Medical Care Practices Research Articles

Health or medical care system?: matters in efficiency

This work seeks to explore a country’s organization of its national health systems, its allocation of resources in the process and well as the efficiency of such organized system. The paper also aims to contribute in improving the organization of an integrated health system. The vast majority of countries in the world have formulated their national health system based on their medical care system, ignoring the importance of public and community health. In other words, they are more oriented towards waiting for people to get sick, than taking a preventive approach with early detection of disease to avoid the development of sickness and its complications. Such reactive, rather than proactive approach, continues to contribute to the high costs of medical care associated with the increased number of chronic patients and a greater population longevity. Their reactive formulation of their health systems makes the system inefficient. On the other hand, the practice of medical care is considered recuperative health; however, an increasing demand of chronic patients to medical care services raises the question if the medical practice is really recuperative or only treatment of a chronic disease. The existence of a functional divorce between public health and medical care limits and weakens efficiency. Therefore, it is urgent to integrate both practices into a single organized and coordinated health system that prioritizes prevention over disease treatment, primary prevention rather than secondary prevention (chronicity) or tertiary prevention (damage to other organs as a complication). The COVID_19 pandemic is predominantly public health issue rather than medical, although social behavior has been a major factor in the persistence of the pandemic.

IDF21-0589 Initial learnings from an eHealth platform for identifying individuals at high risk of diabetes in Mexico

Background: Type 2 diabetes mellitus (DM2) is a leading cause of morbidity and mortality in Mexico. Since the early onset of DM2 is associated with a worse prognosis, the widespread implementation of evaluation risk tests could facilitate its identification among subjects at high risk, in order to promote strategies that reduce the risk and burden of the disease. Aim: To report the initial findings of the open access eHealth platform implementation, based on a chat-box, for the identification of risk factors for diabetes and subjects at high risk of the disease. Method: To identify risk factors for diabetes, an open access eHealth platform (GYANT®) was promoted among the general population in Mexico, through social networks of non-governmental organizations (Mexican Diabetes Federation). This platform is a chat-bot that uses artificial intelligence to guide the conversation with spontaneous users, who provide the information requested. Afterwards, the platform provides the user with a result on their risk profile for diabetes and suggests practical medical care recommendations in a friendly way. Data obtained from January to October 2020 were analyzed to evaluate the performance of this initiative and identify subjects at high risk. The diabetes risk test (DRT) and the metabolic syndrome cohort office-based prediction model (MSCPM) for incidental diabetes were used to define the presence of diabetes risk. Today, the MSCPM is the only predictive model for diabetes in the Mexican population and was developed in middle-aged adults. Results: Data from 23,662 participants were analyzed. The mean age of the participants was 21 ± 9 years, most of them male (51%), with secondary or higher education (79%). The risk factors in the participants were: family history of diabetes (99.1%), overweight (26.1%), hypertension (20%) and obesity (19.8%). Moderate to high risk of diabetes was found in 12%, according to the diabetes risk test, and in 75.4% for the MSCPM (moderate risk [69.1%], moderate-high risk [5.4%] and high risk [0.9%]). A higher BMI was associated with self-reported hypertension (13%), hypercholesterolemia (12.6%), smoking (12%), and poor exercise performance (14.6%). Discussion: Participants in the eHealth platform reported a high prevalence of high-risk factors for diabetes. Early age and a family history of diabetes may have led to participation, which indicates about health concerns that occur in this young adult population. This is the first report of its kind on health initiatives to identify the risk of diabetes in Mexico. We acknowledge that the use of self-reported data is a limitation of this study, as it may be less reliable due to possible lack of precision in responses, as well as possible intentional and unintentional reporting bias. However, we consider that this type of eHealth tools could help to identify subjects with high-risk profiles, so its massive implementation should be considered in health policies, including binding actions to the strategies of diagnosis and/or prevention programs.

Cognitive Bias in Medical Decision Making

Cognitive bias is well known recognized factor that causes many diagnostic errors. Such errors hampers with quality patient care in medical practice. This paper focuses on various biases that may affect decision making and idea flow. Growing awareness for such biases is need of hour as only then de biasing techniques could be adopted to prevent such cognitive errors.

Internship Experience: A Transition from Academic World to Health Care Workplace

internship; medical student; work.

