Comprehensive Medicine Research Articles

Acute-on-chronic liver failure: definition, diagnosis, and pathogenesis

Acute-on-chronic liver failure (ACLF) is a form of complex syndrome with acute deterioration of liver function that occurs on the basis of chronic liver disease, and is accompanied by hepatic and extrahepatic organ failure with high mortality rate. The short-term mortality rate of comprehensive internal medicine treatment is as high as 50%-90%. This paper summarizes the current common definitions and diagnostic criteria, early-warning prediction models, and pathogenesis of ACLF.

Comprehensive traditional East Asian medicine treatment strategy for obesity considering the therapeutic effects and adverse events: A protocol for systematic review and network meta-analysis.

Background:Obesity has become a serious global health problem due to its increasing prevalence. Because of several limitations or adverse events associated with conventional western medicine therapies, there has been an increase in demand for alternative therapies such as traditional East Asian medicine (TEAM). This study aims to provide comprehensive evidence-based information assessing the clinical efficacy and safety of TEAM treatment for obesity as the basis for reliable clinical strategies for patients with obesity.Methods:Electronic searches of the PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure, OASIS, and Korea Citation Index will be performed. Methodological quality will be assessed using the “risk of bias” tool. The primary outcome for efficacy will be weight loss. The secondary outcomes will be response rate, body mass index, waist circumference, and blood pressure. We will also evaluate the rates of adverse events and mortality for safety assessment. First, we will conduct a conventional pairwise meta-analysis. Next, we will conduct network meta-analysis using the frequentist approach. We shall verify the assumption of network meta-analysis and provide network geometry, P-score, net league table, and intervention-based forest plot. A subgroup analysis will be conducted to ascertain the factors that affect treatment, such as dosage, treatment duration, and severity of obesity.Results:The results of this study will provide high-quality systematic reviews that can assist decision making in obesity management. Our network meta-analysis results can provide direct and indirect comparison evidence on comparative efficacy and safety.Conclusion:This study will provide fundamental data for prospective research on the application of TEAM in patients with obesity.Protocol registry number of online registry:This study protocol was registered in open Science framework (OSF) (Registration DOI: 10.17605/OSF.IO/ETWDS)URL of the online registry:https://osf.io/etwds.

Assessing local California trends in emergency physician opioid prescriptions from 2012 to 2020: Experiences in a large academic health system.

There has been increased focus nationally on limiting opioid prescriptions. National data demonstrates a decrease in annual opioid prescriptions among emergency medicine physicians. We analyzed data from 2012 to 2020 from a large academic health system in California to understand trends in opioid prescribing patterns for emergency department (ED) discharged patients and assessed the potential impact of two initiatives at limiting local opioid prescriptions. In 2012-2020, monthly ED visit data was used to evaluate the total number of outpatient opioid prescriptions and percent of ED visits with opioid prescriptions (as primary outcomes). Descriptive statistics, graphic representation, and segmented regression with interrupted times series were used based on two prespecified time points associated with intensive local initiatives directed at limiting opioid prescribing1) comprehensive emergency medicine resident education and 2) electronic health record (EHR)-based intervention. Between March 2012 and July 2020, a total of 41,491 ED discharged patients received an opioid prescription. The three most commonly prescribed drugs were hydrocodone (84.1%), oxycodone (10.8%), and codeine (2.8%). After implementing comprehensive emergency medicine resident education, the total number of opioid prescriptions, the percentage of opioid prescriptions over total ED visit numbers and the total tablet number showed decreasing trends (p's≤0.01), in addition to the natural (pre-intervention) decreasing trends. In contrast, later interventions in the EHR tended to show attenuated decreasing trends. From 2012 to 2020, we found that total opioid prescriptions decreased significantly for discharged ED patients. This trend is seen nationally. However, our specific interventions further heightened this downward trend. Evidence-based legislation, policy changes, and educational initiatives that impact prescribing practices should guide future efforts.

