Medical Certification Research Articles

Navigating Medical Device Certification: A Qualitative Exploration of Barriers and Enablers Amongst Innovators, Notified Bodies and Other Stakeholders

BackgroundMedical device certification has undergone significant changes in recent years. However, exploration of stakeholder experiences remains relatively limited, particularly in the context of software as a medical device. This study sought to explore stakeholder experiences of medical device certification across both the UK and EU.MethodsSemi-structured interviews (n = 22) analysed using inductive-thematic analysis, synthesised using activity theory.ResultsInnovators, consultants and notified bodies share more similarities than differences when discussing barriers and enablers to achieving medical device certification. Systemic tensions between existing rules, tools, community understanding and division of labour currently undermine the intended aim of certification processes. Existing rules are considered complex, with small and medium-sized enterprises considered disproportionality affected, resulting in several unintended outcomes including the perceived ‘killing’ of innovation. Existing certification processes are described as unfit for purpose, unethical and unsustainable.ConclusionStakeholder experiences suggest that the intention of establishing a robust and sustainable regulatory framework capable of ensuring a high level of safety whilst also supporting innovation is not yet being realised. Failure to enact desired changes may further jeopardise future innovations, outcomes and care quality.

Atrial fibrillation can be diagnosed using a combined wrist-worn photoplethysmography and electrocardiography

Abstract Background Current ESC Clinical Practice Guideline for management of atrial fibrillation requires a minimum of 30-seconds of atrial fibrillation (AF) to be visually confirmed from an electrocardiography (ECG) recording for diagnosis. Single-channel ECG recorded from any measurement lead is sufficient. The current method of 24–48 h Holter ECG may not detect rarely occurring AF episodes, and thus extended duration recording devices are needed. Intermittent portable ECG devices intended for clinical use exist but those lack continuous rhythm monitoring and are thus unable to notify the user in case of asymptomatic episode. Purpose We evaluated the performance of a wrist-worn solution (Fig. 1) intended for clinical use that combines continuous photoplethysmography (PPG) -based rhythm assessment with intermittent ECG measurements in the detection of atrial fibrillation in ambulatory conditions. Methods 30 adult patients with previous diagnosis of AF were recruited for 48-hour measurements. Simultaneous 5-lead Holter monitoring was used as the reference. The patients were taking intermittent ECG measurements at pre-scheduled times (4 times a day), when notified by the device (irregular rhythm detected by PPG), and if feeling symptoms of AF. Results The obtained sensitivity and specificity for PPG-based AF detection were 95.5% and 99.2%, respectively when evaluated in 5-minute segments. Only the segments during which adequate amount, approximately 30-seconds, of good quality PPG data was available, were considered in the analysis. On average this equals 54% of the segments. Patients took in total 456 30-second ECG measurements. Out of these 411 and 392 were assessed as analysable quality by ECG algorithm and visually by two cardiologists, HS and KK, respectively. Automatic ECG analysis algorithm labelled ECG measurements taken during atrial fibrillation correctly as “Possible arrhythmia” with 95.7% sensitivity and 92.0% specificity. 99.5% of the analysable quality ECGs measured during AF were marked with any type of label e.g., tachycardia that highlights them to the clinician. An example ECG measurement with markings of the analysis algorithm an overall classification is shown in Fig. 2. All patients having AF during the 48-hour monitoring (14/30) were correctly identified based on the wrist device data. Conclusion Based on the obtained results, wrist-worn device combining continuous PPG and intermittent ECG measurements can be reliably used in detecting atrial fibrillation in ambulatory conditions. The user-friendliness and unobtrusiveness of wrist-worn technology enables virtually unlimited monitoring time thus facilitating the detection of rarely occurring AF episodes. The information of continuous rhythm monitoring can also be used for the estimation of AF burden. The solution used in the study has received medical device CE certification in early 2022. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): The study was funded by PulseOn company.