Impact of coronavirus disease 2019 on infectious disease treatment and infection control at a tertiary hospital in Japan

IntroductionCoronavirus disease 2019 (COVID-19) has greatly impacted medical care practices. Although the effects on infectious disease treatment and infection control, such as antimicrobial resistance, have been specified, very few reports exist on the specific effects of COVID-19. MethodsWe investigated the effects of COVID-19 on daily medical practices at a tertiary hospital in Japan by comparing the use of hand sanitizers, the detection of bacteria from blood cultures, and the amount dose of antibacterial drugs used for one year before (April 2019 to March 2020, fiscal year 2019.) and after COVID-19 admissions began (April 2020 to March 2021, fiscal year 2020). ResultsThe use of hand sanitizers increased by 1.4–3 times during the year after COVID-19 admissions began; the incidence of methicillin-susceptible Staphylococcus aureus and all S. aureus detected in blood cultures reduced in all departments. No decrease was observed in the usage of all antibacterial drugs; rather, the usage of all antibacterial drugs tended to increase in all departments. Therefore, no significant change was observed in the detection of drug-resistant bacteria and the trends of antibacterial drug use based on the acceptance of COVID-19 patients. ConclusionsThe prevalence of drug-resistant bacteria and trends of antibacterial drug use remained unchanged despite the increased use of hand sanitizers due to the admission of patients with COVID-19.

Practice of home medical care by general hospitals can be applied to practice of neurology

Practice of home medical care by general hospitals can be applied to practice of neurology

Gender dysphoria in adolescents with Ehlers-Danlos syndrome.

Ehlers-Danlos Syndrome represents a family of heritable connective tissue disorders that include joint hypermobility, tissue fragility, and skin hyperextensibility. Ehlers-Danlos Syndrome presents with clinical sequela across multiple body systems that require multidisciplinary care. Little is known about adolescents with Ehlers-Danlos Syndrome who are transgender and gender diverse. To date, there have been no reports of transgender and gender diverse youth in pediatric patients with Ehlers-Danlos Syndrome. The objective of this study was to characterize transgender and gender diverse adolescents with Ehlers-Danlos Syndrome seen in a pediatric multidisciplinary specialty clinic. A retrospective chart review was performed and it was found that 28 patients were seen in the Ehlers-Danlos Syndrome multidisciplinary clinic were reported being transgender and gender diverse. Chart review included analysis of all documents in the electronic medical record, including demographic data, gender identity, chosen pronouns, specialty care previously received for Ehlers-Danlos Syndrome, symptoms and conditions related to it, and medications. Of the 166 total adolescents seen in the pediatric multidisciplinary Ehlers-Danlos Syndrome clinic during the study period, 17% reported gender dysphoria. The average age at Ehlers-Danlos Syndrome diagnosis was 13.5 years (range 8-17 years). Most (61%) reported their gender identity as transgender, followed by nonbinary (14%). Most had preferred male (he/him) pronouns (47%), followed by nonbinary (they/them) pronouns (39%). The vast majority reported fatigue (75%), musculoskeletal issues (96%), psychiatric issues (86%), cardiac issues (71%), gastrointestinal issues (68%), and neurologic issues (79%). Here we report the first cohort of transgender and gender diverse adolescents in the Ehlers-Danlos syndrome population and show an association between the two. This report increases awareness for providers who care for patients with Ehlers-Danlos Syndrome. As care for those with Ehlers-Danlos Syndrome is often complex and multidisciplinary, providers should adopt practices of gender-affirming medical care that contribute to improved care and outcomes.

A cross-sectional study to assess knowledge, attitude, and practices regarding Zika virus among nursing students in a tertiary care center of central India

Introduction: Recently, the Zika virus (ZIKV) has become a major concern across the world. ZIKV can primarily spread through the bite of infected Aedes aegypti mosquitoes. Till now, ZIKV is considered an incurable infectious disease. As Zika is an emerging disease of an international concern with the ongoing speculation about a potential outbreak in India in the future, the present study was conducted with an aim to assess knowledge, attitude, and practices regarding ZIKV among nursing students. Materials and Methods: This hospital-based cross-sectional study was conducted among 240 nursing students during 2019, and data were collected using a pretested, predesigned, standardized, and self-administered questionnaire. The ethical approval was obtained from the Institutional Ethical committee before the conduct of the study. All tests were performed at 5% level of significance. Results: The present study has included 240 nursing students (228 female students and 12 male students). The most common source of information related to ZIKV was social media among 75.6% of the students and 46.7% of the participants has low knowledge regarding ZIKV. Surprisingly, about one-tenth of the participants (14.2%) made an attempt to gain more knowledge about ZIKV, and nearly one-fifth of the participants were not using any method at all (17.1%) to prevent mosquito bites. Conclusion: This study showed inadequate knowledge among nursing students which will be future health care providers about ZIKV infection. The awareness about ZIKV infection should be ensured and maintained among health care providers to face any possible emergence in the region. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning, and Systems-based practice.

