4% for males), older age (31.6% for those > 85 years versus 63.3% for patients < 55 years), diabetics (45.3% versus 62.0% for non-diabetic patients) and hypertensives (47.3% versus 57.8% for non-hypertensive patients). Prevention strategies should be implemented in order to improve the long-term prognosis and decrease overall morbidity and mortality from coronary artery disease in Libyan patients.

  2. Relationships among NANDA-I diagnoses, nursing outcomes classification, and nursing interventions classification by nursing students for patients in medical-surgical units in Korea.

    Science.gov (United States)

    Noh, Hyun Kyung; Lee, Eunjoo

    2015-01-01

    The purpose of this study was to identify NANDA-I, Nursing Outcomes Classification (NOC), and Nursing Interventions Classification (NIC; NNN) linkages used by Korean nursing students during their clinical practice in medical-surgical units. A comparative descriptive research design was used to measure the effects of nursing interventions from 153 nursing students in South Korea. Nursing students selected NNN using a Web-based nursing process documentation system. Data were analyzed by paired t-test. Eighty-two NANDA-I diagnoses, 116 NOC outcomes, and 163 NIC interventions were identified. Statistically significant differences in patients' preintervention and postintervention outcome scores were observed. By determining patient outcomes linked to interventions and how the degree of outcomes change after interventions, the effectiveness of the interventions can be evaluated. © 2014 NANDA International, Inc.

  3. An intervention to improve the catheter associated urinary tract infection rate in a medical intensive care unit: Direct observation of catheter insertion procedure.

    Science.gov (United States)

    Galiczewski, Janet M; Shurpin, Kathleen M

    2017-06-01

    Healthcare associated infections from indwelling urinary catheters lead to increased patient morbidity and mortality. The purpose of this study was to determine if direct observation of the urinary catheter insertion procedure, as compared to the standard process, decreased catheter utilization and urinary tract infection rates. This case control study was conducted in a medical intensive care unit. During phase I, a retrospective data review was conducted on utilsiation and urinary catheter infection rates when practitioners followed the institution's standard insertion algorithm. During phase II, an intervention of direct observation was added to the standard insertion procedure. The results demonstrated no change in utilization rates, however, CAUTI rates decreased from 2.24 to 0 per 1000 catheter days. The findings from this study may promote changes in clinical practice guidelines leading to a reduction in urinary catheter utilization and infection rates and improved patient outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Different patterns of inappropriate antimicrobial use in surgical and medical units at a tertiary care hospital in Switzerland: a prevalence survey.

    Directory of Open Access Journals (Sweden)

    Alexia Cusini

    Full Text Available BACKGROUND: Unnecessary or inappropriate use of antimicrobials is associated with the emergence of antimicrobial resistance, drug toxicity, increased morbidity and health care costs. Antimicrobial use has been reported to be incorrect or not indicated in 9-64% of inpatients. We studied the quality of antimicrobial therapy and prophylaxis in hospitalized patients at a tertiary care hospital to plan interventions to improve the quality of antimicrobial prescription. METHODOLOGY/PRINCIPAL FINDINGS: Experienced infectious diseases (ID fellows performed audits of antimicrobial use at regular intervals among all patients--with or without antimicrobials--hospitalized in predefined surgical, medical, haemato-oncological, or intensive care units. Data were collected from medical and nursing patient charts with a standardized questionnaire. Appropriateness of antimicrobial use was evaluated using a modified algorithm developed by Gyssens et al.; the assessment was double-checked by a senior ID specialist. We evaluated 1577 patients of whom 700 (44.4% had antimicrobials, receiving a total of 1270 prescriptions. 958 (75.4% prescriptions were for therapy and 312 (24.6% for prophylaxis. 37.0% of therapeutic and 16.6% of prophylactic prescriptions were found to be inappropriate. Most frequent characteristics of inappropriate treatments included: No indication (17.5%; incorrect choice of antimicrobials (7.6%; incorrect application of drugs (9.3%; and divergence from institutional guidelines (8%. Characteristics of inappropriate prophylaxes were: No indication (9%; incorrect choice of antimicrobials (1%; duration too long or other inappropriate use (6.7%. Patterns of inappropriate antimicrobial varied widely in the different hospital units; empirical prescriptions were more frequently incorrect than prescriptions based on available microbiological results. CONCLUSIONS/SIGNIFICANCE: Audits of individual patient care provide important data to identify local

  5. Acute kidney injury patterns and outcomes in low-risk versus high-risk critically ill patients admitted to the medical intensive care unit

    Directory of Open Access Journals (Sweden)

    Cyriacus Anaele

    2017-01-01

    Full Text Available Background: Acute kidney injury (AKI is often one component of multiple organ failure (MOF in the intensive care unit (ICU. However, not all patients with MOF develop AKI, and AKI may develop in the absence of MOF. We compared the impact of AKI alone and in combination with MOF on the survival of patients admitted to a large tertiary care medical intensive care unit (MICU.  Methods: We abstracted data from the electronic medical records of patients admitted to the MICU from April 2012 through June 2013 and categorized patients as either high-risk or low- risk status based on use of vasopressor support or mechanical ventilation during the ICU stay. The outcomes we considered were in-hospital, 30-day, 90-day, 180-day, and 1-year mortality. Results: Of the 834 critically ill patients, 743 (89% developed some degree of AKI. Ninety-one percent of the high-risk cohort developed AKI and 87% of the low-risk cohort developed AKI. Patients with AKI had higher mortality at 1-year than patients without AKI (adjusted odds ratio [OR], 2.5; 95% confidence interval [CI], 1.38 to 4.53; P interaction 0.0026.  Hospital mortality was greater for high-risk patients without AKI than for low-risk patients with AKI. Conclusion: Acute kidney injury occurs at similar frequency in high and low-risk ICU patients and has significant impact on survival in both groups.  Cardiovascular collapse or respiratory failure has greater impact on short term mortality than AKI, but this effect diminishes over time. Conversely, the impact of AKI on mortality increased over time and remained an independent risk factor for mortality.

  6. Attitude is everything? The impact of workload, safety climate, and safety tools on medical errors: a study of intensive care units.

    Science.gov (United States)

    Steyrer, Johannes; Schiffinger, Michael; Huber, Clemens; Valentin, Andreas; Strunk, Guido

    2013-01-01

    Hospitals face an increasing pressure toward efficiency and cost reduction while ensuring patient safety. This warrants a closer examination of the trade-off between production and protection posited in the literature for a high-risk hospital setting (intensive care). On the basis of extant literature and concepts on both safety management and organizational/safety culture, this study investigates to which extent production pressure (i.e., increased staff workload and capacity utilization) and safety culture (consisting of safety climate among staff and safety tools implemented by management) influence the occurrence of medical errors and if/how safety climate and safety tools interact. A prospective, observational, 48-hour cross-sectional study was conducted in 57 intensive care units. The dependent variable is the incidence of errors affecting those 378 patients treated throughout the entire observation period. Capacity utilization and workload were measured by indicators such as unit occupancy, nurse-to-patient/physician-to-patient ratios, levels of care, or NEMS scores. The safety tools considered include Critical Incidence Reporting Systems, audits, training, mission statements, SOPs/checklists, and the use of barcodes. Safety climate was assessed using a psychometrically validated four-dimensional questionnaire.Linear regression was employed to identify the effects of the predictor variables on error rate as well as interaction effects between safety tools and safety climate. Higher workload has a detrimental effect on safety, whereas safety climate-unlike the examined safety tools-has a virtually equal opposite effect. Correlations between safety tools and safety climate as well as their interaction effects on error rate are mostly nonsignificant. Increased workload and capacity utilization increase the occurrence of medical error, an effect that can be offset by a positive safety climate but not by formally implemented safety procedures and policies.

  7. National Ambulatory Medical Care Survey: terrorism preparedness among office-based physicians, United States, 2003-2004.

    Science.gov (United States)

    Niska, Richard W; Burt, Catharine W

    2007-07-24

    This investigation describes terrorism preparedness among U.S. office-based physicians and their staffs in identification and diagnosis of terrorism-related conditions, training methods and sources, and assistance with diagnosis and reporting. The National Ambulatory Medical Care Survey (NAMCS) is an annual national probability survey of approximately 3,000 U.S. nonfederal, office-based physicians. Terrorism preparedness items were added in 2003 and 2004. About 40 percent of physicians or their staffs received training for anthrax or smallpox, but less than one-third received training for any of the other exposures. About 42.2 percent of physicians, 13.5 percent of nurses, and 9.4 percent of physician assistants and nurse practitioners received training in at least one exposure. Approximately 56.2 percent of physicians indicated that they would contact state or local public health officials for diagnostic assistance more frequently than federal agencies and other sources. About 67.1 percent of physicians indicated that they would report a suspected terrorism-related condition to the state or local health department, 50.9 percent to the Centers for Disease Control and Prevention (CDC), 27.5 percent to the local hospital, and 1.8 percent to a local elected official's office. Approximately 78.8 percent of physicians had contact information for the local health department readily available. About 53.7 percent had reviewed the diseases reportable to health departments since September 2001, 11.3 percent had reviewed them before that month, and 35 percent had never reviewed them.

  8. Charles Edouard Brown-Séquard's departure from the Medical College of Virginia: incompatible science or incompatible social views in pre-Civil War southern United States.

