Independent Doctor Research Articles

Perancangan Database Sistem Informasi Dokter Praktik Mandiri (Si_Dori)

In the practice of independent doctors, patient registration is still done manually, so they have to come first because it takes longer, in addition, doctors cannot find out the disease experienced early and the follow-up actions that need to be taken. This study aims to make it easier for patients to register online, consult online, screen online, and have new features that make it easier for patients to access their conditions. The method used is the prototype method which is useful for designing and knowing the interaction between the system and the user, to be implemented by programmers. The results of this study are the design of an independent doctor's information system which includes a database design. The design of this independent doctor's information system can make it easier for patients to register online, consult online which can be given a prescription and redeemed at the nearest pharmacy, and more complete feature updates.

Health Care System Application (Good Care) Android-Based at Primary Health Care (Case Study at Clinic of Wijaya Kusuma)

The development of information systems is currently experiencing very rapid development which we now recognize as the era of digitalization, one of which is in the field of health services. Primary healthcare is a type of medical health service that provides health services to individuals at the first level health service. The problem that most often arises is related to the registration system which is still done manually by recording in the registration book, thereby allowing the risk of errors occurring and the process of searching for visit data taking a long time. This research aims to improve better service for visits so it is necessary a good, systematic and integrated data handling and processing in a developing service system, even at the level of independent health service practice. This research method uses Field Observation, Library Research, Interviews, Study Research Literature (Research Literature Study), System Design, System Implementation and Testing. Application system from syntax errors and functionally produces functions as expected. The health service system application (Good Care) has been tested and can be used so that it can increase the effectiveness and efficiency of health services at the independent doctor's practice at Clinic of Wijaya Kusuma.

IJCM_196A: Exploring the transition from medical students to interns: A leap into clinical practice

Background: The transition from medical student to independent doctor is a crucial phase, marked by a year-long clinical internship in India. Despite this, challenges arise, and stress is common among interns. This study aims to assess the preparedness of interns graduating under the present MBBS curriculum in India and understand the challenges they face during their internship. Methodologyology: This cross-sectional analytical study was conducted in teaching hospitals affiliated with Kasturba Medical College, Mangalore. Interns working in various departments of these hospitals were included in the study. Universal sampling was employed, approaching all available interns during the 14-day study duration. The sampling strategy was non-random, based on convenient sampling. Results: Out of 150 interns, 77 scored well in various aspects of clinical skills. However, discrepancies were observed in specific areas. While 84% demonstrated good history-taking skills, only 55% could effectively discuss medications with patients. Interns displayed lower competence in understanding drug interactions, with only 37 out of 150 scoring well. Communication and teamwork were strong points, with 82 interns effectively working in a multi-disciplinary team. On the contrary, clinical procedures and diagnostic skills showed dismal performance, especially in emergency situations and practical procedures. Conclusion: Interns exhibit strength in communication and teamwork but face challenges in diagnostic skills and clinical procedures. The findings emphasize the need for targeted interventions in specific areas, ensuring a well-rounded preparation for junior doctors. Addressing these challenges will contribute to a smoother transition from medical students to competent healthcare professionals.

Exploring recent trends (2014–21) in preferencing and accepting Queensland medical internships in rural hospitals

BackgroundMedical internship is a key transition point in medical training from student to independent (junior) doctor. The national Regional Training Hubs (RTH) policy began across Australia in late 2017, which aims to build medical training pathways for junior doctors within a rural region and guide students, interns and trainees towards these. This study aims to explore preferencing and acceptance trends for rural medical internship positions in Queensland. Moreover, it focuses on internship preference and acceptance outcomes prior to and following the establishment of RTHs, and their association with key covariates such as rural training immersions offered by medical schools.MethodsData from all applicants to Queensland Health intern positions between 2014–2021 were available, notably their preference order and location of accepted internship position, classified as rural or metropolitan. Matched data from Queensland’s medical schools were added for rural training time and other key demographics. Analyses explored the statistical associations between these factors and preferencing or accepting rural internships, comparing pre-RTH and post-RTH cohorts.ResultsDomestic Queensland-trained graduates first preferencing rural intern positions increased significantly (pre-RTH 21.1% vs post-RTH 24.0%, p = 0.017), reinforced by a non-significant increase in rural acceptances (27.3% vs 29.7%, p = 0.070). Rural interns were more likely to have previously spent ≥ 11-weeks training in rural locations within medical school, be rurally based in the year applying for internship, or enrolled in the rural generalist pathway.ConclusionsThe introduction of the RTH was associated with a moderate increase of graduates both preferencing and accepting a rural internship, though a richer understanding of the dominant reasons for and against this remain less clear. An expansion of graduates who undertook longer periods of undergraduate rural training in the same period did not diminish the proportion choosing a rural internship, suggesting there remains an appetite for these opportunities. Overall, domestic graduates are identified as a reliable source of intern recruitment and retention to rural hospitals across Queensland, with entry to the rural generalist pathway and extended rural placement experiences enhancing uptake of rural practice.