“The Army of Exempts”: Medical Examinations and the Challenges of Mobilization in Civil War Connecticut

“The Army of Exempts”: Medical Examinations and the Challenges of Mobilization in Civil War Connecticut

Death certification errors in medical certificates of cause of death related to COVID-19 disease

Background: In the case of public health emergency scenarios, mortality surveillance done by analyzing medical certificates of cause of death (MCCDs) provides accurate morbidity and mortality data. Precise death certification in the novel coronavirus disease 2019 deaths is critical to understanding the magnitude and advancement of the pandemic. Inaccurate death certificates may cause underreporting or overwhelming reporting of COVID-19 deaths.Methods: The aim of the study was to analyse the MCCDs issued by the institute where the cause of death was attributed to or associated with the COVID-19 infection for certification errors. 729 MCCDs issued in COVID-19 deaths were audited primarily for their formal correctness and completeness and errors, using categories previously reported with some minor modifications. The study did not include analyzing the medical and hospital records of the deceased for the factual correctness of these MCCDs.Results: All types of major and minor certification errors were observed. Incomplete MCCDs were observed in 697 (95.61%) cases. 691 MCCDs (94.8%) were having either major or minor or both types of errors. Abbreviations were used in the MCCDs in 65.29% of cases while improper sequencing of the causes of death was observed in 52.92% of cases. Wrong terminologies like “COVID”, “COVID pneumonia”, “COVID +ve”, and “coronavirus” were used instead of the standard terminology.Conclusions: The lack of completeness and accuracy in writing the causes of death related to COVID-19 indicates a problem faced by the certifying doctors in analyzing them, especially in the early days of the pandemic.

« Docteur, pourrais-je avoir une copie du certificat ? » Étude pluricentrique concernant l’application des décrets du 31 mars 2021 et du 23 novembre 2021

On 31 March 2021, a decree was published in the Official Journal concerning the procedures for the delivery of medical certificates to victims of violence. These victims can now obtain a copy of the certificate drafted by the doctor required by the judicial authorities, particularly as regards medical examiners. PurposeThe aim of our study was to assess the impact of the March 31, 2021 decree on victims’ requests to the medical examiner for a copy of the medical certificate. MethodsThis prospective study was conducted among three forensic services receiving victims in consultation, using a paper questionnaire linked to Medlé data, over a three-month period. ResultsOf the 1,492 consultations conducted during the study period, a copy of the certificate was only given to the victim in 13.1 % of the consultations. It was requested spontaneously by the victim in 15.2 % of cases, most often to exercise his right (46.4 %). These were primarily consultations following an accident, psychological abuse, and assault. This copy was requested spontaneously by less than 3 % of victims of domestic violence. There was some disparity between the three centres regarding the minor victim. ConclusionThis study is a small sample over a short period. The information of the victims, especially of domestic violence, on access to the copy of the medical-legal certificate seems still insufficient, and the principle of surrender, when it can help the victim in his efforts, can also be a source of confusion.

Depression as a Risk Factor for Dementia in older people with type 2 Diabetes and the Mediating Effect of Inflammation

Objective: The aim of this study is to detect the relation between depression and dementia in patients with type 2 diabetes. Methods: Clinically diagnosed Type 2 diabetes underwent screening for depression using Beck's Depression Inventory scale and subsequent risk of dementia defined using medical reports, prescription data and death certificates. The mediating act of inflammation systemically was measured by assessing four inflammatory markers (C reactive protein, ESR and Fibrinogen). Results: The study was conducted on 102 diabetic type 2 patients, included 48 males and 54 females. Patients divided into 12 (11.7%) patients with depression and 90 (88.3%) patients without depression (mean age 61±8.6 and 60.9±9.2 respectively). Mean BMI in depressive patients was 33.5 ± 9.3 and was 31.9 ± 8.9 in non-depressive cases (P value 0.01). There were no significant differences in patients with and without depression regarding the presence of hypertension, hyperlipidemia and smoking as risk factors of dementia. Patients with depression had significant impaired cognition and the total MoCA scores were significantly lower than those of patients without depression (23.21 ± 3.48 vs 26.34 ± 3.78, P <0.05). Complication of diabetes in patients with depression as neuropathy was significant (P value 0.005). Other complications as diabetic retinopathy and nephropathy were non-significant. Inflammatory markers levels in patients with depressive symptoms were significantly higher (P value < 0.01). Conclusion: In patients with type 2 diabetes, there is an important association between dementia and depression. Systemic inflammation had a significant role in the relation between depression and dementia.