    Science.gov (United States)

    Watson, Joseph C; Ho, Stephen V

    2011-01-01

    Charles Edouard Brown-Séquard was one of the most colorful characters in modern physiology. His scientific methods of self-experimentation and animal vivisection led to many great observations, including the eponymous syndrome of hemisection of the spinal cord. Despite his renown, he stayed but one year in his first major academic post. Details of his sojourn at the Medical College of Virginia (now part of Virginia Commonwealth University) in Richmond were divined from perusal of archival material, letters, and from the available literature. His notoriety in the field of physiology landed him a post at the Medical College of Virginia in 1854 as the chair of physiology. During a brief time here, he was able to publish his landmark monograph of 1855 on the pathways of the spinal cord "Experimental and Clinical Researches on the Physiology and Pathology of the Spinal Cord." He had a near-death experience while experimenting on himself to determine the function of the skin. It was rumored that his English was poor, his lectures unintelligible, and his scientific methods disturbing to the neighbors and that for those reasons he was asked to vacate his post. Personal communications and other accounts indicate a different view: his mixed-blood heritage and his views on slavery were unpopular in the pre-Civil War southern United States. These disparate viewpoints lend an insight into the life and career of this pioneer in modern medicine and experimental design and to the clash of science and social views.

  9. Early re-presentation to hospital after discharge from an acute medical unit: perspectives of older patients, their family caregivers and health professionals.

    Science.gov (United States)

    Slatyer, Susan; Toye, Christine; Popescu, Aurora; Young, Jeanne; Matthews, Anne; Hill, Andrew; Williamson, D James

    2013-02-01

    To explore the perceptions of older patients who re-presented to hospital within 28 days of discharge from an acute medical unit (AMU), their family caregivers and appropriately experienced health professionals. Hospitals are increasingly using AMUs to provide rapid assessment and treatment for medical patients. Evidence of efficacy is building, however in-depth exploration of the experiences of older patients who re-present to hospital soon after discharge from an AMU, and those who care for them, appears to be lacking. A qualitative, descriptive design was used. In 2007, our team purposively sampled older patients who re-presented to hospital within 28 days of discharge from an AMU (n = 12), family caregivers (n = 15), and health professionals (n = 35). Data were collected using semi-structured interviews and subjected to thematic content analysis. Four themes emerged: the health trajectory, communication challenges, discharge readiness and the decision to return. Re-presentation to hospital was seen as part of a declining health trajectory. The AMU was viewed as treating acute illness well, however patients and family caregivers left hospital with limited understanding of underlying health problems and, therefore, ill-prepared for future health crises. There are clear benefits for older patients from AMUs, which expedite treatment for acute health crises. However, AMU discharge planning needs to consider patients' overall health status and likely future needs to optimise outcomes. Such a requirement is problematic in the context of acute time pressures. To ensure prompt and expert attention to key aspects of discharge planning for older people leaving AMUs, there is a role for in-depth clinical expertise in the care of older people facing deteriorating life-limiting conditions. Therefore, a leadership role for nurses with geriatric and palliative care expertise, alongside medical and allied health professionals, merits attention in this context. © 2013

  10. Linear units improve articulation between social and physical constructs: An example from caregiver parameterization for children supported by complex medical technologies

    Science.gov (United States)

    Bezruczko, N.; Stanley, T.; Battle, M.; Latty, C.

    2016-11-01

    Despite broad sweeping pronouncements by international research organizations that social sciences are being integrated into global research programs, little attention has been directed toward obstacles blocking productive collaborations. In particular, social sciences routinely implement nonlinear, ordinal measures, which fundamentally inhibit integration with overarching scientific paradigms. The widely promoted general linear model in contemporary social science methods is largely based on untransformed scores and ratings, which are neither objective nor linear. This issue has historically separated physical and social sciences, which this report now asserts is unnecessary. In this research, nonlinear, subjective caregiver ratings of confidence to care for children supported by complex, medical technologies were transformed to an objective scale defined by logits (N=70). Transparent linear units from this transformation provided foundational insights into measurement properties of a social- humanistic caregiving construct, which clarified physical and social caregiver implications. Parameterized items and ratings were also subjected to multivariate hierarchical analysis, then decomposed to demonstrate theoretical coherence (R2 >.50), which provided further support for convergence of mathematical parameterization, physical expectations, and a social-humanistic construct. These results present substantial support for improving integration of social sciences with contemporary scientific research programs by emphasizing construction of common variables with objective, linear units.

  11. Race differences in obesity and its relationship to the sex hormone milieu.

    Science.gov (United States)

    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.

  12. 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.

  13. Increasing social interaction using prelinguistic milieu teaching with nonverbal school-age children with autism.

    Science.gov (United States)

    Franco, Jessica H; Davis, Barbara L; Davis, John L

    2013-08-01

    Children with autism display marked deficits in initiating and maintaining social interaction. Intervention using play routines can create a framework for developing and maintaining social interaction between these children and their communication partners. Six nonverbal 5- to 8-year-olds with autism were taught to engage in social interaction within salient play routines. Prelinguistic milieu teaching (PMT) techniques were used to teach the children to communicate intentionally during these routines. Intervention focused on the children's social interaction with an adult. The effects of intervention were evaluated using a multiple baseline design across participants. At study onset, the participants demonstrated few consistent interaction with others. With intervention, all of the children improved their ability to sustain social interactions, as evidenced by an increase in the number of communicative interactions during play routines. Participants also increased their overall rate of initiated intentional communication. Development of intentional prelinguistic communication within salient social routines creates opportunities for an adult to teach social and communication skills to young school-age children with autism who function at a nonverbal level.

  14. Peri-Implantation Hormonal Milieu: Elucidating Mechanisms of Abnormal Placentation and Fetal Growth1

    Science.gov (United States)

    Mainigi, Monica A.; Olalere, Devvora; Burd, Irina; Sapienza, Carmen; Bartolomei, Marisa; Coutifaris, Christos

    2013-01-01

    ABSTRACT Assisted reproductive technologies (ART) have been associated with several adverse perinatal outcomes involving placentation and fetal growth. It is critical to examine each intervention individually in order to assess its relationship to the described adverse perinatal outcomes. One intervention ubiquitously used in ART is superovulation with gonadotropins. Superovulation results in significant changes in the hormonal milieu, which persist during the peri-implantation and early placentation periods. Epidemiologic evidence suggests that the treatment-induced peri-implantation maternal environment plays a critical role in perinatal outcomes. In this study, using the mouse model, we have isolated the exposure to the peri-implantation period, and we examine the effect of superovulation on placentation and fetal growth. We report that the nonphysiologic peri-implantation maternal hormonal environment resulting from gonadotropin stimulation appears to have a direct effect on fetal growth, trophoblast differentiation, and gene expression. This appears to be mediated, at least in part, through trophoblast expansion and invasion. Although the specific molecular and cellular mechanism(s) leading to these observations remain to be elucidated, identifying this modifiable risk factor will not only allow us to improve perinatal outcomes with ART, but help us understand the pathophysiology contributing to these outcomes. PMID:24352558

  15. Lower implantation rates in high responders: evidence for an altered endocrine milieu during the preimplantation period.

    Science.gov (United States)

    Pellicer, A; Valbuena, D; Cano, F; Remohí, J; Simón, C

    1996-06-01

    To determine serum E2 and P levels around the time of implantation in normal and high IVF responders. In Vitro Fertilization program at the Instituto Valenciano de Infertilidad. Twenty-nine women undergoing IVF, who accepted to be studied daily, were classified according to the number of oocytes retrieved in normal (n = 16) and high responders (n = 13). Prospective study in which blood was drawn daily from the day of hCG administration (day 0) up to 7 days later (day 6). In vitro fertilization parameters (number of ampules, FSH-hMG, number of oocytes, fertilization rates, number of transferred embryos, implantation rates, and pregnancy rates); serum E2 and P levels during the 7 days of the study. Implantation rate was significantly higher in normal (18.5%) as compared with high (0%) responders. Estradiol and P levels were elevated significantly in high responders. The E2:P ratio was significantly different between normal and high responders during the preimplantation period. Pregnancy and implantation rates decreased as serum E2 levels increased on days 4 to 6 of the study. A different endocrine milieu between normal and high responders is detected by daily steroid measurements up to the preimplantation period, suggesting that this difference could be responsible for an impaired implantation in high responder patients undergoing IVF. An increase in serum E2 levels seems to be the cause of this difference.

  16. 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.

  17. Topical medication utilization and health resources consumption in adult patients affected by psoriasis: findings from the analysis of administrative databases of local health units

    Science.gov (United States)

    Perrone, Valentina; Sangiorgi, Diego; Buda, Stefano; Degli Esposti, Luca

    2017-01-01

    Aim The objectives of this study were to: 1) analyze the drug utilization pattern among adult psoriasis patients who were newly prescribed with topical medication; and 2) assess their adherence to topical therapy and the possibility of switching to other strategies in the treatment process. Methods An observational retrospective analysis was conducted based on administrative databases of two Italian local health units. All adult subjects who were diagnosed with psoriasis or who were newly prescribed for topical medication with at least one prescription between January 1, 2010, and December 31, 2014, were screened. Only patients who were “non-occasional users of topical drugs” (if they had at least two prescriptions of topical drugs in a time space of 2 years) were considered for the first and second objectives in the analysis. The date of the first prescription of topical agents was identified as the index date (ID), which was then followed for all time available from ID (follow-up period). The adherence to therapy was assessed on the basis of cycles of treatment covered in the 6 months before the end of the follow-up period. The mean health care costs in patients who switched to disease-modifying antirheumatic drugs (DMARDs) or biologics after the ID were evaluated. Results A total of 17,860 patients with psoriasis who were newly prescribed for topical medication were identified. A total of 2,477 were identified as “non-occasional users of topical drugs”, of whom 70.2% had a prescription for a topical fixed combination regimen at ID. Around 19% adhered to their medication, whereas 6% switched to other options of psoriasis treatment. Multivariable logistic regression model shows that patients on fixed combination treatment were less likely to be non-adherent to treatment and less likely to switch to other treatments. The annual mean pharmaceutical costs were €567.70 and €10,606.10 for patients who switched to DMARDs and biologics, respectively

  18. Brand name and generic proton pump inhibitor prescriptions in the United States: insights from the national ambulatory medical care survey (2006-2010).