Vertical integration of primary care practices with acute hospitals in England and Wales: why, how and so what? Findings from a qualitative, rapid evaluation

ObjectivesTo understand the rationale, implementation and early impact of vertical integration between primary care medical practices and the organisations running acute hospitals in the National Health Service in England and...

Coproduction, Coeducation, and Patient Involvement: Everyone Included Framework for Medical Education Across Age Groups and Cultures.

Medical education, research, and health care practice continue to grow with minimal coproduction guidance. We suggest the Commons Principle approach to medical education as modeled by Ostrom and Williamson, where we share how adapting these models to multiple settings can enhance empathy, increase psychological safety, and provide robust just-in-time learning tools for practice. We here describe patient and public coproduction in diverse areas within health care using the commons philosophy across populations, cultures, and generations with learning examples across age groups and cultures. We further explore descriptive, mixed methods participatory action in medical and research education. We adopt an “Everyone Included” perspective and sought to identify its use in continuing medical education, citizen science, marginalized groups, publishing, and student internships. Overall, we outline coproduction at the point of need, as we report on strategies that improved engagement. This work demonstrates coproduction with the public across multiple settings and cultures, showing that even with minimal resources and experience, this partnership can improve medical education and care.

An Innovative Approach for Integrating Mandatory, Longitudinal Spirituality Training Into the Medical School Curriculum.

Most Americans indicate they are religious and/or spiritual and wish to have their beliefs taken into account when engaging with health care providers, yet gaps in medical education and health care practice remain. To underscore the importance of spirituality as a significant social determinant of health, a team at the Icahn School of Medicine at Mount Sinai in New York developed mandatory spirituality and health training for students integrated into all 4 years of the undergraduate medical education curriculum. From 2014 to 2020, a small group of faculty took an innovative approach, launching the initiative and expanding the team by engaging interprofessional faculty and staff from across the institution. The team used an iterative process to integrate 4 distinct modules into 4 existing courses, spanning the 4 years of medical school. The majority of students found that the spirituality and health curriculum was valuable to training and professional development. They appreciated the importance of patients' spiritual needs, valued learning about the role chaplains play in patient care and how to initiate a consult, and indicated they intended to integrate spiritual history taking in their patient care. With respect to process, 3 key factors-establishing an interprofessional team, working through an iterative process, and integrating the curriculum into existing courses-were critical to designing and implementing the modules. The team aims to expand and improve the curriculum by linking learning to specific standardized competencies as well as developing more specific performance assessments to demonstrate achievement of competencies. Professional development efforts will be enhanced so faculty can better model and reinforce the integration of spirituality into health care practices and expand the curriculum on spirituality and health into graduate medical education.

Data Analytics in Health Management System

Large information, a quickly creating theme, has begun to have a crucial influence in the production of medical care exploration and practices. It has enabled people to assemble, put together, examine, or ingest monstrous volumes of heterogeneous, coordinated, and unstructured information made by the present wellbeing frameworks. Large information investigation has as of late been utilized to help with the conveyance of care and infection research. In any case, a few major hardships innate in the huge information worldview keep on preventing acknowledgment and examination extension in this field. We address a portion of these crucial difficulties in this paper, with an emphasis on three arising and entrancing disciplines of clinical science: picture, sign, and age sequencing investigation. The utilization of huge volumes of clinical information while consolidating multimodal information from numerous sources is investigated considering current discoveries. Potential examination subjects in this space that can impact medical care arrangement are likewise assessed.

Overview of Perinatal Practices with Potential Neurodevelopmental Impact for Children Affected by Preterm Birth

There is increasing recognition of the importance of addressing both medical care practices and interventions, as well as nonmedical factors and interventions for the mother–infant dyad in neonatal intensive care. This update addresses the evidence for medical and nonmedical practices affecting the outcomes of infants born preterm who require intensive care.