Using “thinking hat” debates to address controversial topics and enhance critical thinking in the pharmacy programme

Background: This study shares advantages and lessons learned on the design and incorporation of the “thinking hat” in debates in the pharmacy curriculum, which was used to address controversial topics, including Diversity, Equity, Inclusion and Anti-racism (DEIA). Methods: The “thinking hat” was administered in three independent Doctor of Pharmacy degree (PharmD) programmes to five student cohorts. The debate topics were: “COVID-19 vaccination mandates” and “genetic sequencing in healthcare.” The structure and assessment were similar. At the completion, students completed a perception survey and reflected on their experience. Results: The “thinking hat” can be implemented in pharmacy schools to increase critical thinking, and integrate awareness of topics, like DEIA. The “thinking hat” is easily reproducible and versatile for each institution’s needs, making it a useful tool to share. Common themes from student feedback included enhanced class engagement, applicability of concepts discussed in the classroom, better preparation for facing challenging opinions in practice, and awareness of diversity and inclusion. Conclusions: The “thinking-hat” activity was conducted in multiple locations, with different delivery methods, and with larger cohorts than previous debates in the literature. The “thinking hat” approach applies across various settings and can be used to introduce timely and controversial topics.

THE CASES OF STUDENT BURNOUT AT INDEPENDENT DOKTOR

This study aims to find out how big burnout cases are in independent medical practice. It was taken from burnout cases that occurred in independent medical practices, from January 2018 to December 2021. The patient was tested for burnout with Maslach Burnout Inventory-Human Service Survey (MBI-HSS) instrument. Burnout cases that enter the independent doctor's practice are those with physical symptoms such as stomach complaints and heart complaints. The method used in this research is quantitative and qualitative. Qualitative to see the relationship between sex and burnout shirts. Qualitative to analyze suggested solutions. The results obtained are as follows, there is an almost threefold increase in burnout cases during the pandemic. Calculation of chi-squared shows that gender affects burnout cases in students seen in the chi quadrant with an error rate of 5%. Before the pandemic, the incidence of burnout in women was more. After the pandemic, there were more burnout cases in men. The solution that should be done is to create a special curriculum on professional development to explore the motivation of students to overcome burnout. Some examples of countermeasures are those that have been implemented at the Faculty of Medicine, Universitas Indonesia, Indonesia, or do a coping strategy. This research is done to know how to prevent cases burnout cases in more students

Implementation of the Rapid Application Development Method for Designing an Outpatient Online Registration System in an Independent Doctor's Practice

The use of the website has become a necessity in health services and makes it easier to work in health care facilities. Doctors' independent practice as a health service facility can use the website to assist the outpatient registration process. Outpatient registration services at independent doctor's practices still use a manual system, patients must come to registration, take a queue card printed by the officer, wait according to the queue number obtained so that the process causes patient waiting time at the service to be long. The purpose of this study is to produce an outpatient online registration system in independent doctor’s practices that is able to assist outpatients to register online for outpatients. Development of an Outpatient Online Registration System at this Independent Doctor's Practice using the Rapid Application Development (RAD) method, this development model is used because this model is considered a time-honored model, so the process is relatively faster. This study applies the Rapid Application Development method to produce an outpatient online registration system at independent Practitioners that is able to manage patient data, doctor data, polyclinic queue data, polyclinic data, queue data and outpatient registration data. The Rapid Application Development method has been able to streamline the processing time for making the system to produce an Outpatient Online Registration System.