An Asymptomatic Patient with Persistent Anti-HAV IgM and Anti-HAV IgG: A Case Report and Literature Review

<p>?一名61歲女性，因職業為供膳人員而需要每年健檢，2015年於本院健檢時意外發現A型肝炎病毒IgM抗體(anti-HAV IgM)呈現陽性反應，懷疑是急性A型肝炎感染，因而轉至胃腸肝膽科門診檢查。個案本身並無症狀，實驗室報告顯示並無異常。隔年健康檢查仍發現anti-HAV IgM呈現陽性，再次安排實驗室檢查及理學檢查，也無顯示任何異常，隨後入院接受肝臟切片病理檢驗，但報告亦無特異性表現，且個案於住院期間也無任何不適。本次入院前，個案在外院也檢查了A型肝炎病毒IgG抗體(anti-HAV IgG)，發現也呈現陽性反應，且後續追蹤直至2020年期間，個案的anti-HAV IgM及anti-HAV IgG皆持續呈現陽性反應。持續性anti-HAV IgM陽性並不常見，本文針對造成持續性anti-HAV IgM陽性的原因，進行文獻回顧，並分析此案例可能的原因及後續適當之處理程序。</p> <p> </p><p>A 61-year-old female restaurant caterer had received regular annual health examinations. In 2015, hepatitis A virus immunoglobulin M antibody (anti-HAV IgM) was detected, though she showed no symptom or sign of HAV infection. She was then transferred to the gastroenterology (GI) outpatient clinic where she underwent further laboratory tests that revealed no specific findings. Medical certificates were therefore issued and regular follow-ups arranged. However, reactive anti-HAV IgM persisted with reactive result of anti-HAV IgG in 2016, and laboratory tests again showed negative findings. She was accordingly admitted for liver biopsy. Nevertheless, the pathology report also revealed no sign or symptom of infection, and she did not report any symptoms of HAV infection. As a result, she was discharged for annual monitoring. During the period from 2017 to 2020, she had visited our family medicine outpatient clinic for regular follow-ups; anti-HAV IgM and anti-HAV IgG were followed and revealed reactive findings. Persistent anti-HAV IgM is rare in the literature, and concurrent persistent anti-HAV IgG is even more unusual. In this article, we present a rare case of the above condition while the literature of persistent anti-HAV IgM is also reviewed.</p> <p> </p>

Effects of an Aquatic Physical Exercise Program on Ventilatory Parameters in People with Parkinson's Disease.

Problems in the respiratory system are the main cause of death in Parkinson's disease (PD). Ventilatory limitations can also be part of a vicious cycle involving physical-functional limitations (e.g., walking difficulties) and the patients' perception of fatigue. The objective of this study was to analyze the effects of an aquatic physical exercise intervention program on ventilatory parameters, perception of fatigue, and gait capacity in participants with PD. This quasi-experimental study had a single group with repeated measures in four assessments, proposing an aquatic physical exercise intervention program. The inclusion criteria encompassed being in levels 1 to 4 on the Hoehn and Yahr scale and having a medical certificate for the activities. Assessments took place at 3-month intervals between them—the first period was the control, the second following the intervention, and the third period was the follow-up. The intervention had 25 biweekly sessions over 3 months. A total of 13 people (71.3 ± 5.61 years old) participated in the intervention, without significant differences in the control period. Between the intervention assessments, they had statistically significant differences in MIP, MEP, FVC, Tiffeneau index, MVV, and fatigue. The study demonstrated that the aquatic physical exercise intervention was effective for ventilatory outcomes and fatigue in people with PD.

Impact of the COVID-19 pandemic on accredited conformity assessment bodies: insights from a multinational study

The COVID-19 pandemic posed new and manifold challenges to organizations and their operations worldwide. Conformity assessment bodies (CABs), such as testing or medical laboratories, certification, and inspection bodies, were also affected by the associated disruptions. Their role in this crisis is highly relevant, as CABs are essential pillars of the quality infrastructure: their activities ensure that products and services meet requirements as defined in standards and regulations, thereby contributing to their safety and reliability. The question arises of how CABs and their operations were affected by the pandemic and how they responded. To this end, we present the results of an international survey of 986 CABs of all types in Germany, the UK, Italy, and New Zealand. Overall, CABs reported, on average, a reduction in demand for their services during the pandemic, facing restrictions in all countries. In addition, the pandemic had an overall negative impact on the CABs’ investment and innovation activities. However, investments in digital infrastructure were increased as a countermeasure, with CABs reporting a higher need for digitalization. The paper highlights and discusses results from in-depth analyses relevant to policymakers and industry alike.