    Science.gov (United States)

    Gawron, Andrew J; Feinglass, Joseph; Pandolfino, John E; Tan, Bruce K; Bove, Michiel J; Shintani-Smith, Stephanie

    2015-01-01

    Introduction. Proton pump inhibitors (PPI) are one of the most commonly prescribed medication classes with similar efficacy between brand name and generic PPI formulations. Aims. We determined demographic, clinical, and practice characteristics associated with brand name PPI prescriptions at ambulatory care visits in the United States. Methods. Observational cross sectional analysis using the National Ambulatory Medical Care Survey (NAMCS) of all adult (≥18 yrs of age) ambulatory care visits from 2006 to 2010. PPI prescriptions were identified by using the drug entry code as brand name only or generic available formulations. Descriptive statistics were reported in terms of unweighted patient visits and proportions of encounters with brand name PPI prescriptions. Global chi-square tests were used to compare visits with brand name PPI prescriptions versus generic PPI prescriptions for each measure. Poisson regression was used to determine the incidence rate ratio (IRR) for generic versus brand PPI prescribing. Results. A PPI was prescribed at 269.7 million adult ambulatory visits, based on 9,677 unweighted visits, of which 53% were brand name only prescriptions. In 2006, 76.0% of all PPI prescriptions had a brand name only formulation compared to 31.6% of PPI prescriptions in 2010. Visits by patients aged 25-44 years had the greatest proportion of brand name PPI formulations (57.9%). Academic medical centers and physician-owned practices had the greatest proportion of visits with brand name PPI prescriptions (58.9% and 55.6% of visits with a PPI prescription, resp.). There were no significant differences in terms of median income, patient insurance type, or metropolitan status when comparing the proportion of visits with brand name versus generic PPI prescriptions. Poisson regression results showed that practice ownership type was most strongly associated with the likelihood of receiving a brand name PPI over the entire study period. Compared to HMO visits

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

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    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.

  20. An analysis of Japan Disaster Medical Assistance Team (J-DMAT) deployments in comparison with those of J-DMAT's counterpart in the United States (US-DMAT).

    Science.gov (United States)

    Fuse, Akira; Yokota, Hiroyuki

    2010-12-01

    Lessons learned from the Great Hanshin-Awaji earthquake of 1995 underscored the necessity of establishing Disaster Medical Assistance Teams (DMATs) in Japan, and in 2005, the Japanese government's Central Disaster Prevention Council revised its Basic Disaster Management Plan to include full deployment of DMATs in disaster areas. Defining a DMAT as a trained, mobile, self-contained medical team that can act in the acute phase of a disaster (48 to 72 hours after its occurrence) to provide medical treatment in the devastated area, the revised plan called for the training of DMAT personnel for rapid deployment to any area of the country hit by a disaster. This paper presents descriptive data on the number and types of missions carried out by Japan DMAT (J-DMAT) in its first 5 years, and clarifies how J-DMAT differs from its counterpart in the United States (US-DMAT). The DMAT that the present authors belong to has been deployed for 2 natural disasters and 1 man-made disaster, and the operations carried out during these deployments are analyzed. Reports on J-DMAT activities published from 2004 through 2009 by the Japanese Association for Disaster Medicine are also included in the analysis. After training courses for J-DMAT personnel started in fiscal 2004, J-DMATs were deployed for 8 disasters in a period of 4 years. Five of these were natural disasters, and 3 man-made. Of the 5 natural disasters, 3 were earthquakes, and of the 3 man-made disasters, 2 were derailment accidents. Unlike in the United States, where hurricanes and floods account for the greatest number of DMAT deployments, earthquakes cause the largest number of disasters in Japan. Because Japan is small in comparison with the US (Japan has about 1/25 the land area of the US), most J-DMATs head for devastated areas by car from their respective hospitals. This is one reason why J-DMATs are smaller and more agile than US-DMATs. Another difference is that J-DMATs' activities following earthquakes involve

  1. External validation of the simple clinical score and the HOTEL score, two scores for predicting short-term mortality after admission to an acute medical unit.

    Science.gov (United States)

    Stræde, Mia; Brabrand, Mikkel

    2014-01-01

    Clinical scores can be of aid to predict early mortality after admission to a medical admission unit. A developed scoring system needs to be externally validated to minimise the risk of the discriminatory power and calibration to be falsely elevated. We performed the present study with the objective of validating the Simple Clinical Score (SCS) and the HOTEL score, two existing risk stratification systems that predict mortality for medical patients based solely on clinical information, but not only vital signs. Pre-planned prospective observational cohort study. Danish 460-bed regional teaching hospital. We included 3046 consecutive patients from 2 October 2008 until 19 February 2009. 26 (0.9%) died within one calendar day and 196 (6.4%) died within 30 days. We calculated SCS for 1080 patients. We found an AUROC of 0.960 (95% confidence interval [CI], 0.932 to 0.988) for 24-hours mortality and 0.826 (95% CI, 0.774-0.879) for 30-day mortality, and goodness-of-fit test, χ(2) = 2.68 (10 degrees of freedom), P = 0.998 and χ(2) = 4.00, P = 0.947, respectively. We included 1470 patients when calculating the HOTEL score. Discriminatory power (AUROC) was 0.931 (95% CI, 0.901-0.962) for 24-hours mortality and goodness-of-fit test, χ(2) = 5.56 (10 degrees of freedom), P = 0.234. We find that both the SCS and HOTEL scores showed an excellent to outstanding ability in identifying patients at high risk of dying with good or acceptable precision.

  2. Comparison of signs and symptoms of myocardial infarction and unstable angina in male and female hospitalizedpatients in coronary care units of Kerman Medical University hospital, 2004-2005

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    S. Sabzevari

    2007-01-01

    Full Text Available Abstract Background and purpose: Coronary Artery Disease (CAD is one of the most common causes of mortality and disability in the world. The results of some studies show that there are differences in signs and symptoms of CAD between male and female.Materials and Methods: This research was done to compare males and females for these signs and symptoms in 600 hospitalized patients in coronary care units of Kerman Medical University from December 2004 to July 2005. For data collection a questionnaire was used which was designed in five sections: demographic characteristics, disease variables, pictures for determining the points of chest pain, Visual Analog Scale for determining the intensity of pain and measures taken by patients after the beginning the signs and symptoms. This questionnaire was completed by two nurses in different shifts by interviewing the patients. For data analysis T test, χ2, Fisher exact and Man-Whitney U were used.Results: The results showed that the women were older than men (p<0.001. Most women had unstable angina and men had myocardial infarction (P<0.05. There were no significant differences between the chest pain in both genders but neck pain, back pain, fatigue, decrease of appetite, flushing, dizziness, tiredness, visual disturbances, suffocation feeling, palpitation and restlessness were experienced in women more than men (p<0.05. Also dyspenea during the heart attack was seen in most women (44.7% vs 29.4% but there was no significant difference between two genders for intensity of pain.Conclusion: This study showed that atypical signs and symptoms of unstable angina and myocardial infarction were seen in female more than male. Furthermore this may be followed by some problems in diagnosis and then delay in referring the patients to medical centers. On the other hand, health care workers may not pay enough attention to these atypical signs and symptoms, in women with normal ECG so they might not receive nessaceery

  3. RETINOPATHY OF PREMATURITY SCREENING OF 500 INFANTS IN A LEVEL II NEONATAL INTENSIVE CARE UNIT AT A MEDICAL COLLEGE HOSPITAL IN SOUTHERN KARNATAKA

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    Keerthi

    2014-09-01

    Full Text Available INTRODUCTION: Retinopathy of prematurity (ROP is the leading cause of infant blindness and predominantly affects premature, low birth weight babies.1 India and other middle-income countries are said to be suffering from the ‘third epidemic’. ROP is multi-factorial and early detection and treatment of threshold ROP with timely laser treatment results in excellent outcome.3-8 OBJECTIVES: 1. To determine the yield of ROP in a level II neonatal intensive care unit (NICU at a Government Medical College Hospital in Mandya district. 2. To determine disease characteristics and outcome of treatment. METHODOLOGY: The study is a prospective analysis of infants admitted during March 1st 2009 and November 30th, 2011(33 months at the NICU of Mandya Institute of Medical Sciences (MIMS Hospital. All infants weighing

  4. “The Patient is Dying, Please Call the Chaplain”: The Activities of Chaplains in One Medical Center’s Intensive Care Units

    Science.gov (United States)

    Choi, Philip J.; Curlin, Farr A.; Cox, Christopher E.