ABOUT THE SYSTEM OF MARKET RELATIONS BETWEEN A FAMILY DOCTOR AND A PATIENT IN CONDITIONS OF QUALITY PROVISION / RECEIPT OF MEDICAL SERVICES DURING THE DECENTRALIZATION OF POWER IN UKRAINE

Aim of the research. Scientific substantiation of organizational model of commodity-market relations in obtaining medical services to rural population of united territorial communities (UTC) in conditions of «country with market economy». Materials and methods. In this study were used results of scientific research, obtained by using qualimetric, retrospective, sociological, abstract methods, and as well as methods of descriptive modeling, deductive awareness, structural and logical analysis with the system principles and requirements of management theories with changes. Results and discussions. According to the results of survey and basic functional processes of organization system, where fully used the principles: Entrance → Set of actions → Exit → Feedback, modeled organizational system of accessible and high quality system of commodity - market relations in obtaining medical services to rural population of UTC (Model), which fully meets the conditions of system transformation of primary medical care to European standard.Implementation of functioning Model to the primary level of medical care occurs through the consistent implementation of the main tasks of each of the seven interconnected stages and which content is revealed in this paper. Conclusions. Implementation of this innovation of organizational content to practical medical care will allow to transform medical care at primary level to conditions of market economy of the country, through the creation of high quality and effective system of medical service to rural population of UTC, which will serve as the effective impetus to the optimization of specialized and highly specialized medical care.

What is ‘sibling support’? Defining the social support sector serving siblings of people with disability

‘Sibling support’ is a form of support for the brothers and sisters of people with disability within medical, health and social care practice, promoting outcomes for them such as improved self-expression, mental health, wellbeing, skills and networks. There has been significant research interest in sibling support, however most has only evaluated individual interventions. There has been little-to-no research that has examined what sibling support is as a sector or overall field of practice. This paucity of research on sibling support as a field of practice is a problematic gap as it prevents recognition of sibling support as a distinct service type/sector, and may ultimately prevent sibling support from getting due support, acknowledgement, funding and promotion.Drawing on a study of national-level sibling support providers in the USA, UK, Canada, New Zealand and Australia, this article therefore seeks to describe sibling support as a sector and field of practice: the principles underpinning it, purposes/functions it addresses and delivery methods used. The article also discusses variation and emerging practice between sibling support providers, as well as the importance and implications of the findings for building greater recognition of sibling support within medicine, health and social care, particularly within the context of policy changes and increasing conditions of austerity, requiring more targeted decisions about what service types service systems support and promote.

A process model for quality in use evaluation of clinical decision support systems

ContextClinical decision support systems (CDSSs) are used to help healthcare professionals in making decisions, offering them a tool for improved medical care practices based on monitoring and management procedures. Although CDSSs exhibit many advantages, challenges remain in terms of their adoption in the clinician community. One such issue is related to user satisfaction and the system reliability. Ensuring the quality of CDSSs is a way to improve their acceptance and adoption. ObjectiveThis study aims to propose a process model for evaluation of the quality in use characteristics of a CDSS to identify deficiencies that reduce its use by healthcare professionals. MethodsWe reviewed the existing literature on CDSS assessment and developed a process model based on the international standards ISO/IEC 25010 System and software quality models, and ISO/IEC 25022 Measurement of quality in use. To select measures for evaluating these characteristics, we adopted the Goal-Question-Metric (GQM) method. We evaluated the quality in use characteristics because they can represent system usability. Measurement of these characteristics helps us understand user needs, improve the user experience, and mitigate the low acceptance of CDSS, particularly by the primary users. ResultsWe developed a process model for measuring the quality in use (QiU) characteristics of CDSSs, explaining its applicability through an illustrative example focused on the characteristics of satisfaction and efficiency. ConclusionWe consider that the proposed process model will benefit the CDSS adoption and contribute to the improvement of the quality of such systems by measuring its QiU.

Awareness and Attitude Regarding Complementary and Alternative Medicine among Middle Aged Adults.

Complementary and Alternative Medicine is a group of diverse medical and health care practices and products that are not presently considered to be part of conventional medicine. The purpose of study was to assess the level of awareness and attitude of Complementary and Alternative medicine among middle aged adults and to find out the correlation between awareness and attitude. A descriptive, correlational study design was carried out on 63 subjects through convenient sampling technique. Data was collected through face to face interview method among middle aged adults of Kirtipur municipality in Kathmandu by using Nepali version of structured set of questionnaire for all respondents. Data were entered using SPSS-20 and analyzed using descriptive statistics for socio-demographic and study variables, and inferential statistics namely Spearman Rank correlation coefficient was used to assess the relation between awareness and attitude regarding Complementary and Alternative medicine. Highest proportion (36.5%) of respondents was aged from 41-45 years. Majority (88.9%) of the respondents were literate. It was found that majority (71.4%) of the middle aged adults pose moderate knowledge and favorable attitude (93.7%) regarding complementary and alternative medicine, with negligible relationship between awareness and attitude(r=0.171). This study concluded that majority of the middle aged adults pose moderate knowledge and favorable attitude regarding complementary and alternative medicine, with negligible relationship between awareness and attitude.