Implementing an Artificial Intelligence System in the Work of General Practitioner in the Yamalo-Nenets Autonomous Okrug: Pilot Cross-sectional Screening Observational Study

Background. Early identification of risk factors (RF) associated with cardiovascular diseases (CVD) is essential for the prevention of CVDs and their complications. CVD risk factors can be identified using Artificial Intelligence (AI) systems, which are capable of learning, analyzing and drawing conclusions. The advantage of AI systems consists in their capacity to process large amounts of data over a short period of time and produce ready-made information. Objectives. Evaluation of the efficiency of implementing an AI software application by a general practitioner for identifying CVD risk factors.Methods. The study included data from 1778 electronic medical histories of patients aged over 18, assigned to an outpatient and polyclinic department of Muravlenkovskaya Gorodskaya Bolnitsa (Muravlenko municipal hospital), Yamalo-Nenets Autonomous Okrug (Russia). The study was conducted in four stages. The first stage involved a preliminary training of the Artificial Intelligence (AI) system under study using numerous CVD risk assessment scales. The Webiomed predictive analytics and risk management software by K-SkAI, Russia, was selected as a platform for this purpose. The second stage included an analysis of medical data to identify CVD risk factors according to the relative risk scale for patients under 40 and the SCORE scale for patients over 40. At the third stage, a specialist analyzed the previous and new information received about each patient. According to the results of the third stage, four risk groups for CVD (low, medium, high and very high) were formed. At the fourth stage, newly diagnosed patients with a high risk of CVD, who had not been previously subject to regular medical check-up, were directed for additional clinical, laboratory and instrumental follow-up examination and consultations of relevant specialists. Statistical data in absolute terms and as a percentage were obtained. Statistical processing of the results was carried out by a computer program aimed at medical decision support. Content visualization was performed in spreadsheets and charts.Results. Based on the data obtained, the AI system under study divided all patients into CVD risk groups and identified uncounted factors. The AI system confirmed a high and very high risk of CVD according to SCORE (Systematic COronary Risk Evaluation) in 623 people, who were already receiving appropriate cardiological assistance. The RFs that had not previously been taken into account in the diagnosis were recorded in 41 (11.5%) patients from the very highrisk group and in 37 (12.7%) high-risk patients. The AI system identified a high risk of CVD in 29 people who had not been previously under care of a general practitioner or other specialists due to their infrequent visits to health care facilities. These patients were detected by the AI system following periodic and preliminary medical check-ups (35%), full in-patient treatment for other diseases (31%), when seeking help of other specialists (17%), as well as when obtaining a medical certificate for a driving license (12%), admission to a swimming pool (3%) or possessing a weapon (2%). In a group with the newly diagnosed patients at a high risk of CVD, men dominated (24 persons, 82%) and women comprised only 8% (5 persons). All these people were of working age between 40 and 50. In order to confirm the information received, the supervising physician subsequently referred patients for a follow-up examination, as a result of which only 1 person (3%) was not diagnosed with a somatic pathology.Conclusion. The efficiency of the AI system under study comprised 97%. Permanent monitoring of all parameters of electronic medical histories and outpatient records is an efficient method for timely identification of RF at any visit of a person to a health care facility (preventive and periodic medical examinations, regular check-ups, specialist consultations, etc.) and their assignment to respective CVD risk groups. Such monitoring ensures an effective medical supervision of able-bodied populations.

Improving attribution of extreme heat deaths through interagency cooperation

Attributing individual deaths to extreme heat events (EHE) in Canada and elsewhere is important for understanding the risk factors, protective interventions, and burden of mortality associated with climate change. However, there is currently no single mechanism for identifying individual deaths due to EHE and different agencies have taken different approaches, including (1) vital statistics coding based on medical certificates of death, (2) probabilistic methods, and (3) enhanced surveillance. The 2018 EHE in Montréal provides an excellent case study to compare EHE deaths identified by these different approaches. There were 353 deaths recorded in the vital statistics data over an 8-day period, of which 102 were potentially attributed to the EHE by at least one approach and 251 were not attributed by any approach. Only nine of the 102 deaths were attributed to the EHE by all three approaches, 23 were attributed by two approaches, and 70 were attributed by only one approach. Given that there were approximately 50 excess deaths during the EHE, it remains unclear exactly which of the total 353 deaths should be attributed to the extreme temperatures. These results highlight the need for a more systematic and cooperative approach to EHE mortality in Canada, which will continue to increase as the climate changes.