The Effect Of Implementation Of Permenkes No 46 Of 2015 Regarding Accreditation Of Puskesmas, Primary Clinics, Places Of Mandiri Doctor Practices, And Mandiri Medical Practices On The Performance Of Human Resources And The Effectiveness Of Using The Use O

Effect of implementation of Permenkes no. 46 of 2015 concerning the accreditation of Health Centre, pratama clinics, independent doctor's practice, and independent dentist’s practice on the performance of human resources and the effectiveness of the use of funds and their impact on the quality of services at health centre. This study aims to determine whether there is an influence on the implementation of Permenkes no. 46 of 2015 concerning the accreditation of health centre, pratama clinics, independent doctor's practice, and independent dentist’s practice on the performance of human resources and the effectiveness of the use of funds and their impact on the quality of services at health centre in bekasi. This research was conducted based on purposive sampling, the aim of which was targeted at respondents of the head of health centre, administrative coordinator, treasurer Jaminan Kesehatan Nasional, treasurer bantuan operasional Kesehatan, treasurer Anggaran Pendapatan Belanja Daerah, so that sample of 100 respondents was obtained sufficiently and represented the population in the city of Bekasi. This study used a research questionnaire that was distributed to 20 health centre units. The method used is SEMPLS (partial least square structural equation modeling) which is based on an evaluation of the interdependence relationship between variables. From the results of the study it was found that there was a significant positive strong relationship between the implementation of Permenkes no. 46 of 2015 concerning the accreditation of health centre, pratama clinics, independent doctor's practice, and independent dentist’s practice on human resource performance. There was no significant relationship between the implementation of Permenkes no. 46 of 2015 concerning the accreditation of health centre, pratama clinics, independent doctor's practice, and independent dentist’s practice to the effectiveness of the use of funds shows a significant positive relationship between Permenkes no. 46 of 2015 concerning the accreditation of health centre, pratama clinics, independent doctor's practice places, and independent dentist’s practice places on the quality of services at healt centre in Kota Bekasi. Permenkes no. 46 of 2015 on the performance of human resources and the effectiveness of the use of funds and their impact on the quality of services at the puskesmas.

Hemodynamics and functional outcomes after resistance training in hypertensive and normotensive elderly: An experimental study

Aim: To evaluate the chronic effects of resistance training on resting blood pressure, handgrip strength, gait speed, and Timed Up and Go test (TUG) in normotensive and hypertensive elderly individuals. Methods: Experimental study based on TREND. Hypertensive patients were diagnosed by an independent doctor. Before and after 12 weeks of progressive resistance training, we evaluated blood pressure, heart rate, body composition, Timed Up and Go test, gait speed, and handgrip strength. Results: Sample consisted of 41 participants divided into two groups (normotensive n = 28; hypertensive n = 13). We observed significant values in the reduction of blood pressure levels only in the group of hypertensive participants. In functionality outcomes, we observed significant values in all tests and both groups. Outcomes contemplate effect sizes ranging from small to moderate. Conclusion: Progressive resistance training lowers resting blood pressure levels, increases handgrip strength, and improves physical functional performance. Although the normotensive group did not show a reduction in blood pressure levels, an improvement was observed in the functional physical tests.

Brief Consent Methods Enable Rapid Enrollment in Acute Stroke Trial: Results From the TICH-2 Randomized Controlled Trial.

