Medical Supervisors Research Articles

A hybrid type II effectiveness-implementation trial of a positive emotion regulation intervention among people living with HIV engaged in Ryan White Medical Case Management: protocol and design for the ORCHID study

BackgroundThe Ryan White Medical Case Management System, which serves more than half of people living with HIV (PLWH) in the USA, is an opportune setting for identifying and addressing depression among PLWH. A growing body of research suggests that interventions that promote positive emotion may lessen symptoms of depression and improve physical and psychological well-being among people experiencing a variety of health-related stress, including living with HIV. Research on how best to integrate standardized mental health screening and referral to evidence-based interventions in Ryan White Medical Case Management settings has the potential to improve the health and wellbeing of PLWH.MethodsThis mixed-methods study will enroll up to N = 300 Ryan White clients who screen positive for depressive symptoms in ORCHID (Optimizing Resilience and Coping with HIV through Internet Delivery), a web-based, self-guided positive emotion regulation intervention. The study will be conducted in 16 Ryan White Medical Case Management clinics in Chicago, IL. Following pre-implementation surveys and interviews with Medical Case Managers (MCMs) and Supervisors to develop an implementation facilitation strategy, we will conduct a hybrid type 2 implementation-effectiveness stepped wedge cluster randomized trial to iteratively improve the screening and referral process via interviews with MCMs in each wedge. We will test the effectiveness of ORCHID on depression and HIV care outcomes for PLWH enrolled in the program. RE-AIM is the implementation outcomes framework and the Consolidated Framework for Implementation Research is the implementation determinants framework.DiscussionStudy findings have the potential to improve mental health and substance use screening of Ryan White clients, decrease depression and improve HIV care outcomes, and inform the implementation of other evidence-based interventions in the Ryan White Medical Case Management System.Trial registrationClinicalTrials.gov NCT05123144. Trial registered 6/24/2021

Improved Glycemic Control during a One-Week Adventure Camp in Adolescents with Type 1 Diabetes-The DIACAMP Study.

Adolescence remains a crucial age associated with diabetes distress in individuals living with type 1 diabetes (T1D). The Austrian organization "Diabär" regularly hosts a one-week adventure camp for adolescents (12-18 years) living with T1D. The camp focuses on "fun activities" without a structured educational protocol in order to minimize diabetes distress and increase diabetes management skills. In contrast to educational camps, training is kept to a minimum. However, attendees analyze the glycemic data of the previous day with their medical supervisor once daily during the camp. All subjects used a standardized real-time continuous glucose monitoring (CGM) system (DexcomG7) throughout the whole study. Glycemic metrics were prospectively analyzed during three periods: week 1 = home phase, week 2 = adventure camp, and week 3 = after the camp. Safety (time below range 1 [TBR1], 69-54 mg/dL, and time below range 2 [TBR2], <54 mg/dL) and efficacy (time in range [TIR], 70-180 mg/dL) were assessed by comparing the CGM data during weeks 1-3. The CGM data of 14 participants were analyzed. The TIR was higher during the camp week versus week 1 (70.4 ± 11.1% vs. 53.1 ± 20.2%; p = 0.001). The TBR1 significantly increased during camp compared to week 1 (2.5 ±1.7% vs. 1.3 ± 1.2%; p = 0.009), whereas the TBR2 did not differ. No serious adverse events occurred. This adventure camp without a main focus on education showed feasibility and safety in adolescents with T1D.

Mathematical Model to Evaluate the Effect of Information Quality, and Management Capability on Hospital Performance

Introduction:The objective of this study is to make active interaction among actual and theoretical outcomes of the view of 100 medical staff and medical supervisors of the university hospital and to study and analyze the effect of important parameters (quality information, employee trust, employee engagement, and management capability) on the hospital performance using the proposed mathematical model. Methods:Primary data were collected from the highest-level medical job position in a hospital (medical doctors, head of the medical department, and medical supervisors). Using convenient sampling, the proposed mathematical model represents the input parameters as information quality, employee trust, employee engagement, and management capability, and output parameters for hospital performance dimensions as output. Results:The identification system depends on the actual outcomes to evaluate the effects of information quality (IQ), employee trust (ET), employee engagement (EM), and management capability (MC) against hospital performance were 60.032%, 43.428%, 78.186%, and 62.817%, respectively. Conclusions:The derived mathematical model has a high accuracy to represent all the active parameters of the system and optimize the conditions to produce high outcomes