ZAGROŻENIA CHEMICZNE W ROLNICTWIE

Farm work is highly diverse and can be intense during growing seasons. It involves machin- ery and tools, close contact with animals and changing environmental conditions. Farmers face many dangers as part of their everyday duties, among them being chemical hazards such as pesticides, fuels and lubricants, mineral fertilizers and disinfectants. This risk is followed by dust generated when growing plants, feeding animals and cleaning the farm. Mineral fertilizers should be applied in a way that is safe for the health of humans, animals and the environment. Work related to the application of fertilizers may be performed only by healthy adults after appropriate training: any sick workers require medical certification before working with mineral fertilizers. In all cases, direct contact with the skin and eyes should be avoided, and mineral fertilizers, especially dusty ones, should only be spread on windless days. Pesticides are among the most harmful compounds to which farmers are exposed. The user is at risk during their use, as well as while they are stored in a warehouse when disposing of residues and empty packaging. A thorough knowledge of risk factors significantly increases work safety in agriculture.

Conducting verbal autopsy by telephone interview during the pandemic to support mortality surveillance: a feasibility study in Malaysia.

ObjectiveVerbal autopsy (VA) through face-to-face interviews with caregivers is a way to determine cause of death without medical certification. In Malaysia, the use of VA has improved mortality statistics. However, during the coronavirus disease 2019 (COVID-19) pandemic, face-to-face interviews were delayed, reducing VA data collection and affecting data for mortality surveillance. This study aims to investigate the feasibility and acceptability of conducting VA interviews via telephone calls, and the quality of the data gathered.MethodsThe study was conducted in Malaysia from September to October 2020 using a cross-sectional design. Participants were health-care workers from established VA teams across the country. They conducted VA interviews via telephone and provided feedback through a customized online form. Data collected from the form were used to assess the feasibility, acceptability and quality of the telephone interviews using IBM SPSS version 23.ResultsResponses were received from 113 participants. There were 74 (65.5%) successful interviews, representing 91% of the 81 cases who were able to be contacted. More than two thirds of health-care workers provided positive feedback on the telephone interview method for themselves and the interviewees. Only 10.8% of causes of death were unusable.DiscussionThis study provides preliminary evidence that VA via telephone interview is feasible, acceptable and can be used as an alternative to face-to-face interviews without affecting data quality. During times when face-to-face interviews are not advisable, VA telephone interviews can be used for data collection for mortality surveillance.

Medical Certification of Pilots Through the Insulin-Treated Diabetes Mellitus Protocol at the FAA.

INTRODUCTION: In 2019, the Federal Aviation Administration (FAA) announced a protocol to evaluate pilots with insulin treated diabetes mellitus (ITDM) for special issuance (SI) medical certification for first-/second-class pilots. The protocol's aim is improved assessment of ITDM control/hypoglycemia risk and relies on continuous glucose monitoring (CGM) data. This study compares the characteristics of first-/second-class pilots with ITDM and certification outcome.METHODS: Data was collected retrospectively from the FAA Document Imaging Workflow System (DIWS) for pilots considered for a first-/second-class SI under the ITDM program between November 2019 and October 2021. Inclusion criteria required submission of information required for certification decision (SI vs. denial). We extracted data on demographics and CGM parameters including mean glucose, standard deviation, coefficient of variance, time in range (%), time > 250 mg · dl-1 (%), and time < 70-80 mg · dl-1 (%). We compared these parameters between pilots issued an SI vs. denial with Mann-Whitney U-tests and Fisher exact tests using R.RESULTS: Of 200 pilots with ITDM identified, 77 met inclusion criteria. Of those, 55 received SIs and 22 were denied. Pilots issued SI were statistically significantly older (46 vs. 27 yr), had a lower hemoglobin A1c (6.50% vs. 7.10%), lower average glucose (139 mg · dl-1 vs. 156 mg · dl-1), and spent less time with low glucose levels (0.95% vs. 2.0%).DISCUSSION: The FAA program has successfully medically certificated pilots with ITDM for first-/second-class. Pilots granted an ITDM SI reflect significantly better diabetes control, including less potential for hypoglycemia. As this program continues, it will potentially allow previously disqualified pilots to fly safely.Stanwyck LK, DeVoll JR, Pastore J, Gamble Z, Poe A, Gui GV. Medical certification of pilots through the insulin-treated diabetes mellitus protocol at the FAA. Aerosp Med Hum Perform. 2022; 93(8):627-632.