    2015-01-01

    Context Patients and families commonly experience spiritual stress during an intensive care unit (ICU) admission. While a majority of patients report that they want spiritual support, little is known about how these issues are addressed by hospital chaplains. Objectives To describe the prevalence, timing, and nature of hospital chaplain encounters in ICUs. Methods This was a retrospective cross-sectional study of adult ICUs at an academic medical center. Measures included: days from ICU admission to initial chaplain visit, days from chaplain visit to ICU death or discharge, hospital and ICU length of stay, severity of illness at ICU admission and chaplain visit, and chart documentation of chaplain communication with the ICU team. Results Of a total of 4169 ICU admissions over six months, 248 (5.9%) patients were seen by chaplains. Of the 246 patients who died in an ICU, 197 (80%) were seen by a chaplain. There was a median of two days from ICU admission to chaplain encounter and a median of one day from chaplain encounter to ICU discharge or death. Chaplains communicated with nurses after 141 encounters (56.9%), but with physicians after only 14 encounters (5.6%); there was no documented communication in 55 encounters (22%). Conclusion In the ICUs at this tertiary medical center, chaplain visits are uncommon and generally occur just before death among ICU patients. Communication between chaplains and physicians is rare. Chaplaincy service is primarily reserved for dying patients and their family members rather than providing proactive spiritual support. These observations highlight the need to better understand challenges and barriers to optimal chaplain involvement in ICU patient care. PMID:26025278

  5. Identification of differentially expressed genes of Trichinella spiralis larvae after exposure to host intestine milieu.

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    Hui Jun Ren

    Full Text Available Although it has been known for many years that T. spiralis muscle larvae (ML can not invade intestinal epithelial cells unless they are exposed to the intestinal milieu and activated into intestinal infective larvae (IIL, which genes in IIL are involved in the process of invasion is still unknown. In this study, suppression subtractive hybridization (SSH was performed to identify differentially expressed genes between IIL and ML. SSH library was constructed using cDNA generated from IIL as the 'tester'. About 110 positive clones were randomly selected from the library and sequenced, of which 33 T. spiralis genes were identified. Thirty encoded proteins were annotated according to Gene Ontology Annotation in terms of molecular function, biological process, and cellular localization. Out of 30 annotated proteins, 16 proteins (53.3% had binding activity and 12 proteins (40.0% had catalytic activity. The results of real-time PCR showed that the expression of nine genes (Ts7, Ndr family protein; Ts8, serine/threonine-protein kinase polo; Ts11, proteasome subunit beta type-7; Ts17, nudix hydrolase; Ts19, ovochymase-1; Ts22, fibronectin type III domain protein; Ts23, muscle cell intermediate filament protein OV71; Ts26, neutral and basic amino acid transport protein rBAT and Ts33, FACT complex subunit SPT16 from 33 T. spiralis genes in IIL were up-regulated compared with that of ML. The present study provide a group of the potential invasion-related candidate genes and will be helpful for further studies of mechanisms by which T. spiralis infective larvae recognize and invade the intestinal epithelial cells.

  6. Pituitary Adenlylate Cyclase Activating Peptide Protects Adult Neural Stem Cells from a Hypoglycaemic milieu.

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    Shiva Mansouri

    Full Text Available Hypoglycaemia is a common side-effect of glucose-lowering therapies for type-2 diabetic patients, which may cause cognitive/neurological impairment. Although the effects of hypoglycaemia in the brain have been extensively studied in neurons, how hypoglycaemia impacts the viability of adult neural stem cells (NSCs has been poorly investigated. In addition, the cellular and molecular mechanisms of how hypoglycaemia regulates NSCs survival have not been characterized. Recent work others and us have shown that the pituitary adenylate cyclase-activating polypeptide (PACAP and the glucagon-like peptide-1 receptor (GLP-1R agonist Exendin-4 stimulate NSCs survival against glucolipoapoptosis. The aim of this study was to establish an in vitro system where to study the effects of hypoglycaemia on NSC survival. Furthermore, we determine the potential role of PACAP and Exendin-4 in counteracting the effect of hypoglycaemia. A hypoglycaemic in vitro milieu was mimicked by exposing subventricular zone-derived NSC to low levels of glucose. Moreover, we studied the potential involvement of apoptosis and endoplasmic reticulum stress by quantifying protein levels of Bcl-2, cleaved caspase-3 and mRNA levels of CHOP. We show that PACAP via PAC-1 receptor and PKA activation counteracts impaired NSC viability induced by hypoglycaemia. The protective effect induced by PACAP correlated with endoplasmic reticulum stress, Exendin-4 was ineffective. The results show that hypoglycaemia decreases NSC viability and that this effect can be substantially counteracted by PACAP via PAC-1 receptor activation. The data supports a potential therapeutic role of PAC-1 receptor agonists for the treatment of neurological complications, based on neurogenesis impairment by hypoglycaemia.

  7. Qualité de l’offre et usage du transport public en milieu urbain

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    Cyrille Genre-Grandpierre

    2007-06-01

    Full Text Available L’objectif de ce travail est de mieux cerner les déterminants de la mobilité quotidienne en bus en milieu urbain. Il s’agit en particulier d’étudier dans quelle mesure la qualité de l’offre de transport en bus en détermine l’intensité de l’usage. Une première étape a consisté à élaborer un indicateur décrivant localement la qualité de l’accessibilité fournie par le bus. Dans un second temps, des données originales portant sur les déplacements quotidiens à Besançon ont été collectées grâce à une enquête téléphonique, puis implémentées dans un Système d’Information Géographique. Dans un troisième temps, la mise en relation de l’offre et de l’usage du bus a permis de montrer que la qualité de l’offre bus n’en explique l’usage qu’à un niveau très agrégé, mais qu’elle explique en revanche bien la satisfaction quant à cet usage. Plutôt qu’à travers une estimation globale de la qualité de l’offre bus, il est apparu que ce n’est que dans la comparaison de l’offre bus et de l’offre automobile sur un ensemble d’origines-destinations bien précis que l’on parvenait à comprendre les ressorts du choix modal.

  8. Immunological milieu in the peritoneal cavity at laparotomy for gastric cancer

    Institute of Scientific and Technical Information of China (English)

    Akira Yoneda; Shinichiro Ito; Seiya Susumu; Mitsutoshi Matsuo; Ken Taniguchi; Yoshitsugu Tajima; Susumu Eguchi

    2012-01-01

    AIM:To investigate the immunological repertoire in the peritoneal cavity of gastric cancer patients.METHODS:The peritoneal cavity is a compartment in which immunological host-tumor interactions can occur.However,the role of lymphocytes in the peritoneal cavity of gastric cancer patients is unclear.We observed 64 patients who underwent gastrectomy for gastric cancer and 11 patients who underwent laparoscopic cholecystectomy for gallstones and acted as controls.Lymphocytes isolated from both peripheral blood and peritoneal lavage were analyzed for surface markers of lymphocytes and their cytokine production by flow cytometry.CD4+CD25high T cells isolated from the patient's peripheral blood were co-cultivated for 4 d with the intra-peritoneal lymphocytes,and a cytokine assay was performed.RESULTS:At gastrectomy,CCR7-CD45RA CD8+ effector memory T cells were observed in the peritoneal cavity.The frequency of CD4+ CD25 high T cells in both the peripheral blood and peritoneal cavity was elevated in patients at advanced stage [control vs stage Ⅳ in the peripheral blood:6.89 (3.39-10.4) vs 15.34 (11.37-1931),P < 0.05,control vs stage Ⅳ in the peritoneal cavity:8.65 (5.28-12.0) vs 19.56 (14.81-24.32),P < 0.05].On the other hand,the suppression was restored with CD4+ CD25highT cells from their own peripheral blood.This study is the first to analyze lymphocyte and cytokine production in the peritoneal cavity in patients with gastric cancer.Immune regulation at advanced stage is reversible at the point of gastrectomy.CONCLUSION:The immunological milieu in the peritoneal cavity of patients with advanced gastric cancer elicited a Th2 response even at gastrectomy,but this response was reversible.

  9. Cross-Milieu Terrorist Collaboration: Using Game Theory to Assess the Risk of a Novel Threat.

    Science.gov (United States)

    Ackerman, Gary A; Zhuang, Jun; Weerasuriya, Sitara

    2017-02-01

    This article uses a game-theoretic approach to analyze the risk of cross-milieu terrorist collaboration-the possibility that, despite marked ideological differences, extremist groups from very different milieus might align to a degree where operational collaboration against Western societies becomes possible. Based upon theoretical insights drawn from a variety of literatures, a bargaining model is constructed that reflects the various benefits and costs for terrorists' collaboration across ideological milieus. Analyzed in both sequential and simultaneous decision-making contexts and through numerical simulations, the model confirms several theoretical arguments. The most important of these is that although likely to be quite rare, successful collaboration across terrorist milieus is indeed feasible in certain circumstances. The model also highlights several structural elements that might play a larger role than previously recognized in the collaboration decision, including that the prospect of nonmaterial gains (amplification of terror and reputational boost) plays at least as important a role in the decision to collaborate as potential increased capabilities does. Numerical simulation further suggests that prospects for successful collaboration over most scenarios (including operational) increase when a large, effective Islamist terrorist organization initiates collaboration with a smaller right-wing group, as compared with the other scenarios considered. Although the small number of historical cases precludes robust statistical validation, the simulation results are supported by existing empirical evidence of collaboration between Islamists and right- or left-wing extremists. The game-theoretic approach, therefore, provides guidance regarding the circumstances under which such an unholy alliance of violent actors is likely to succeed.

  10. Replacement of HA-MRSA by CA-MRSA infections at an academic medical center in the midwestern United States, 2004-5 to 2008.