Seeking consent rapidly in acute stroke trials is crucial as interventions are time sensitive. We explored the association between consent pathways and time to enrollment in the TICH-2 (Tranexamic Acid in Intracerebral Haemorrhage-2) randomized controlled trial. Consent was provided by patients or by a relative or an independent doctor in incapacitated patients, using a 1-stage (full written consent) or 2-stage (initial brief consent followed by full written consent post-randomization) approach. The computed tomography-to-randomization time according to consent pathways was compared using the Kruskal-Wallis test. Multivariable logistic regression was performed to identify variables associated with onset-to-randomization time of ≤3 hours. Of 2325 patients, 817 (35%) gave self-consent using 1-stage (557; 68%) or 2-stage consent (260; 32%). For 1507 (65%), consent was provided by a relative (1 stage, 996 [66%]; 2 stage, 323 [21%]) or a doctor (all 2-stage, 188 [12%]). One patient did not record prerandomization consent, with written consent obtained subsequently. The median (interquartile range) computed tomography-to-randomization time was 55 (38-93) minutes for doctor consent, 55 (37-95) minutes for 2-stage patient, 69 (43-110) minutes for 2-stage relative, 75 (48-124) minutes for 1-stage patient, and 90 (56-155) minutes for 1-stage relative consents (P<0.001). Two-stage consent was associated with onset-to-randomization time of ≤3 hours compared with 1-stage consent (adjusted odds ratio, 1.9 [95% CI, 1.5-2.4]). Doctor consent increased the odds (adjusted odds ratio, 2.3 [1.5-3.5]) while relative consent reduced the odds of randomization ≤3 hours (adjusted odds ratio, 0.10 [0.03-0.34]) compared with patient consent. Only 2 of 771 patients (0.3%) in the 2-stage pathways withdrew consent when full consent was sought later. Two-stage consent process did not result in higher withdrawal rates or loss to follow-up. The use of initial brief consent was associated with shorter times to enrollment, while maintaining good participant retention. Seeking written consent from relatives was associated with significant delays. URL: https://www.isrctn.com; Unique identifier: ISRCTN93732214.

McGill University Faculty of Medicine.

McGill University Faculty of Medicine.

A Study on the children’s family doctor system

A Study on the children’s family doctor system

PENGARUH LAMA PRAKTIK DAN PENGETAHUAN DOKTER PRAKTIK MANDIRI TERHADAP PENEMUAN TERDUGA TUBERCULOSIS ANAK DI WILAYAH SURABAYA UTARA

Indonesia is the second most populated country with TB in the world. The proportion of Tuberculosis (TB) and adult tuberculosis cases in Indonesia is increasing every year. East Java is ranked second in TB cases in Indonesia. Surabaya is the most common city of TB cases. Therefore, WHO recommends the DOTS program for TB control that focuses on finding and healing TB patients, especially TB children. However, the implementation of this program has an imbalance in the number of adult TB findings and child TB. Factors that influence the discovery of TB suspected children are the length of practice and knowledge of Independent Practice Doctors (DPM). The purpose of this study was to analyze the effect of long time practice and knowledge of Practice Doctor Mandiri on TB child suspected finding. This research is an umbrella research of operational research of child TB treatment network with cross sectional study design. The sampling technique is simple random sampling with the amount of 42 people. Data collection is secondary data using data collection sheets. Data analysis using logistic regression. The result shows that there is a long effect of practice on TB children with p value 0,015 &lt;0,05 and OR value is 8,182. Independent Practice Physician Knowledge has no effect on TB children with p value 0,297&gt; 0,05 and OR 2,125. There is a need for regular socialization of child TB, especially the management of child TB and the commitment of the Independent Practice Doctor to the discovery of TB suspected

Correlation Between History of ISTC Training on Independent Practicing Doctor With Discovery of TB Suspected Children in Surabaya City

The burden of Tuberculosis in children cases in the world is unknown due to the lack of diagnostic tools that are child friendly and the inadequacy of recording and reporting systems. TB findings in East Java province is second only to west java and the highest number of cases is in Surabaya. The purpose of this study was to analyse the relationship between history of ISTC training with the discovery of TB suspected Children. This research was done with case control design. The case samples were 14 doctors who found suspected TB in children and control sample that was 56 doctors which did not find suspected TB in children. Sampling technique was simple random sampling. Data analysis using Odds Ratio (OR) and 95% CI. The results of the analysis showed that OR value = 5.222 (95% CI 1.470 <OR <18.546). Which means the history of participation or had received training on TB DOTS / ISTC program from independent practice doctor have the chance to find suspected TB Children 5.222 times higher than doctors who have never attended or received any training on the TB DOTS/ISTC program. Suggestions are submitted to the department of health or primary health care to provide training of TB DOTS program to the doctors in the area of Surabaya and cooperate with independent practicing physicians especially in recording and reporting in order to improve case finding, the coverage of TB in children treatment is increasing. Keywords: History of ISTC training, physician practice, TB children