Impact of COVID-19 on initial emergency medical services certification in the United States.

ObjectiveAs the COVID‐19 pandemic began, there were significant concerns for the strength and stability of the emergency medical services (EMS) workforce. These concerns were heightened with the closure of examination centers and the cessation of certification examinations. The impact of this interruption on the EMS workforce is unclear. Our objective was to evaluate the impact of COVID‐19 on initial EMS certification in the United States. In addition, we evaluated mitigation measures taken to address these interruptions.MethodsThis study was a cross‐sectional evaluation of the National Certification Cognitive Examination administration and results for emergency medical technician (EMT) and paramedic candidates. We compared the number of examinations administered and first‐attempt pass rates in 2020 (pandemic) to 2019 (control). Descriptive statistics and 2 one‐sided tests of equivalence were used to assess if there was a relevant difference of ±5 percentage points.ResultsTotal number of examinations administered decreased by 15% (EMT, 14%; paramedic, 7%). Without the addition of EMT remote proctoring, the EMT reduction would have been 35%. First‐time pass rates were similar in both EMT (−0.9%) and paramedic (−1.9%) candidates, which did not meet our threshold of a relevant difference.ConclusionCOVID‐19 has had a measurable impact on examination administration for both levels of certification. First‐time pass rates remained unaffected. EMT remote proctoring mitigated some of the impact of COVID‐19 on examination administration, although a comparison with mitigation was not assessed. These reductions indicate a potential decrease in the newly certified workforce, but future evaluations will be necessary to assess the presence and magnitude of this impact.

Gender and early-career faculty disparities in hematology and oncology board review lecture series

AbstractParticipation of women and early-career faculty in hematology and medical oncology board review lecture series has not been studied previously. We aimed to evaluate gender and early-career faculty disparities in hematology and medical oncology board review lecture series. Speakers at major hematology and/or oncology board review lecture series meetings in the United States were analyzed in this cross-sectional study during a 5-year period from the years 2017 through 2021. Data about the lecture topic, field, speaker’s gender, years of experience, and the frequency at which the lecture was given by the speaker were collected. Of 386 speakers participating, 315 (81.6%) were ABIM (American Board of Internal Medicine)-certified. A total of 1,224 board review lectures were given in the studied period, of which 1,016 (83%) were given by an ABIM-certified speaker. Women constituted 37.7% of all speakers, with less than 50% representation in five out of six courses. Lectures discussing malignant hematology topics had the lowest proportion of women presenters (24.8%), followed by solid tumors (38.9%) and benign hematology lectures (44.1%). Faculty with more than 15 years since initial certification presented more than 50% of lectures. The median time from initial hematology or medical oncology certification to lecture presentation was 12.5 years and 14 years, respectively. A positive trend in the participation of women was found at all board review conferences across the studied period. Our data suggest that women and early-career faculty participation in hematology and oncology board review series is inadequate.

Patients awareness, perception, and willingness toward dental treatment during COVID-19 pandemic in India

Objectives: COVID-19 has badly affected the global economy, also affecting the health-care sector with a major effect on dentistry. It is important to understand the reason behind it from patient’s perspective, by knowing their awareness, perception, and willingness toward dental treatment during COVID-19 times. This might help the dentist to increase patient inflow. Materials and Methods: A cross-sectional study was conducted using an online survey. A validated questionnaire was circulated to participants by investigators, consisting questions related to demographic data, awareness, perception, and willingness toward dental treatment. A total of 616 participants responded. Statistical analysis was performed using Statistical Package for the Social Sciences version 22. Results: More than 90% of participants are aware of COVID-19 and various precautions to be taken to prevent the spreads of the disease. The majority of participants about 74% are aware that dentists are at higher risk of acquiring COVID-19 infection. Many respondents 76.6% are afraid to visit the dentist, due to fear of acquiring COVID-19 infection 74% prefer to delay dental treatment. Around 71.8% are willing to consult through teledentistry, 69.8% are not willing to provide medical certificates, and 58.2% are willing to pay more fees than usual for the extra precaution taken by the dentist to prevent COVID-19 spread. Conclusion: People are afraid to visit dental clinics due to fear of cross infection. People are ready to pay more for precautions taken by their dentists. People should be made aware of precautionary measures taken by the dentist so that they feel safe to visit a dental clinic during COVID-19 times.