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    Michael Z David

    Full Text Available We noted anecdotally that infections designated as health care-associated (HA- MRSA by epidemiologic criteria seemed to be decreasing in incidence at the University of Chicago Medical Center (UCMC after 2004. We compared MRSA patients seen at any site of clinical care at UCMC and the isolates that caused their infections in 2004-5 (n = 545 with those in 2008 (n = 135. The percent of patients with MRSA infections cultured > 2 days after hospital admission decreased from 19.5% in 2004-5 to 7.4% in 2008 (p = 0.001. The percent in 2004-5 compared with 2008 who had a hospitalization (49.1% to 26.7%, p = 0.001 or surgery (43.0% to 14.1%, p<0.001 in the previous year decreased. In 2008 a greater percent of patients was seen in the emergency department (23.1% vs. 39.3% and a smaller percent both in intensive care units (15.6% vs. 6.7% and in other inpatient units (40.7% vs. 32.6% (p<0.001. The percent of patients with CA-MRSA infections by the CDC epidemiologic criteria increased from 36.5% in 2004-5 to 62.2% in 2008 (p<0.001. The percent of MRSA isolates sharing genetic characteristics of USA100 decreased from 27.9% (152/545 to 12.6% (17/135, while the percent with CA-MRSA (USA300 characteristics increased from 53.2% (290/545 to 66.7% (90/135. The percent of infections that were invasive did not change significantly. Our data suggest that HA-MRSA infections, both by epidemiologic and microbiologic criteria, relative to CA-MRSA, decreased between 2004-5 and 2008 at UCMC.

  11. How should teaching on whole person medicine, including spiritual issues, be delivered in the undergraduate medical curriculum in the United Kingdom?

    Science.gov (United States)

    Harbinson, Mark T; Bell, David

    2015-06-02

    Although the General Medical Council recommends that United Kingdom medical students are taught 'whole person medicine', spiritual care is variably recognised within the curriculum. Data on teaching delivery and attainment of learning outcomes is lacking. This study ascertained views of Faculty and students about spiritual care and how to teach and assess competence in delivering such care. A questionnaire comprising 28 questions exploring attitudes to whole person medicine, spirituality and illness, and training of healthcare staff in providing spiritual care was designed using a five-point Likert scale. Free text comments were studied by thematic analysis. The questionnaire was distributed to 1300 students and 106 Faculty at Queen's University Belfast Medical School. 351 responses (54 staff, 287 students; 25 %) were obtained. >90 % agreed that whole person medicine included physical, psychological and social components; 60 % supported inclusion of a spiritual component within the definition. Most supported availability of spiritual interventions for patients, including access to chaplains (71 %), counsellors (62 %), or members of the patient's faith community (59 %). 90 % felt that personal faith/spirituality was important to some patients and 60 % agreed that this influenced health. However 80 % felt that doctors should never/rarely share their own spiritual beliefs with patients and 67 % felt they should only do so when specifically invited. Most supported including training on provision of spiritual care within the curriculum; 40-50 % felt this should be optional and 40 % mandatory. Small group teaching was the favoured delivery method. 64 % felt that teaching should not be assessed, but among assessment methods, reflective portfolios were most favoured (30 %). Students tended to hold more polarised viewpoints but generally were more favourably disposed towards spiritual care than Faculty. Respecting patients' values and beliefs and the need for guidance in

  12. Using a Cost-Construction Model To Assess the Cost of Educating Undergraduate Medical Students at the University of Texas-Houston Medical School.

    Science.gov (United States)

    Franzini, Luisa; And Others

    1997-01-01

    Using a cost-construction model, cost of the University of Texas-Houston Medical School program, instructional costs, educational costs, and milieu costs were calculated. Sensitivity analysis revealed the financial effects of various factors, some of which increased and some of which decreased cost. Despite inherent complexities of the method and…

  13. Management of sacroiliac joint disruption and degenerative sacroiliitis with nonoperative care is medical resource-intensive and costly in a United States commercial payer population

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    Ackerman SJ

    2014-02-01

    Full Text Available Stacey J Ackerman,1 David W Polly Jr,2 Tyler Knight,3 Tim Holt,4 John Cummings5 1Covance Market Access Services Inc, San Diego, CA, USA; 2University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA; 3Covance Market Access Services Inc, Gaithersburg, MD, USA; 4Montgomery Spine Center, Orthopaedic Surgery, Montgomery, AL, USA; 5Community Health Network, Neurosurgery, Indianapolis, IN, USA Introduction: Low back pain is common and originates in the sacroiliac (SI joint in 15%–30% of cases. Traditional SI joint disruption/degenerative sacroiliitis treatments include nonoperative care or open SI joint fusion. To evaluate the usefulness of newly developed minimally-invasive technologies, the costs of traditional treatments must be better understood. We assessed the costs of nonoperative care for SI joint disruption to commercial payers in the United States (US. Methods: A retrospective study of claim-level medical resource use and associated costs used the MarketScan® Commercial Claims and Encounters as well as Medicare Supplemental Databases of Truven Healthcare. Patients with a primary ICD-9-CM diagnosis code for SI joint disruption (720.2, 724.6, 739.4, 846.9, or 847.3, an initial date of diagnosis from January 1, 2005 to December 31, 2007 (index date, and continuous enrollment for ≥1 year before and 3 years after the index date were included. Claims attributable to SI joint disruption with a primary or secondary ICD-9-CM diagnosis code of 71x.xx, 72x.xx, 73x.xx, or 84x.xx were identified; the 3-year medical resource use-associated reimbursement and outpatient pain medication costs (measured in 2011 US dollars were tabulated across practice settings. A subgroup analysis was performed among patients with lumbar spinal fusion. Results: The mean 3-year direct, attributable medical costs were $16,196 (standard deviation [SD] $28,592 per privately-insured patient (N=78,533. Among patients with lumbar spinal fusion (N=434, attributable 3-year

  14. How to make the medical consultation more successful from a patient's perspective? Tips for doctors and patients from lay people in the United Kingdom, Italy, Belgium and the Netherlands.

    NARCIS (Netherlands)

    Bensing, J.M.; Deveugele, M.; Moretti, F.; Fletcher, I.; Vliet, L. van; Bogaert, M. van; Rimondini, M.

    2011-01-01

    Objective: The aim of this study is to generate empirically based 'tips' from lay people on how medical consultations could become more successful from a patient perspective. Methods: 258 Lay people in the United Kingdom, Italy, Belgium and the Netherlands, distributed over 32 focus groups, were inv

  15. Experience of the air medical evacuation team of Serbian armed forces in the united nations mission in the Democratic Republic of Congo - deployment stress and psychological adaptation

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    Joković Danilo B.

    2016-01-01

    Full Text Available Background/Aim. Wars of the nineties in former Yugoslavia, Somalia, Rwanda imposed new tasks to the United Nations (UN forces, such as providing humanitarian aid, protection of civilians, peacekeeping, and in many instances providing armed enforcement of peace. The aim of this study was an observational analysis of Serbian participation in the UNs Mission in the Democratic Republic of Congo with the emphasis on stress and coping techniques. Methods. Serbian contribution in this mission dates back to April 2003 till the present days with a military contingent consisting of six members as a part of Air Medical Evacuation Team. The observed stressogenous factors acted before arrival to the mission area and in the mission area. In this paper we analysed ways to overcome them. Results. The productive ways of overwhelming stress used in this mission were: honesty and openness in interpersonal communications, dedication to work, maintaining discipline and order, strict following of appropriate regime of work, diet, rest and recreation; regular communication with family and organizing and participation in various social, cultural and sports manifestations. Conclusion. This analysis indicates that out of all the observed factors, the most important is appropriate selection of personnel.

  16. Maternal Opioid Drug Use during Pregnancy and Its Impact on Perinatal Morbidity, Mortality, and the Costs of Medical Care in the United States

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    Valerie E. Whiteman

    2014-01-01

    Full Text Available Objective. To identify factors associated with opioid use during pregnancy and to compare perinatal morbidity, mortality, and healthcare costs between opioid users and nonusers. Methods. We conducted a cross-sectional analysis of pregnancy-related discharges from 1998 to 2009 using the largest publicly available all-payer inpatient database in the United States. We scanned ICD-9-CM codes for opioid use and perinatal outcomes. Costs of care were estimated from hospital charges. Survey logistic regression was used to assess the association between maternal opioid use and each outcome; generalized linear modeling was used to compare hospitalization costs by opioid use status. Results. Women who used opioids during pregnancy experienced higher rates of depression, anxiety, and chronic medical conditions. After adjusting for confounders, opioid use was associated with increased odds of threatened preterm labor, early onset delivery, poor fetal growth, and stillbirth. Users were four times as likely to have a prolonged hospital stay and were almost four times more likely to die before discharge. The mean per-hospitalization cost of a woman who used opioids during pregnancy was $5,616 (95% CI: $5,166–$6,067, compared to $4,084 (95% CI: $4,002–$4,166 for nonusers. Conclusion. Opioid use during pregnancy is associated with adverse perinatal outcomes and increased healthcare costs.

  17. Image workstation in a medical intensive care unit changes viewing patterns and timing of image-based clinical actions in routine portable chest radiographs

    Science.gov (United States)

    Redfern, Regina O.; Kundel, Harold L.; Polansky, Marcia; Langlotz, Curtis P.; Lanken, Paul N.; Brikman, Inna; Horii, Steven C.; Bozzo, Mary T.; Feingold, Eric R.; Nodine, Calvin F.