Improving medical students’ attitude toward patients with substance use problems through addiction medicine education

Background:Patients with addiction often encounter negative attitudes from health care professionals, including medical doctors. Addiction medicine training might improve medical students’ attitudes toward patients with addiction problems and change the way they think about addiction. We evaluated the effect of comprehensive addiction medicine training on students’ attitudes and illness perceptions and explored which perceptions are most relevant for attitude development. Methods: In a quasi-experimental non-randomized study, fourth-year students (n = 296) participated in either addiction medicine training (intervention) or one of three other blocks (control). We used the Medical Condition Regards Scale to measure attitudes and the Illness Perception Questionnaire Addiction version for perceptions. We analyzed the effect of the intervention using repeated measures MANOVA. The contribution of illness perception to attitude was explored in the intervention group using linear regression analysis. Results: Addiction medicine training improved students’ attitudes toward patients with addiction, compared to the control group. After the training, students expressed a less demoralized perception, a stronger perception of a coherent understanding of addiction, addiction as a cyclical condition, and attributed addiction more to psychological factors, compared to the control group. In the intervention group, attitude and emotional representation before training and illness coherence after the training were associated with attitude after the training. Conclusions: Addiction medicine training is effective in improving medical students’ attitudes toward patients with addiction and changing their illness perceptions of addiction. The development of an understanding of addiction might be particularly relevant for attitude improvement. These findings underscore the relevance of addiction medicine training as part of medical curricula and argue for including aspects related to attitude development in the curriculum.

Transdisciplinary approach in general practice: comprehensive general practice medicine

Transdisciplinary approach in general practice: comprehensive general practice medicine

Percepção de mulheres sobre o teleatendimento durante o período de pandemia do coronavírus (SARS-CoV-2)

Abstract Introduction Since the new coronavirus (SARS-CoV-2) was declared a pandemic, health care was one of the fields that underwent significant changes. Telemedicine, that uses technological and communication resources to provide health care, was deemed a safe alternative to continue patient care while quarantine and social isolation measures were in place. Objective To analyze the perception of women treated at an outpatient clinic in relation to remote health care implemented during the COVID-19 pandemic. Methods Descriptive research conducted at the Women’s Physiotherapy Outpatient Clinic of the Prof. Fernando Figueira Comprehensive Medicine Institute (IMIP) in Recife, Pernambuco state, Brazil. The study included women above the age of 18 years who were being remotely treated and excluded those who discontinued treatment. Data were collected from November 2020 to July 2021, using a questionnaire which was sent to the participants via WhatsApp. Results Twenty-six women with an average age of 52 ± 10.1 years were interviewed. Most (61.54%) were being treated for urinary incontinence at the outpatient clinic and 38.5% had been undergoing physiotherapy for at least six months. A total of 92.3% of the participants reported feeling safe with remote health care and 70.4% noticed an improvement in their symptoms. Conclusion Most patients noticed an improvement in their symptoms, felt comfortable and safe with teleservices and would agree to continue even after returning to in-person care. However, to ensure more effective results, patients need to be well informed and have some prior knowledge about the proposed treatment.

A 15-Year Review of Clinical Practice Patterns and Evidence-Based Medicine in Carpometacarpal Joint Arthroplasty.

The purpose of this study was to help understand national practice patterns in carpometacarpal (CMC) arthroplasty and how they have evolved with evidence-based recommendations over the past 15 years. The American Board of Plastic Surgery (ABPS) started collecting practice data on primary CMC joint arthroplasty in 2006 as a portion of its continuous certification (CC) process. Data on primary CMC arthroplasty from May 2006 through December 2013 were reviewed and compared to those from January 2014 to March 2020. National practice trends observed in these data were evaluated. Comprehensive evidence-based medicine reviews published in 2008, 2011, 2013, and 2017 were reviewed alongside the CC data. In all, 570 primary CMC joint arthroplasty cases were included from May 2006 to March 2020. The average age at the time of repair was 62 years and the patient population was predominantly female (79%). Most cases were done under general anesthesia (69%), and there was an increase in the use of regional anesthesia with nerve block when our 2 cohorts were compared (27% vs 37%; P = .020). A trapezium excision with flexor carpi radialis tendon ligament reconstruction was the most popular technique (72%) and an increase in the use of simple trapeziectomy was observed (6% vs 14%; P = .001). One-third of patients did not receive any form of deep vein thrombosis prophylaxis. The ABPS CC data provide a databank that allows for direct observation of national practice trends and sheds light on potential avenues for improvement in patient care.

A comprehensive high cost drugs dataset from the NHS in England - An OpenSAFELY-TPP Short Data Report.