Review: Pharmacological Activity, Chemical Composition and Medical Importance of Leonotis nepetifolia R.Br.

India is perhaps the most unique country in the world, with the richest tradition of indigenous and health care medical practices. Most of these practices are unique and known to very few individuals or communities. Leonotis nepetifolia Family (Lamiaceae) commonly known as ‘Klip dagga’ which has a long history of several traditional medicinal uses in many countries in the world. A huge number of phytoconstituents have been reported from the plant are allenic acid, iridoids, glycosides, terpenoids, and many more. This plant exhibited various biological activities and has been attributed to a variety of physiological effects like antifungal, antidiabetic, anxiolytic, arthritic, and many more activities. This literature review presents important species covering phytochemistry and pharmacological activities aspects systematically.

Practice of medical care and rescue Amne Machin extreme cross-country challenge

To share the practice of medical care and rescue in the 2017-2019 Amne Machin extreme cross-country challenge. At the invitation of the Organizing Committee of Amne Machin extreme cross-country challenge of Maqin County of Qinghai Province. More than 150 medical personnel were sent to make the rescue plan and implement the medical security for three consecutive years. The support was divided into leading command group, expert consulting group, on-site medical support group, rear medical support group, and medical material support group. The on-site medical support group was equipped with the ambulance, corresponding emergency medical equipments and medicines to provide medical support at eight medical stations from the starting point to the endpoint and along the route between each station. There were no cardiac arrest and sudden death cases during the three competitions. A total of 56 patients (5 cases of combined injuries) were received, including 21 cases of mild altitude reaction, 8 cases of abrasions, 13 cases of muscle spasm and strain, 11 cases of hypoglycemia, and 3 cases of abdominal pain. All the injured were treated and observed in time. Each patient achieved a complete remission. To achieve the success of medical security of the highest average altitude cross-country race certified by International Trail Running Association (ITRA), we must formulate a scientific and perfect medical security work plan in the first place: pre competition physical examination, especially the application of sports cardiopulmonary function test, screen out athletes who may have medical accidents; during the competition, focus on monitoring and tracking the players who may have problems; each support point is closely connected with the support vehicle; do a good job of first aid training for all kinds of personnel, so that medical accidents can be found, aided, and transferred at the first time. The medical care and rescue of Amne Machin extreme cross-country challenge have played a good role in the security of the international plateau sports events, which provides a reference for the security of similar events.

DEEP Study: Utility of the multidimensional pain inventory in persistent oro-facial pain.

Persistent oro-facial pain (POFP) is disabling, and patients' treatment outcomes are difficult to predict; psychosocial factors play a role. The West Haven-Yale Multidimensional Pain Inventory (MPI) is a self-report measure, which to our knowledge, has not been studied across primary and secondary care in heterogeneous POFP. Assess the MPI's ability to predict clinical outcome in POFP patients across primary and secondary care settings receiving usual care. About 146 patients receiving usual care for POFP were recruited from primary and secondary care medical and dental practices in north-east England. Participants completed the MPI (v3) and Graded Chronic Pain Scale (GCPS) at recruitment, and after 6, 12, 18 and 24months. The Patient Health Questionnaire-4 (PHQ-4) was completed at recruitment, 12, and 24months. 'Good' and 'poor' outcome status was assigned to participants based on their mode dichotomised GCPS score across timepoints. Logistic regression was used with overall GCPS outcome (good/poor) as the dependent variable and MPI subscale scores, demographic variables, and PHQ-4 scores as predictors. 110 participants had a 'good', and 36 had a 'poor' outcome. In the 'poor' outcome group, age, mean income, and life control scores were lower; deprivation, months in pain, PHQ-4, pain severity, interference, and affective distress scores were higher. In the 'good' group, MPI scores improved over time. Interference was the only consistent predictor of 'poor' outcome in the logistic regression model (OR: 1.14-1.98, p<0.05). The MPI interference subscale may help to identify patients with POFP who are likely to have consistent pain-related disability over time; it may therefore be useful clinically to identify patients likely to need early intervention.