Initiation of Increasing Tuberculosis Medication Supervisors Roles: An Action Research Approach

Indonesia is ranked second in the number of Tuberculosis (TB) cases worldwide. TB patients and their families experience a complex burden. Hence, support and strengthening TB medication supervisors (Pengawas Minum Obat/ PMO) role is needed. The aim of this study was to enhance the Community Health Center (CHC)-based PMOs’ role by improving their knowledge and strengthening peer group support. The method used was an action research cycle with four stages. The diagnosis stage was carried out by consensus decision making group with CHC to determine priority problems, namely the need to increase basic knowledge of TB and its treatment. Optimizing peer group was also necessary, as the Self Reporting Questionnaire-20 showed that more PMOs from patient families have psychological problems than cadres. The planning stage was conducted by preparing educational sessions and creating educational media. The action stage was a quasi-experimental (without control, non-randomization)—an educational talk show provided by the TB program manager, pulmonologist, and psychiatrist. Peer groups are also activated by triggering shared media education and discussion. At the evaluation stage, knowledge was measured by giving pre and post-tests (n= 21, total sampling). The results of the analysis using the Wilcoxon's Signed Ranks Test showed that participants' knowledge had increased significantly (p=0.000; r=0.59). In conclusion, education can increase PMO knowledge as an initial step to strengthen their role in supporting the success of TB treatment. Innovation, cross-sector assistance, and support are needed to enable the PMO to succeed in the TB program.

Human errors in emergency medical services: a qualitative analysis of contributing factors

BackgroundThe dynamic and challenging work environment of the prehospital emergency care settings creates many challenges for paramedics. Previous studies have examined adverse events and patient safety activities, but studies focusing on paramedics’ perspectives of factors contributing to human error are lacking. In this study, we investigated paramedics’ opinions of the factors contributing to human errors.MethodData was collected through semi-structured individual interviews (n = 15) with paramedics and emergency medical field supervisors in Finland. The data was analyzed using inductive content analysis. Consolidated criteria for reporting qualitative research were used.ResultsContributing factors to human errors were divided into three main categories. The first main category, Changing work environment, consisted of two generic categories: The nature of the work and Factors linked to missions. The second main category, Organization of work, was divided into three generic categories: Inadequate care guidelines, Interaction challenges and Challenges related to technological systems. The third main category, Paramedics themselves, consisted of four generic categories: Issues that complicate cognitive processing, Individual strains and needs, Attitude problems and Impact of work experience.ConclusionVarious factors contributing to human errors in emergency medical services (EMS) settings were identified. Although many of them were related to individual factors or to the paramedics themselves, system-level factors were also found to affect paramedics’ work and may therefore negatively impact patient safety. The findings provide insights for organizations to use this knowledge proactively to develop their procedures and to improve patient safety.

Blood donor questionnaires and infectious disease screening in Latin American countries.

Blood donor questionnaires are tools used to screen prospective blood donors to determine their eligibility. There are limited data regarding blood donor questionnaires and infectious disease screening of the blood supply in Latin American countries. This study aimed to survey donor centres in Latin American countries to learn more about blood donor screening and infection assessment. An international team of transfusion medicine professionals including medical directors and supervisors who work or collaborate with Latin American donor centres, called 'Comité de Investigación en Medicina Transfusional', designed a survey (16 questions) to characterize blood donor eligibility in Latin America. Eighty-two institutions from 14 Latin American countries responded to the survey. Most donor centres (66%; 54 of 82) had a donor deferral percentage between 5% and 25%, and the most common causes of deferrals were low haemoglobin and high-risk behaviour. Most donors in blood centres were directed family donors compared with voluntary donors. Infection evaluation included mostly serologic assessment (81%; 30 of 37) for human immunodeficiency virus (HIV), Hepatitis B, Hepatitis C, Treponema pallidum and Trypanosoma cruzi rather than nucleic acid tests (5%; 2 of 37). Heterogeneity exists in donor selection and infectious disease screening in Latin American countries. This survey provides valuable information to understand Latin American blood centre practices.

Enabling and inhibiting doctors transitions: introducing the social identity resource and belonginess model (SIRB).