    1996-05-01

    In order to determine the effect of an image workstation, viewing patterns and related clinical actions were evaluated in a randomized prospective study. During 16 weeks of Computed Radiography data collection, an image workstation was conveniently available to the Medical Intensive Care Unit clinicians. The workstation was not available for clinical use during 16 weeks of Analog Film data collection. Viewing patterns were evaluated by comparing viewing times. Patient care was evaluated by comparing the time of performing image based clinical actions. The percentage of routine exams viewed before AM Radiology Conference increased from 0% during the Analog Periods to 27% during the CR PACS Periods. Clinicians selected images taken during the first few days of the patient's admission for viewing before conference. Images taken later in admission were viewed during or after conference. On days when radiology conference was not held, images were viewed significantly earlier when the workstation was available. Clinical actions based on images viewed on the workstation were performed significantly earlier. When an image workstation was available routine images were viewed sooner and image based actions occurred earlier.

  18. Improving health promotion to American Indians in the midwest United States: preferred sources of health information and its use for the medical encounter.

    Science.gov (United States)

    Geana, Mugur V; Greiner, K Allen; Cully, Angelia; Talawyma, Myrietta; Daley, Christine Makosky

    2012-12-01

    American Indians and Alaska Natives suffer significant health disparities for many infectious and chronic diseases as compared to the general population. Providing accurate and culturally tailored health information to underserved groups has been shown to influence health behaviors and health outcomes. Little prior research has explored American Indians health information use and preferences. National representative sample surveys such as the Health Information National Trends Survey provide some data on minority groups but are underpowered to provide useful information on American Indians. The present study analyzes data from a survey of over 900 American Indians from the Midwest United States and explores their sources of health information, their preferences for information presentation, and their use of health information prior to and during medical encounters. We conclude that campaigns targeting Natives should be narrowly focused and be community driven or employing community resources. American Indians use a diversity of media sources to obtain health information, with the Internet being underutilized compared to the general population. Partnership with Indian Health Service providers and pharmacists, as well as traditional healers, in the development and dissemination of new health information for Natives may provide the "expert" tone needed to promote health improvements in American Indians.

  19. Trends in the use, sociodemographic correlates, and undertreatment of prescription medications for chronic obstructive pulmonary disease among adults with chronic obstructive pulmonary disease in the United States from 1999 to 2010.

    Directory of Open Access Journals (Sweden)

    Earl S Ford

    Full Text Available BACKGROUND: The extent to which patients with COPD are receiving indicated treatment with medications to improve lung function and recent trends in the use of these medications is not well documented in the United States. The objective of this study was to examine trends in prescription medications for COPD among adults in the United States from 1999 to 2010. METHODS: We performed a trend analysis using data from up to 1426 participants aged ≥20 years with self-reported COPD from six national surveys (National Health and Nutrition Examination Survey 1999-2010. RESULTS: During 2009-2010, the age-adjusted percentage of participants who used any kind of medication was 44.2%. Also during 2009-2010, the most commonly used medications were short-acting agents (36.0%, inhaled corticosteroids (ICS (18.3%, and LABAs (16.7%. The use of long-acting beta-2 agonists (LABAs (p for trend <0.001, ICS (p for trend = 0.013 increased significantly over the 12-year period. Furthermore, the use of tiotropium increased rapidly during this period (p for trend <0.001. For the years 2005-2010, the use of LABAs, ICS and tiotropium increased with age. Compared with whites, Mexican Americans were less likely to use short-acting agents, LABAs, ICS, tiotropium, and any kind of COPD medication. Among participants aged 20-79 years with spirometry measurements during 2007-2010, the use of any medication was reported by 19.0% of those with a moderate/severe obstructive impairment and by 72.6% of those with self-reported COPD and any obstructive impairment. CONCLUSION: The percentages of adults with COPD who reported having various classes of prescription medications that improve airflow limitations changed markedly from 1999-2000 to 2009-2010. However, many adults with COPD did not report having recommended prescription medications.

  20. Release of hydrogen peroxide and antioxidants by the coral Stylophora pistillata to its external milieu

    Science.gov (United States)

    Armoza-Zvuloni, R.; Shaked, Y.

    2014-09-01

    Hydrogen peroxide (H2O2), a common reactive oxygen species, plays multiple roles in coral health and disease. Elevated H2O2 production by the symbiotic algae during stress may result in symbiosis breakdown and bleaching of the coral. We have recently reported that various Red Sea corals release H2O2 and antioxidants to their external milieu, and can influence the H2O2 dynamics in the reef. Here, we present a laboratory characterization of H2O2 and antioxidant activity release kinetics by intact, non-stressed Stylophora pistillata. Experimenting with bleached and non-bleached corals and different stirring speeds, we explored the sources and modes of H2O2 and antioxidant release. Since H2O2 is produced and degraded simultaneously, we developed a methodology for resolving the actual H2O2 concentrations released by the corals. H2O2 and antioxidant activity steadily increased in the water surrounding the coral over short periods of 1-2 h. Over longer periods of 5-7 h, the antioxidant activity kept increasing with time, while H2O2 concentrations were stabilized at ~ 1 μM by 1-3 h, and then gradually declined. Solving for H2O2 release, corals were found to release H2O2 at increasing rates over 2-4 h, and then to slow down and stop by 5-7 h. Stirring was shown to induce the release of H2O2, possibly since the flow reduces the thickness of the diffusive boundary layer of the coral, and thus increases H2O2 mass flux. Antioxidant activity was released at similar rates by bleached and non-bleached corals, suggesting that the antioxidants did not originate from the symbiotic algae. H2O2, however, was not released from bleached corals, implying that the symbiotic algae are the source of the released H2O2. The observed flow-induced H2O2 release may aid corals in removing some of the internal H2O2 produced by their symbiotic algae, and may possibly assist in preventing coral bleaching under conditions of elevated temperature and irradiance.

  1. Utilisation of a Helicopter Emergency Medical Service (HEMS) for equestrian accidents in a regional major trauma network in the United Kingdom.

    Science.gov (United States)

    McQueen, Carl; Crombie, Nick; Cormack, Stef; George, Arun; Wheaton, Steve

    2015-05-01

    The utilisation of Helicopter Emergency Medical Services (HEMS) in response to equestrian accidents has been an integral part of operations for many years throughout the UK. The recent establishment of major trauma networks in the UK has placed great emphasis on the appropriate tasking of HEMS units to cases where added benefit can be provided and the incidence of time critical injury in cases of equestrian accidents has been shown to be low. This study assesses the impact made on the utilisation of the different HEMS resources for cases of equestrian accidents within the West Midlands following the launch of the regional trauma network. We present a retrospective analysis of all equestrian accidents attended by Midlands Air Ambulance (MAA) between 1 April 2012 and 1 April 2013. Data were abstracted from the MAA operational database relating to mission activations/scene attendances; team configuration (physician led and Critical Care Paramedic (CCP) led); on-scene interventions; mission timings and patient conveyance by helicopter. A total of 114 activations involved equestrian accidents (6% of overall workload). The contribution of equestrian accidents to overall workload was similar for physician led and CCP-led (69/1069) platforms (5% vs. 6%, p=0.50). Only three patients (3%) required pre-hospital RSI during the period analysed and there were no recorded cases of ketamine administration for analgesia/conscious sedation. In approximately half of all scene attendances patients did not require any medication to be administered by the HEMS team. The vast majority of incidents occurred in rural locations with over 80% of patients conveyed to hospital by helicopter. The average mission time for scene attendances resulting in conveyance by helicopter was in excess of 90 min on both types of platform. There is a clear requirement for the design and implementation of informed and intelligent tasking models to respond to the need for assistance in equestrian accidents

  2. Pattern of the Body Image in La Maison en Petits Cubes on the Basis of Milieu and Individual Relationship

    Directory of Open Access Journals (Sweden)

    Yasemin Kılınçarslan

    2014-04-01

    Full Text Available Kunio Kato’s film “La Maison En Petits Cubes” has two dimensions. One of these is the content design, which depends on aristo aesthetic, and the other one is the visual aesthetic, which depends on tranquil, simple, refreshing and relaxing traditional japan pictures like Ando Hirosige’s. The director manages to configure a visual and content integrity between the form of human body and the design of the city. The human- city analogy is the key point to look at the human consciousness which inquiries the existentialism problems related to changing milieu.

  3. L'hemorragie grave du peripartum en milieu de reanimation dans un centre universitaire tunisien de niveau 3: épidémiologie et facteurs de risque de mortalité maternelle

    OpenAIRE

    Nasr, Laidi Ben; Marzouk, Sofiene Ben; Kehila, Mehdi; Jabri, Hamed; Thamleoui, Saber; Maghrebi, Hayen

    2015-01-01

    L'hémorragie grave du péripartum demeure une des causes principales de mortalité maternelle. L'objectif de notre étude était de décrire le profil épidémiologique des patientes qui ont été prises en charge en milieu de réanimation suite à une hémorragie grave du péripartum et de rechercher d’éventuels facteurs de risque de mortalité. Notre étude est rétrospective descriptive et analytique. Nous avons inclus tous les cas d'hémorragie du péripartum ayant séjourné en unité de réanimation obstétri...