Background: At the outset of the COVID-19 pandemic, there was no routine comprehensive hospital medicines data from the UK available to researchers. These records can be important for many analyses including the effect of certain medicines on the risk of severe COVID-19 outcomes. With the approval of NHS England, we set out to obtain data on one specific group of medicines, "high-cost drugs" (HCD) which are typically specialist medicines for the management of long-term conditions, prescribed by hospitals to patients. Additionally, we aimed to make these data available to all approved researchers in OpenSAFELY-TPP. This report is intended to support all studies carried out in OpenSAFELY-TPP, and those elsewhere, working with this dataset or similar data. Methods: Working with the North East Commissioning Support Unit and NHS Digital, we arranged for collation of a single national HCD dataset to help inform responses to the COVID-19 pandemic. The dataset was developed from payment submissions from hospitals to commissioners. Results: In the financial year (FY) 2018/19 there were 2.8 million submissions for 1.1 million unique patient IDs recorded in the HCD. The average number of submissions per patient over the year was 2.6. In FY 2019/20 there were 4.0 million submissions for 1.3 million unique patient IDs. The average number of submissions per patient over the year was 3.1. Of the 21 variables in the dataset, three are now available for analysis in OpenSafely-TPP: Financial year and month of drug being dispensed; drug name; and a description of the drug dispensed. Conclusions: We have described the process for sourcing a national HCD dataset, making these data available for COVID-19-related analysis through OpenSAFELY-TPP and provided information on the variables included in the dataset, data coverage and an initial descriptive analysis.

A comparative study of the effectiveness of an osteopathic primary care sports medicine led intervention on performance in men's collegiate lacrosse players.

Comprehensive sports medicine care goes beyond the treatment of injuries resulting from athletic activities. Ultimately, it is a competence that includes knowledge in physical therapy, training, nutrition, coaching, motivation, competition, mentoring, psychology, and spirituality that allows the physician and patient to collaborate on promoting the patient's health goals. The current literature demonstrates a lack of knowledge in the Osteopathic Primary Care Sports Medicine Model's effectiveness in performance. To determine whether a comprehensive osteopathic primary care sports medicine approach can improve performance and health outcomes in collegiate athletes. A randomized controlled trial commenced just prior to the start of the lacrosse season and concluded atthe end of the season. All the New York Institute of Technology (NYIT) collegiate lacrosse players were educated first in a 1-day seminar of the core competencies, and all participants had access to ask questions on their own volition. Then they were randomized into two groups, either the experimental group receiving thedirect osteopathic primary care sports medicine intervention (n=18) or the control group not having active intervention (n=19). Also, the overall team winning percentage for that season was computed and compared tothat for the previous years and the following year. Participants were assessed before and after the intervention with the Patient Health Questionnaire (PHQ-9), the 36-Item Short Form Survey (SF-36), custom Osteopathic Primary Care Sports Medicine questionnaire, and body fat composition, and their changes were compared between the experimental group and the control group. Collected data were analyzed using the repeated-measures analysis of variance. Thirty-seven participants were enrolled in the study. After 14 participants were excluded due to being lost to follow-up, 23 athlete records were analyzed. The winning percentage of the team was highest during the year of the study period time than in the 3 previous years and the following year. The test group did not have any statistically significant change in the PHQ-9, SF-36, custom Osteopathic Primary Care Sports Medicine questionnaire, as well as in body fat composition. When used during a collegiate lacrosse season, this Osteopathic Primary Care Sports Medicine intervention did not significantly improve health outcomes. This preliminary study, despite its limitations incompliance and study population size, did demonstrate improvement in overall team performance when comparing the intervention sport season to other seasons but was not statistically significantly. Therefore, further studies are warranted to improve the understanding inthis approach to athlete health outcomes and performance.

Identifying priority medicines policy issues for Qatar: exploring perspectives and experiences of healthcare professionals through a qualitative study

ObjectivesTo identify priority medicines policy issues, including the ‘use’ and ‘access to medicines’ in Qatar.DesignIn this qualitative study, general inductive method was used and semi-structured exploratory interviews conducted.SettingStakeholders from a...

VGH-TAYLOR: Comprehensive precision medicine study protocol on the heterogeneity of Taiwanese breast cancer patients.