The Capability Gap in Occupational Health Information Management.

The lack of an integrated approach to data capture, information management, and analysis limits the contribution of occupational and environmental medicine to protecting 2.3 million uniformed and civilian DoD workers. Despite an abundance of military information systems that include the terms "Safety" and "Occupational Health" in their names, none of these systems provide capabilities needed to aggregate and analyze the results of occupational medicine exams, use medical surveillance to mitigate exposure incidents, provide enterprise-level management of occupational medicine services, or comply with privacy and recordkeeping law and regulation. Instead, they provide a patchwork of data that meets most regulatory compliance requirements but fails to achieve the true objectives of occupational health programs. Bridging these capability gaps will improve the occupational health care of the DoD workforce, improve the quality of occupational medicine services, increase public trust in the DoD management of exposure incidents, and potentially generate hundreds of millions of dollars through cost-avoidance on workers' compensation claims and through identification and elimination of non-value-added medical certification exams. The ongoing Military Health System transformation represents a unique opportunity to bridge these long-recognized but persistent capability gaps.

Developing Medical Student Competencies, Clinical Skills, and Self-Efficacy With an Emergency Medical Responder Certification Course

IntroductionPrevious studies have claimed gap year clinical experiences before medical school matriculation increase student self-efficacy and clinical confidence. At the University of Central Florida College of Medicine, 41 first-year medical students participated in a new certification course to become emergency medical responders before beginning their coursework. This study describes the results of a follow-up study that aims to investigate the impact the course had on student competency, self-efficacy, and clinical efficacy and if the course would prepare students similarly to previous clinical experience.MethodsFirst-year medical students completed a 30-question survey consisting of a Likert scale and free-response questions. Questions were based on the Accreditation Council for Graduate Medical Education core competencies: medical knowledge, practice-based learning and improvement, systems-based practice, patient care, professionalism, and interpersonal and communication skills. Questions on the perceived benefit of the emergency medical responder course and previous clinical experiences were also included. Responses were separated based on participation in the emergency medical responder course and prior clinical experience. Two-tail Welch’s t-tests were performed on the data to determine significance.ResultsOf 98 responses: 20.4% (20/98) of participants of the emergency medical responder course had previous clinical experience, 21.5% (21/98) of participants of the course had no clinical experience, 26.5% (26/98) did not participate in the course but had previous clinical experience, and 31.6% (31/98) did not participate in the course nor had previous clinical experience. Students with previous clinical experience reported the emergency medical responder course improved both their patient care skills and performance in courses that emphasized patient interviewing and physical exams. Students with clinical experience had significantly higher medical knowledge (p < 0.1) and professionalism (p < 0.1) Likert scores. Eighty-seven percent of students agreed the course had a positive impact on their patient care skills.ConclusionLarger sample size is needed to make stronger conclusions; however, the responses show the emergency medical responder course had a positive subjective impact on students with previous medical experience. Previous clinical experience leads to the most positive subjective reporting of competencies such as medical knowledge and professionalism. Early clinical exposure, such as an emergency medical responder certification course, may improve self-efficacy and patient care skills for medical students with no previous clinical experience.

Knowledge engineering–based DApp using blockchain technology for protract medical certificates privacy

In the Industry 4.0 era, an inherited featured technology, blockchain, plays a vital role in knowledge engineering applications. Blockchain provides privacy to sensitive data as an intelligent agent, so its adoption rate increases in all the advanced domains. Especially in the health care department, blockchain technology usage helps avoid attacks like the Wannacry ransomware attack during 2017. Therefore, this paper described a decentralised application (DApp) expert system using public blockchain to create and maintain official health documents, especially medical certificates. Current existing systems, either paper-based or database or clouds to save the medical certificates, have more scope to do attacks. Hence, proposed a blockchain-based DApp that acts as an interface between intelligent agents, blockchains, and system related to the medical certificates. The main strength of this paper is implementation results, which are not among the maximum literary works currently available. The associate cost for conducting distributed application operations on the blockchain in terms of Gas comprehensively presented here. Furthermore, it consists of comparing the system's non-functional functions by considering blockchain and non-blockchain environments. Also, presented the simulation results with the performance results compared with the existed systems.