  4. A league of their own: demographics, motivations and patterns of use of 1,955 male adult non-medical anabolic steroid users in the United States

    Directory of Open Access Journals (Sweden)

    Darkes Jack

    2007-10-01

    Full Text Available Abstract Background Rule violations among elite-level sports competitors and tragedies among adolescents have largely defined the issue of non-medical anabolic-androgenic steroid (NMAAS use for the public and policy makers. However, the predominant and oft-ignored segment of the NMAAS community exists in the general population that is neither participating in competitive sports nor adolescent. A clearer profile of NMAAS users within the general population is an initial step in developing a full understanding of NMAAS use and devising appropriate policy and interventions. This survey sought to provide a more comprehensive profile of NMAAS users by accessing a large sample of user respondents from around the United States. Methods U.S.-based male NMAAS users (n = 1955 were recruited from various Internet websites dedicated to resistance training activities and use of ergogenic substances, mass emails, and print media to participate in a 291-item web-based survey. The Internet was utilized to provide a large and geographically diverse sample with the greatest degree of anonymity to facilitate participation. Results The majority of respondents did not initiate AAS use during adolescence and their NMAAS use was not motivated by athletics. The typical user was a Caucasian, highly-educated, gainfully employed professional approximately 30 years of age, who was earning an above-average income, was not active in organized sports, and whose use was motivated by increases in skeletal muscle mass, strength, and physical attractiveness. These findings question commonly held views of the typical NMAAS user and the associated underlying motivations. Conclusion The focus on "cheating" athletes and at risk youth has led to ineffective policy as it relates to the predominant group of NMAAS users. Effective policy, prevention or intervention should address the target population(s and their reasons for use while utilizing their desire for responsible use and

  5. [Prevention of heel pressure sores with a foam body-support device. A randomized controlled trial in a medical intensive care unit].

    Science.gov (United States)

    Cadue, Jean-François; Karolewicz, Stéphane; Tardy, Catherine; Barrault, Claudie; Robert, René; Pourrat, Olivier

    2008-01-01

    To assess in a prospective controlled study the efficacy and safety of a specific foam body-support device designed as to prevent heel pressure ulcers. A randomization table was used to allocate 70 patients into 2 groups. The control group was treated with our standard pressure sore prevention protocol (half-seated position, water-mattress and preventive massages 6 times a day); the experimental group was treated with the same standard protocol as well as with the foam body-support device being evaluated. Patients were included if their Waterlow score was >10, indicating a high risk of developing pressure ulcers and if they had no skin lesion on the heels. Foam devices, covered with jersey, were constructed for the legs and allowed the heels to be free of any contact with the bed; another foam block was arranged perpendicularly to the first, in contact with the soles, to prevent ankles from assuming an equinus position (to prevent a dropfoot condition). The principal criterion for efficacy was the number of irreversible skin lesions on the heel (that is, beyond the stage of blanching hyperemia, reversible after finger pressure); these lesions were assessed every day until the end of the study (up to 30 days). The number of irreversible heel pressure ulcers was lower in the experimental (3 patients, 8.6%) than in the control group (19 patients, 55.4%) (ppressure ulcer was higher in the experimental group (5.6 days, compared with 2.8 days, p=0.01). The groups did not differ in the number of pressure sores on the sacrum and leg. An anatomical foam body-support is effective in preventing heel pressure ulcers in patients on a medical intensive care unit and is well tolerated.

  6. A Prospective Longitudinal Assessment of Medical Records for Diagnostic Substitution among Subjects Diagnosed with a Pervasive Developmental Disorder in the United States

    Directory of Open Access Journals (Sweden)

    David eGeier

    2015-10-01

    Full Text Available Background: Previously, investigators suggested that diagnostic substitution from other diagnoses, e.g., mental retardation (MR and/or cerebral palsy (CP to pervasive developmental disorder (PDD is a driving factor behind increases in PDD. This study evaluated potential diagnostic substitution among subjects diagnosed with PDD vs MR or CP by examining birth characteristic overlap.Methods: SAS® and StatsDirect software examined medical records for subjects within the Vaccine Safety Datalink (VSD database who were Health Maintenance Organization (HMO-enrolled from birth until diagnosed with an International Classification of Disease, 9th revision (ICD-9 outcome of PDD (299.xx, n=84, CP (343.xx, n=300, or MR (317.xx, 318.xx, or 319.xx, n=51.Results: Subjects with PDD had significantly (p<0.01 increased: male/female ratio (PDD=5.5 vs CP=1.5 or MR=1.3, mean age of initial diagnosis in years (PDD=3.13 vs CP=1.09 or MR=1.62, mean gestational age in weeks at birth (PDD=38.73 vs CP=36.20 or MR=34.84, mean birth weight in grams (PDD=3,368 vs CP=2,767 or MR=2,406, and mean Appearance-Pulse-Grimace-Activity-Respiration (APGAR scores at 1 minute (PDD=7.82 vs CP=6.37 or MR=6.76 and 5 minutes (PDD=8.77 vs CP=7.92 or MR=8.04, as compared to subjects diagnosed with CP or MR.Conclusion: This study suggests diagnostic substitution cannot fully explain increased PDD prevalence during the 1990s within the United States.

  7. [Medical novels as a supplement to medical literature in the (postgraduate) study of medicine].

    Science.gov (United States)

    Landex, Nadia Lander

    2011-12-05

    Medically relevant fiction and biographies are thought to possibly improve the reader's emotional competences, thus contributing to the (postgraduate) study of medicine. This paper evaluates whether medical novels might be relevant in the (postgraduate) study of medicine. The contents of four medical novels were evaluated qualitatively as regard to the professional and cultural contents and relevance. The medical novels were composed uniformly and considered to be both professional and cultural subjects. The professional subjects were mostly described correctly, and milieu and cultural subjects were realistic. The contents of the medical novels were relevant, but briefly described. Students of medicine and junior doctors may identify with the environment and the cultural subjects. It is not ruled out that medical novels can be used to acquire cultural competences, but - as regards professional knowledge - the study of professional literature will be more time-effective.

  8. Ototoxic Medications (Medication Effects)

    Science.gov (United States)

    ... Information for the Public / Hearing and Balance Ototoxic Medications (Medication Effects) By Barbara Cone, Patricia Dorn, Dawn Konrad- ... Audiology Information Series [PDF]. What Is Ototoxicity? Certain medications can damage the ear, resulting in hearing loss, ...

  9. La catalyse enzymatique en milieu organique Enzymatic Catalysis in Organic Media

    Directory of Open Access Journals (Sweden)

    Monot F.

    2006-11-01

    Full Text Available L'environnement naturel des enzymes étant de nature aqueuse, leurs applications industrielles se sont en général limitées à des réactions mettant en jeu des substrats solubles dans l'eau. Depuis quelques années, la possibilité de faire fonctionner des enzymes dans des milieux hydrophobes (hydrocarbures, solvants organiques a été mise en évidence, engendrant ainsi de nombreux travaux visant, d'une part à mieux comprendre les mécanismes permettant aux enzymes de rester actives dans un tel environnement et, d'autre part à explorer les nouvelles applications envisageables. Les produits pétroliers constituant par excellence le domaine des molécules hydrophobes, le présent article se propose de faire le point sur ces deux aspects, compréhension et intérêt de la catalyse enzymatique en milieu organique. Nous détaillerons ainsi les vues actuelles sur le fonctionnement des enzymes dans des solvants organiques, les différents modes de mise en oeuvre possibles et, à travers une revue de leurs applications potentielles, les principaux systèmes enzymatiques utilisés. The extension of enzymatic catalysis, classically carried out in aqueous media, to organic media can be first ascribed to the possibility of using substrates that are poorly soluble or insoluble in water. In biphasic media consisting of an aqueous phase containing the enzyme in solution and of a non water-miscible organic solvent, the enzyme is kept in a suitable aqueous environment. A variant biphasic system consists in creating reverse micelles by the addition of a surfactant in order to increase the interfacial area and thus to improve the transfers between the aqueous phase where the enzyme is located and the organic phase. In these two cases, the partition coefficient of the different reactants plays a crucial role by governing the rates and yields of reaction. Microaqueous media constitute a new system for biocatalysis in organic media. In this case, a solid enzyme

  10. Solubilisation du charbon en milieu organique Solubilizing Coal in an Organic Environment

    Directory of Open Access Journals (Sweden)

    Lahaye Ph.