Heterogeneity in breast cancer leads to diverse morphological features and different clinical outcomes. There are inherent differences in breast cancer between the populations in Asia and in western countries. The use of immune-based treatment in breast cancer is currently in the developmental stage. The VGH-TAYLOR study is designed to understand the genetic profiling of different subtypes of breast cancer in Taiwan and define the molecular risk factors for breast cancer recurrence. The T-cell receptor repertoire and the potential effects of immunotherapy in breast cancer subjects isevaluated. The favorable biomarkers for early detection of tumor recurrence, diagnosis and prognosis may provide clues for the selection of individualized treatment regimens and improvement in breast cancer therapy.

Observation on the Application Effect of Comprehensive Internal Medicine Nursing Intervention in Tuberculous Peritonitis Patients

Observation on the Application Effect of Comprehensive Internal Medicine Nursing Intervention in Tuberculous Peritonitis Patients

SEVERE REFRACTORY IMMUNE THROMBOCYTOPENIA IN AN ONCOLOGY PATIENT WITH COVID-19: RARE BUT FATAL!

TOPIC: Critical Care TYPE: Global Case Reports INTRODUCTION: Immune thrombocytopenia (ITP) has been associated with COVID-19. We present a case of a patient with COVID-19 who developed severe ITP associated with fatal hemorrhage. CASE PRESENTATION: A 50-year-old-female with history of treated breast and renal cancers presented to the emergency department with cough and fever for 10 days. Nasopharyngeal swab was positive for SARS-CoV-2. The patient was administered supplemental oxygen and empiric broad spectrum antibiotics. Her respiratory status rapidly declined necessitating invasive mechanical ventilation and admission to the ICU on Day 1 for severe ARDS. IV Remdesivir, Dexamethasone 6 mg IV daily, convalescent plasma and IV unfractionated heparin infusion were administered. Platelets were 219 x 109/L, fibrinogen 980 and D-dimer level 11.2. On Day 18 platelets fell to 5 x 109/L were administered with improvement in platelets to >150 x 109/L on Day 23. On Day 25, platelets decreased to 150 x 109/L on Day 31. She remained ventilator dependent and underwent tracheostomy on Day 32. Platelet counts remained >200 x 109/L and Romiplostim was discontinued on Day 73. On Day 85, platelets again fell to < 5 x 109/L, associated with massive gastrointestinal hemorrhage and fatal hemorrhagic shock. DISCUSSION: We believe that severe ITP with multiple relapses associated with COVID-19 was the most likely cause of the significant drop in platelet count that caused significant bleeding and death in our patient. We also observed a delayed onset in the clinical presentation of ITP and symptomatic COVID, unlike previous reports. The initial episode of severe thrombocytopenia was responsive to glucocorticoids and IVIG and later required higher doses of steroids and Romiplostim but recurred upon discontinuation of therapy. Fatal hemorrhage due to COVID-19-associated ITP is rare. A review of 45 cases of ITP in COVID-19 patients reported the majority of cases (75%) occurring in moderate-to-severe COVID-19. Severe life-threatening bleeding was uncommon with one death attributed to intracranial hemorrhage. CONCLUSIONS: Clinicians need to be aware of ITP as a severe complication of COVID-19 that should be diagnosed and treated promptly to avoid fatal bleeding complications, as was observed in our patient. REFERENCE #1: Bomhof G, Mutsaers PGNJ, Leebeek FWG, et al. COVID-19-associated immune thrombocytopenia. Br J Haematol. 2020 Jul;REFERENCE #2: Mahevas M, Moulis G, Andres E, et al. Clinical characteristics, management and outcome of Covid-19-associated immune thrombocytopenia. a French multicentre series. Br J Haematol. 2020 Aug;190(4):e224-e229. REFERENCE #3: Bhattacharjee S, Banerjee M. Immune thrombocytopenia secondary to COVID-19: a systematic review. SN Comprehensive Clinical Medicine 2020 DISCLOSURES: No relevant relationships by Alina Dulu, source=Web Response Advisory Committee Member relationship with Jazz Pharmaceuticals Please note: $1-$1000 by Stephen Pastores, source=Web Response, value=Consulting fee Grant Support for Clinical Trial relationship with Biomerieux Please note: $5001 - $20000 by Stephen Pastores, source=Web Response, value=Grant/Research Support No relevant relationships by Katherine Silvey, source=Web Response No relevant relationships by Kate Tayban, source=Web Response

Hepatitis C reinfection following successful direct-acting antiviral therapy among patients attending a multidisciplinary treatment centre for people who use drugs in Zurich, Switzerland.