158. Development of a phenotyping algorithm for Hypertensive Disorders of Pregnancy (HDP) in large-scale prospective genome cohort study

Background To elucidate genetic and environmental factors causing hypertensive disorders of pregnancy (HDP) in large-scale cohort study, we need to conduct precise phenotyping on subjects in cohort study. However, large-scale phenotyping by medical doctors’ diagnoses is impracticable with regard to cost-effectiveness. Here, we developed a rule-based HDP phenotyping algorithm. Our algorithm enables us to identify HDP patients and classify them into subtypes using large-scale cohort dataset. Methods We developed a phenotyping algorithm according to the HDP diagnosis criteria of Japan Society of the Study of Hypertension in Pregnancy (JSSHP). Our phenotyping algorithm was applied to 22,257 mothers with pregnancy recruited by the BirThree Cohort Study of Tohoku Medical Megabank. To validate consistency between our algorithm-based phenotype and medical-doctor’s diagnoses, an independent medical doctor examined medical records and made clinical diagnoses on 50 subjects. Results By conducting our phenotyping algorithm, 1939 (8.71%) subjects were phenotyped with HDP patients. Among them, HDP patients were phenotyped with subtypes as follows; 995 (4.47%) patients with gestational hypertension (GH), 318 (1.43%) patients with super-imposed pre-eclampsia (SuPE), and 626 (2.81%) patients with pre-eclampsia (PE). As for consistency between our algorithm-based phenotype and diagnose, 36 cases shows consistentency for subtypes and timing of onset, whereas 14 cases shows no consistency; 10 cases were inconsistent in onset of HDP, 2 cases were in subtypes and the remaining 2 cases were in timing of onset. Discussion In this study, we developed high-performance HDP phenotyping algorithm. The major part of the reasons of inconsistency was that postpartum hypertension was phenotyped in non-HDP group by our algorithm. This misphenotyping was caused by that postpartum blood pressure was not included in cohort data but included in medical records. In future, we will develop not only rule-based but also machine-learning based phenotyping algorism to perform more precise phenotyping in large scale clinical information.

Tele-aesthetics in South Asia.

Telemedicine is becoming increasingly popular. The best use for it is in the field of aesthetic dermatology - where conditions are not life-threatening, and treatments can be topical and very safe. In this study, we demonstrate that a simple store-and-forward telemedicine system can be applied safely to the field of aesthetic dermatology. This was a prospective study was carried out in Singapore. A total of 102 patients filled up a medical questionnaire and submitted photographs via our online system. Upon submission, there was an independent doctor on the back-end who would review their medical details and their photographs and make diagnoses and recommendations based on this information. There was another doctor who examined the patients face-to-face. Diagnoses made by the online doctor and by the face-to-face doctor were compared for congruency. A total of 358 diagnoses were made by the face-to-face doctor from 102 patients; 346 diagnoses were made by the teleconsultation doctor. For the purpose of this study, the diagnoses made by the FTFD were presumed to be correct. There was total agreement between both doctors in 342 diagnoses, giving a concordance rate of 95.5%. There were 12 missed diagnoses by the teleconsultation doctor and four discordant diagnoses. Our system demonstrates that a store-and-forward system enables our doctor to make accurate skin diagnoses. Our system was also able to detect dangerous conditions such as melanomas, skin cancers, actinic keratosis, and other dangerous diagnoses. There were discordant or missed diagnoses. This was mostly attributed to poor photograph quality. Emerging telemedicine technologies should be rigorously evaluated before they become widely implemented. Any system of value must uphold certain principles. It has to be fundamentally sound, safe, and clearly beneficial to the patient. With current technological limitations, the best use of such a system would be in aesthetics.