    2006-11-01

    Full Text Available La solubilisation du charbon en milieu organique constitue une des voies préconisées pour la valorisation des houilles sous forme de combustibles liquides. Dans le cas d'extractions simples, conduites à des températures inférieures à 150-200' C, on obtient des rendements pondéraux en extrait qui varient, pour un même solvant, dans une large mesure selon les conditions opératoires du traitement et la nature du charbon utilisé. C'est ainsi que le rendement en extrait augmente, d'une part, avec le temps d'extraction, pour atteindre après 48 h une valeur maximale dans les conditions opératoires retenues, et, d'autre part, avec la température d'extraction. De plus, ce même rendement diminue plus ou moins régulièrement depuis les charbons gras jusqu'aux anthracites avec le degré de carbonisation des houilles. Par ailleurs, la nature physico-chimique des solvants d'extraction influe fortement sur les rendements pondéraux en extrait obtenus, dans des conditions opératoires identiques, à partir d'un même charbon. En règle générale, à température d'extraction comparable, le rendement en extrait s'avère d'autant plus important que la basicité du solvant est plus marquée. A cet égard, les composés azotés basiques apparaissent comme des solvants de grande efficacité. En outre, les mélanges binaires de composés basiques manifestent le plus souvent un pouvoir solvant supérieur à celui de leurs constituants engagés à l'état pur. Les principales conclusions dégagées de l'étude des charbons sont susceptibles d'être généralisées à l'extraction de la matière organique contenue dans les roches sédimentaires. Cool solubilisation in an organic environment is one of the recommended ways of upgrading cool in the form of liquid fuels. For simple extractions performed at temperatures lower thon 150-200° C, the weighted extract yields obtained with the same solvent vary to a large extent, depending on the operating

  11. Pratiques de gestion et rapports d’âge en milieu de travail

    Directory of Open Access Journals (Sweden)

    Yolande Pelchat

    2005-05-01

    Full Text Available Le vieillissement de la main-d’œuvre et ses conséquences potentielles préoccupent. Jusqu’à maintenant, les planificateurs ont eu tendance, à l’instar de chercheurs de diverses disciplines, à assimiler cette question à la présence accrue dans les milieux de travail de travailleurs âgés ou de travailleurs vieillissants, des qualificatifs qui sont généralement accolés aux travailleurs dont l’âge d’état civil est 45 ans ou plus. Dans une recherche de nature exploratoire menée dans la fonction publique québécoise, nous avons choisi de suivre une avenue résolument différente et d’examiner comment différents acteurs en co-présence dans les milieux de travail (employés et gestionnaires participent à la construction et à la déconstruction des identités d’âge. L’analyse amène à voir les liens étroits entre ces identités et l’organisation du travail, plus spécifiquement les pratiques de gestion. Les résultats suggèrent, en effet, que les relations qu’entretiennent les employés d’âge différent de même que les caractéristiques attribuées aux uns et aux autres se construisent dans le cours même des pratiques de gestion. La démarche entreprise invite donc à revoir l’a priori d’un « fossé intergénérationnel », déjà existant à l’échelle de la société, et qui ferait du milieu de travail un simple lieu où se manifeste et s’exprime ce fossé.The aging workforce and its potential consequences are causes for concern. To date, planners, like researchers in various disciplines, have tended to merge this issue with the increased presence of older or aging workers - two adjectives that are generally used to describe workers aged 45 or older - in workplaces. During an exploratory study conducted within the Quebec public service, we decided to follow an entirely different path by examining how various actors in workplaces (employees and managers construct and deconstruct age identities

  12. 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.

  13. NICU患儿用药风险因素及应对策略研究进展%The risk factors and coping strategies of medication process in Neonatal Intensive Care Unit

    Institute of Scientific and Technical Information of China (English)

    张欣; 李时雨; 陈京立; 刘华平

    2016-01-01

    由于新生儿重症监护室(NICU)患儿药物治疗的复杂性,使其更易暴露于用药失误的风险中,即使是极小的失误都有可能对患儿造成伤害。本文基于2011年美国药物安全处方中心明确的影响患者用药安全10大风险要素,对国内、外N ICU患儿用药风险及应对策略进行文献回顾,旨在促进我国N ICU护士及管理者构建更为安全、有效的患儿用药系统。%Neonates are highly vulnerable to medication errors because of complex medical interventions in the Neonatal Intensive Care Unit (NICU), which can result in temporary or permanent harm. Based on the 10 risk factors of the safe medication use of Institute for Safe Medication Practices in USA (2011), we reviewed the medication risks and coping strategies within the NICU in China and aboard in order to enhance NICU nurses and administrators to design a safe and efifcient NICU medication use system.

  14. 维和医疗分队集训期心理干预效果评价%Effect Evaluation of Psychological Intervention for the Peacekeeping Medical Unit Servicemen During As-semble for Training

    Institute of Scientific and Technical Information of China (English)

    王乃震; 牛晓棠; 韩兵

    2015-01-01

    目的:探讨心理干预对集训期维和医疗分队人员的影响效果。方法分别在官兵到达集训地后开始集训前一天和临集训结束前一天进行调查,采用症状自评量表( SCL-90)对来自不同部队的63名官兵进行调查。结果2次测试维和医疗分队官兵心理健康(SCL-90)状况较好。且集训结束时,SCL-90总分和部分因子分(躯体化、强迫、人际敏感、抑郁、焦虑和恐怖因子)显著低于集训前(P<0.01)。结论心理干预对集训期维和人员有良好的效果,可以使其保持良好的心理健康水平。%Objective To discuss the psychological intervention effect on the peacekeeping medical unit servicemen during assemble training.Methods Symptom Checklist ( SCL -90 ) were applied 63 peacekeeping medical unit servicemen the day before starting training and the day before the end of training.Results Mental health ( SCL-90) of two tests were good in peacekeeping medical unit servicemen, and the total score of SCL-90 and some factor scores(Somatization, Force, Interpersonal sensitivity, Depression, Anxiety and terror) were significantly lower than that before training(P<0.01).Conclusion The psychological intervention had a good effect on the peacekeeping medical unit servicemen during assemble for training, which can maintain good mental health.

  15. The Direct Cost of Managing a Rare Disease: Assessing Medical and Pharmacy Costs Associated with Duchenne Muscular Dystrophy in the United States.

    Science.gov (United States)

    Thayer, Sarah; Bell, Christopher; McDonald, Craig M

    2017-06-01

    A Duchenne muscular dystrophy (DMD) cohort was identified using a claims-based algorithm to estimate health care utilization and costs for commercially insured DMD patients in the United States. Previous analyses have used broad diagnosis codes that include a range of muscular dystrophy types as a proxy to estimate the burden of DMD. To estimate DMD-associated resource utilization and costs in a sample of patients identified via a claims-based algorithm using diagnosis codes, pharmacy prescriptions, and procedure codes unique to DMD management based on DMD clinical milestones. DMD patients were selected from a commercially insured claims database (2000-2009). Patients with claims suggestive of a non-DMD diagnosis or who were aged 30 years or older were excluded. Each DMD patient was matched by age, gender, and region to controls without DMD in a 1:10 ratio (DMD patients n = 75; controls n = 750). All-cause health care resource utilization, including emergency department, inpatient, outpatient, and physician office visits, and all-cause health care costs were examined over a minimum 1-year period. Costs were computed as total health-plan and patient-paid amounts of adjudicated medical claims (in annualized U.S. dollars). The average age of the DMD cohort was 13 years. Patients in the DMD cohort had a 10-fold increase in health care costs compared with controls ($23,005 vs. $2,277, P costs were significantly higher for the DMD cohort across age strata and, in particular, for DMD patients aged 14-29 years ($40,132 vs. $2,746, P costs of DMD are substantial and increase with age. Funding for this study (GHO-10-4441) was provided by GlaxoSmithKline (GSK). Optum was contracted by GSK to conduct the study. Thayer was an employee of Optum Health Economics and Outcomes Research at the time of this study and was not compensated for her participation as an author of this manuscript. Bell is an employee and shareholder of GSK. McDonald has been a consultant for GSK, Sarepta

  16. Medical Education Funding by Medicare. Hearing before the Subcommittee on Health of the Committee on Finance. United States Senate, Second Session.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. Senate Committee on Finance.

    Hearings on the status of medical education funded under the Medicare program are presented, with attention to how the program reimburses hospitals for medical education costs. The Social Security Act Amendments of 1983 provided for a radical reform in hospital payment. By the end of a 3-year phase-in period, the program was designed to set…

  17. L’intégration des enfants handicapés en milieu scolaire ordinaire - Le cas particulier de l’autisme

    OpenAIRE

    Hayek, Hasnaa

    2013-01-01

    La scolarisation des enfants ayant des troubles autistiques en milieu scolaire ordinaire reste un défi à ce jour là. La recherche vise à croiser le point de vue des parents, des enseignants et des auxiliaires de vie scolaire vis-à-vis de cette scolarisation.; L'intégration des enfants handicapés en milieu scolaire ordinaire -Le cas particulier de l'autisme Résumé L'objectif de notre recherche de doctorat est d'apporter des éléments de réponses aux questions suivantes : La scolarisation dans u...

  18. 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.

  19. Changes in Personality Disorder Traits Following 2 Years of Treatment in a Secure Therapeutic Community Milieu

    Science.gov (United States)

    Morrissey, Catrin; Taylor, Jon

    2014-01-01

    Therapeutic community treatment models have not previously been applied to forensic patients with mild intellectual disabilities (IDs) with a comorbid diagnosis of personality disorder. Thirteen patients with mild IDs were allocated to a unit within a high secure psychiatric service operating a model of treatment based on the principles and…

  20. Analysis and Countermeasures on Causes of Medication Errors in Neonatal Intensive Care Unit%新生儿重症监护室用药差错的原因分析及对策

    Institute of Scientific and Technical Information of China (English)

    靖维维; 金翠翠; 高瑞银

    2016-01-01

    目的:探讨焦作市第二人民医院(以下简称“我院”)儿科发生用药差错的原因,并提出解决对策。方法:对我院新生儿重症监护室( neonatal intensive care unit ,NICU)2011年9月—2013年2月30例发生用药差错的原因进行回顾性分析。结果与结论:30例用药差错中,包括口服用药差错3例、静脉用药差错15例、医嘱转录差错7例、药物剂量不准确5例。导致用药差错的原因主要包括个人因素、环境和组织因素、药物及用药设备因素。应采取充分利用信息化技术、对护士进行药物知识培训及用药安全教育、创建保障护理安全的有利环境、合理放置药物及加强药物管理、提高沟通意识和掌握沟通技巧等措施,以降低用药差错的发生。%OBJECTIVE:To investigate the causes of medication errors in department of pediatrics of Jiaozuo Municipal the Se