On-going risk-exposure followed by reinfection may jeopardize hepatitis C elimination efforts among people who use drugs. We estimated the HCV reinfection incidence in patients who successfully completed HCV therapy and attended a low-threshold access centre for comprehensive addiction medicine. Retrospective chart review was undertaken, in a convenience sample of patients with opioid/cocaine use disorders who achieved sustained viral response (SVR) after direct-acting antiviral (DAA) therapy in Zurich, Switzerland between April 2015 and July 2019 (n=153). HCV reinfection incidence in patients with and without on-going drug use was calculated. 79% of the patients were in opioid agonist treatment, and 19% were being managed for other medical or psychiatric conditions. 58% used drugs after SVR, of whom 49% injected. The follow-up period totalled 346 (median 2.1) person-years (py). Overall HCV reinfection incidence was 1.2 (CI-95: 0.3 to 3.0) per 100 py and 1.6 (0.2 to 5.8) in patients with drug use after SVR. The risk of HCV reinfection after DAA therapy in persons who use drugs can be low if, after SVR, patients remain in care in a well developed comprehensive harm reduction setting.

National Trends and Policy Impacts on Provision of Home Medicines Reviews and Residential Medication Management Reviews in Older Australians, 2009-2019.

Comprehensive medicines reviews such as Home Medicines Review (HMR) and Residential Medication Management Review (RMMR) can resolve medicines-related problems. Changes to Australia’s longstanding HMR and RMMR programs were implemented between 2011 and 2014. This study examined trends in HMR and RMMR provision among older Australians during 2009–2019 and determined the impact of program changes on service provision. Monthly rates of general medical practitioner (GP) HMR claims per 1000 people aged ≥65 years and RMMR claims per 1000 older residents of aged care facilities were determined using publicly available data. Interrupted time series analysis was conducted to examine changes coinciding with dates of program changes. In January 2009, monthly HMR and RMMR rates were 0.80/1000 older people and 20.17/1000 older residents, respectively. Small monthly increases occurred thereafter, with 1.89 HMRs/1000 and 34.73 RMMRs/1000 provided in February 2014. In March 2014, immediate decreases of –0.32 (95%CI –0.52 to –0.11) HMRs/1000 and –12.80 (95%CI –15.22 to –10.37) RMMRs/1000 were observed. There were 1.07 HMRs/1000 and 35.36 RMMRs/1000 provided in December 2019. In conclusion, HMR and RMMR program changes in March 2014 restricted access to subsidized medicines reviews and were associated with marked decreases in service provision. The low levels of HMR and RMMR provision observed do not represent a proactive approach to medicines safety and effectiveness among older Australians.

Stoma care services during the COVID-19 pandemic.