Intern to independent doctor: basic surgical skills required for South African practice and interns’ reports on their competence

Background: The role and scope of general practitioners in semi-urban and rural areas is poorly understood and documented. An absence of specialist support results in generalists being called to perform surgical procedures. It is imperative that they competently and confidently perform specific surgical procedures.Method: This cross-sectional study identified a list of agreed surgical procedures in which generalists should be competent. Enquires were made about generalists’ competence in performing such skills and training junior doctors how to use these them. Interns were asked about the quality of their exposure to and their perceived competence in the skills. A questionnaire was given to interns who completed their internship in 2008 in Mpumalanga and Gauteng, and another to generalists affiliated to the University of Pretoria. Data were analysed descriptively using Microsoft® Excel®.Results: The response rate was 31% and 21% for the interns and generalists, respectively. There was agreement on specific core skills in training. Most generalists (81%) lacked the competence to provide training on some of the specific core skills needed for independent practice. Most of the internships were completed in semi-urban areas (62%). The majority of the interns perceived themselves to be competent in Caesarean sections, the excision of lumps and bumps, and abscess drainage. Interns from urban areas rated themselves as being incompetent in the core surgical skills. Interns who worked in semi-urban regions felt competent in core surgical skills.Conclusion: The training of interns should be supervised by senior doctors in in-service training settings. Basic surgical skills and in-service training can be taught during family medicine rotation internships by surgically skilled family physicians and generalists in semi-urban areas and district hospitals.

Intern to independent doctor: basic surgical skills required for South African practice and interns’ reports on their competence

Background: The role and scope of general practitioners in semi-urban and rural areas is poorly understood and documented. An absence of specialist support results in generalists being called to perform surgical procedures. It is imperative that they competently and confidently perform specific surgical procedures.Method: This cross-sectional study identified a list of agreed surgical procedures in which generalists should be competent. Enquires were made about generalists’ competence in performing such skills and training junior doctors how to use these them. Interns were asked about the quality of their exposure to and their perceived competence in the skills. A questionnaire was given to interns who completed their internship in 2008 in Mpumalanga and Gauteng, and another to generalists affiliated to the University of Pretoria. Data were analysed descriptively using Microsoft® Excel®.Results: The response rate was 31% and 21% for the interns and generalists, respectively. There was agreement on specifi...

Why Chinese medical students are walking away from medicine

We assume that all medical students want to be doctors. However, only one in six of the 600 000 Chinese medical students who have graduated in the past five years have chosen to continue their career in medicine.1 Medical schools report that the number of new students is falling and many healthcare workers discourage their children from following in their footsteps. What’s going wrong? It starts with the length of training. It takes 11 years to become an independent doctor, and another 10 to become a senior medical officer.2 During this time friends of medical students, who studied for shorter degrees, may have become leaders or chief executives in other professional fields. The government does not subsidise any of our fees and we must find ways to fund our studies ourselves. Tuition fees vary widely, from around ¥5000 (£520; €660; $810) to ¥15 000 a year. Most medical students in China are supported financially by their families, putting themselves and their families under financial strain during this long period of training. Once qualified, doctors face considerable professional pressure. …

Timeliness of second opinion appointed doctors' assessments of treatment plans for patients detained in medium security hospitals in London, UK

Mental health legislation in England & Wales requires assessment by a second opinion appointed doctor (SOAD) to safeguard the rights of patients detained in a hospital under this law if they are either refusing certain treatments or are deemed incapable of consenting to them. Our aim was to evaluate timeliness of SOAD assessments. Data were collected from the Mental Health Act administrator on all SOAD requests in 1 year for all in-patients in two English medium security hospital units. One hundred and six patients required a SOAD assessment during the 1-year period examined, of a combined resident total of 295, as did a further 14 patients who had been discharged from hospital and were subject to a community treatment order. About half of the inpatients were seen by a SOAD within 30 days and a further quarter within 60 days, but the remaining quarter waited up to 150 days or more. These results suggest that in these trusts, unlikely to be atypical, neither patients nor clinicians are being adequately protected by legal safeguards on decisions to treat with medication (or electroconvulsive therapy) in the event of impaired competence for decisions about mental health treatments. There should be clear standards for the appropriate length of time from referral to assessment by an independent doctor (SOAD). Compliance with standards should be transparent, so anonymised data on the matter should be routinely collected and stored by health trust Mental Health Act offices. Data should be monitored at agreed intervals by an independent body.