British Journal of NursingVol. 30, No. 16 CommentStoma care services during the COVID-19 pandemicJennie BurchJennie BurchE-mail Address: [email protected]Head of Gastrointestinal Nurse Education, St Mark's HospitalSearch for more papers by this authorJennie BurchPublished Online:11 Sep 2021https://doi.org/10.12968/bjon.2021.30.16.S40AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References COVIDSurg Collaborative. Outcomes from elective colorectal cancer surgery during the SARSCoV-2 pandemic. Colorectal Dis. 2020;00:1–18. https://doi.org/10.1111/codi.15431 Google ScholarD'Antonio D, Pizza F, Tropeano FP, De Palma GD, Marvaso A, Luglio G. COVID-19 outbreak and stoma care on a minor island in Italy: Physically far, virtually near. SN Comprehensive Clinical Medicine. 2020;2(9):1302–1305. https://doi.org/10.1007/s42399-020-00429-3 Crossref, Google ScholarDepartment of Health. New campaign to prevent spread of coronavirus indoors this winter. 2020. https://tinyurl.com/hbdkkfbm (accessed 18 August 2021) Google ScholarFowler A, Abbott TEF, Pearse RM. Can we safely continue to offer surgical treatments during the COVID-19 pandemic? BMJ Qual Saf. 2020;0:1–3. https://doi.org/10.1136/bmjqs-2020-012544 Google ScholarFulham J, Lowther C, Chandler P. Embracing the changes imposed by COVID-19 to shape future stoma care service provision. Br J Nurs. 2020;29(22):S10–S12. https://doi.org/10.12968/bjon.2020.29.22.S10 Link, Google ScholarLancet Oncology (Editorial). Valuing all lives equally: cancer surgery, COVID-19, and the NHS in crisis. Lancet Oncol. 2021;22(2):155. https://doi.org/10.1016/S1470-2045(21)00022-X Crossref, Medline, Google ScholarMarino F, Trompetto M, Gallo G. COVID-19 pandemic: a large boulder on the head of stoma patients. Br J Surg. 2020;107(9):e303. https://doi.org/10.1002/bjs.11754 Crossref, Medline, Google ScholarMorris EJA, Goldacre R, Spata E et al. Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: a population-based study. Lancet Gastroenterol Hepatol. 2021 Mar;6(3):199-208. doi: https://doi.org/10.1016/S2468-1253(21)00005-4 Crossref, Medline, Google ScholarNational Institute for Health and Care Excellence. When should I suspect coronavirus infection? 2021. https://cks.nice.org.uk/topics/coronavirus-covid-19/diagnosis/diagnosis/ (accessed 13 August 2021) Google ScholarNHS Website. How to avoid catching and spreading coronavirus (COVID-19). https://tinyurl.com/a65uname (accessed 18 August 2021) Google ScholarPata F, Bondurri A, Ferrara F, Parini D, Rizzo G; Multidisciplinary Italian Study group for STOmas (MISSTO). Enteral stoma care during the COVID–19 pandemic: practical advice. Colorectal Dis. 2020;22(9):985–992. https://doi.org/10.1111/codi.15279 Crossref, Medline, Google ScholarVailas M, Sotiropoulou M, Schizas D, Maroulis I. Psychological implications on stoma patients waiting for reversal in the era of COVID-19 pandemic. Br J Surg. 2021;108(4):e181. https://doi.org/10.1093/bjs/znab022 Crossref, Medline, Google ScholarVural F, Özer Özlü. In the COVID-19 Pandemic Living with a Stoma and Being a Stoma Nurse. Turk J Colorectal Dis 2020;30:231-236. https://doi.org/10.4274/tjcd.galenos.2020.2020-10-3 Crossref, Google ScholarWoodhouse F, Yeung T. Impact of COVID-19 on stoma care: the experience of one team in Oxford. Br J Nurs. 2020;29(16):S4–S6. https://doi.org/10.12968/bjon.2020.29.16.S4 Link, Google ScholarWorld Health Organization. Coronavirus disease (COVID-19): How is it transmitted? 2020. https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-how-is-it-transmitted (accessed 13 August 2021) Google ScholarWorld Health Organization. Naming the coronavirus disease (COVID-19) and the virus that causes it. 2021. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it#:~:text=Official%20names%20have%20been%20announced,%2DCoV%2D2) (accessed 13 August 2021) Google ScholarXu Y, Huang ZH, Zheng CZ, Li C, Zhang YQ, Guo TA, Liu FQ, Xu Y. The impact of COVID-19 pandemic on colorectal cancer patients: a single-center retrospective study. BMC Gastroenterol. 2021; 20;21(1):185. https://doi.org/10.1186/s12876-021-01768-8 Crossref, Google Scholar FiguresReferencesRelatedDetailsCited byCaring during and after a pandemicAna González Díaz, Concepción Capilla Díaz2 June 2022 | Gastrointestinal Nursing, Vol. 20, No. Sup4 9 September 2021Volume 30Issue 16ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 11 September 2021 Published in print 9 September 2021 Information© MA Healthcare LimitedPDF download

Um currículo para médicos em Cuba pela solidariedade política no campo da saúde: possível explicação para a atuação no programa “Mais Médicos”

This aim of this article is to study the formal medical curriculum for the education of Cuban physicians to identify possible explanations for some differences in their practices, already identified by different studies on the “More Doctors Program” (PMM)5. To do so, we developed a qualitative, documental and bibliographic exploratory study. Therefore, we defined two reading guide axes for the analysis: (i) the construction of the curriculum and the socio-cultural connection reflected in pedagogical reasoning; (ii) the model of medical education in connection with the health system. We identified characteristics in the curriculum studied that tend towards a decolonial perspective, that is, that the encounter with the “other” is not to dominate, but to support and exchange, from a perspective of political solidarity through health actions, with medical missions. There is a lot of emphasis on comprehensive medicine in the curriculum and it is structured by ethical-humanistic medicine, which is a fundamental perspective for the demands of medical practice in the More Doctors Program.

Rehabilitation Management of Post Palatoplasty in Adolescent: Case Report

The objective of this study is to report comprehensive physical medicine and rehabilitation management of post-palatoplasty in an adolescent patient. The cleft palate repair is usually done in the first year of life in order to gain optimal speech function. To achieve normal communication development, normal hearing, normal oral and pharyngeal structures, adequate stimulation, and reinforcement from the environment for communication efforts are needed. Patient was assessed comprehensively using The International Classification of Functioning, Disability and Health (ICF) and by perceptual assessment for speech. The results showed that after one month intervention, the perceptions of hypernasality in plosive /b/ and affricates /c/ were found reduced significantly. There was improvement in articulation after one month of intervention.

Satisfacción de los médicos generales con la preparación recibida en medicina natural y tradicional durante la carrera de Medicina

ObjectiveTo characterize the satisfaction of general practitioners with the preparation of natural and traditional medicine (NTM) received in undergraduate studies at the Facultad de Ciencias Médicas «Dr. José Assef Yara» from Ciego de Ávila. DesignDescriptive and cross-sectional study during the period from May 2018 to April 2019. LocationFacultad de Ciencias Médicas «Dr. José Assef Yara» from Ciego de Ávila. ParticipantsA total of 43 residents of the specialty of Comprehensive General Medicine were selected, by means of an intentional non-probabilistic sampling, because they were first- and second-year residents of the specialty and had completed their intrahospital rotation time in Gynecology and Obstetrics, Pediatrics and Internal Medicine Services. MethodIt was applied a questionnaire that allowed to characterize the state of satisfaction of the residents with the preparation of NTM received in undergraduate, as well as the indicators that influenced it. ResultsAn analysis of the results obtained was carried out, which generally recognized a low percentage of satisfaction, influencing the active participation in practical activities, the accessibility of the bibliography, the use of teaching aids and the amount of time dedicated to the NTM activities. ConclusionsThe characterization of the current state of satisfaction of general practitioners with the approach of the contents of the NTM exposed the higher percentage of satisfaction for the discipline of comprehensive general medicine. The greatest dissatisfactions corresponded to Morphophysiology, the disciplines of General Training, Pediatrics and Obstetrics and Gynecology.

Medical education reform in Tajikistan: comparison of the conventional one-year family medicine residency program and the new two-year residency program for postgraduate medical education

IntroductionThe last two decades have seen a shift in former Soviet countries from highly specialized to more family medicine-focused systems. Medical education has slowly adjusted to these reforms, although the region is still at risk to have a chronic shortage of family doctors. This paper presents the evaluation of a new post-graduate family medicine program in Tajikistan, focused on competency-based training. The findings are relevant for policy makers, international organizations and practitioners participating in similar medical education reform programs.MethodsWe employed a quasi-experimental control group design and compared intervention residents, control group residents with traditional training, and 1st year residents with no training in two outcomes, clinical knowledge and competencies. We employed two objective measures, a written multiple-choice question test (MCQT) and an Objective Structured Clinical Examination (OSCE), respectively. We report reliability and validity of the measures along with ANOVA, planned contrasts and effect size estimates to examine differences across groups.ResultsWe found statistically significant differences in both clinical knowledge and competencies between intervention and control groups. We also detected a large intervention effect size. Participants in the intervention outperformed control group participants in the two measures. Our analysis suggests that intervention and control group participants are comparable in terms of initial knowledge and competencies, strengthening the argument that the intervention caused the improvement in the program outcomes.DiscussionReceiving tailored training and structured opportunities to practice knowledge and competencies in clinical settings have a positive effect on the education of family medicine doctors in Tajikistan. Our results support curriculum reform and investment in medical education in the form of longer and supervised on-the-job preparation designed to be more in line with international standards. We discuss suggestions for future studies and potential requirements to inform replicability in other countries.ConclusionFamily medicine is well recognized as central to health systems throughout the world, but high quality residency training lags behind in some countries. Our study showed that investing in family medicine residency programs and structured training is effective in increasing critical clinical competencies. We encourage promoting comprehensive post graduate family medicine doctor training so that the goals of a family medicine centered health system are attainable.