The transition into postgraduate medical training is complex, requiring an integration into the workplace, adjustment to new identities, and understanding of the social and organisational structure of healthcare. Studies suggest that social resources, including a sense of belonging, inclusivity from social groups, and having strong social identities can facilitate positive transitions. However, little is known about the role these resources play in junior doctors' transitions into the healthcare community. This study aimed to explore the implications of having access to social resources for junior doctors. This study undertook secondary analysis from a longitudinal qualitative study which followed 19 junior doctors (residents within two years of qualification) for nine months. Data were thematically analysed using an abductive approach, with the social identity resource and belongingness (SIRB) model as a conceptual lens to explore how social networks of support act as identity resources (IRs) for junior doctors as they experience transitions. The doctors narrated that having accessible IRs in the form of supportive workplace relationships enabled an integration and a sense of belonging into healthcare practice, supported the construction of new professional identities, and strengthened career intentions. Those with inaccessible IRs (i.e. poor workplace relationships) expressed a lack of belonging, and casted doubt on their identity as a doctor and their career intentions. Our study indicates that SIRB model would be beneficial for medical educators, supervisors, and managers to help them understand the importance and implications of having IRs within the workplace environment and the consequences of their accessibility for healthcare staff experiencing transitions.

The competing role of English and Chinese in the ‘practiced’ language policies for international medical students in a Chinese hospital

ABSTRACT Informed by the theoretical concepts of ‘practiced’ language policy and space, the study investigates the language practices of English-medium Bachelor of Medicine and Bachelor of Surgery (MBBS) programs for international students, focusing on the interactional norms of language choice in a Chinese hospital where international students are interned. In accordance with the tenets of Interactional Sociolinguistics, data were gathered through observation, audio recordings, and interviews with 15 international medical students and clinical supervisors over the course of one year. The study found that three mediums of interaction were adopted across different spaces in the hospital: an English monolingual medium, a Chinese monolingual medium, and an English and Chinese bilingual medium. The findings suggest that ‘practiced’ language policies are never static or prescribed, but rather constructed in relation to personhood, type of activity and place in multiple social spaces. The study offers implications for international medical education and the promotion of an inclusive language environment.

Teleconsulting in wound care: Connecting the primary care to the wound specialist reduces unnecessary referrals.

In the Netherlands the primary care (General Practitioner or homecare nurse) encounter a variety of wounds ranging from traumatic to diabetic foot ulcers. According to a recent study 82.4% of the patients with a wound can be treated in a primary setting with the GP as medical supervisor. The remaining 17.6% of patients need more extensive care including advice by a specialised doctor, diagnosis and treatment. Prompt analyses and treatment of underlying causes by specialised doctors in a multidisciplinary setting is necessary for treating patients with complicated wound. This article describes the impact of Electronic Health Consultation on all wounds treated in the primary care. And describes the effect on the duration until referral to the hospital and the influence on the amount of unnecessary referrals to the hospital. All data was collected prospectively from June 2020 until October 2021. The study involved a process where primary care could seek advice from a Wound Physician at the Alrijne Wound Centre through a specialised Electronic Health Consultation. A total of 118 patients were analysed. 41/118 (34.7%) patients required a physical consultation with analysis and treatment in the hospital, after teleconsultation. The remaining 77/118 (65.3%) could be treated in primary care after Electronic Health Consultation. The mean duration of wound existence until Electronic Health Consultation was 39.3 days (range 5-271, SD: 38.5). 3/41 (7.3%) of the referrals were unnecessary. Electronic Health Consultation serves as a valuable and efficient tool for enhancing wound care, ultimately contributing to improved patient management and resource allocation within the healthcare system. This article describes the impact of Electronic Health Consultation on all wounds treated in the primary care and the influence on the duration until referral to the hospital and the influence on the amount of unnecessary referrals to the hospital.

Girls in scrubs: An ethnographic exploration of the clinical learning environment.

Gender bias is an enduring issue in the medical profession despite women being more represented within medical schools and the health care workforce in numerous countries across the world. There have been frequent calls for further exploration of gender-based discriminations within medical education, owing to its lasting impact on student's professional development and career trajectories. This paper presents an ethnographic exploration of the experiences of female medical students and doctors in the clinical learning environment (CLE), aiming to disrupt the cycle of gender inequity in the clinical workplace. Our research field involved two teaching wards in a Scottish urban hospital, where 120 h of non-participant observations were conducted over 10months. Combining purposive and convenience sampling, we conducted 36 individual interviews with key informants, which included medical students, foundation doctors, postgraduate trainees, consultant supervisors, and other health care professionals such as nurses and pharmacists. Data was thematically analysed using Bourdieu's theory of social power reproduction. The research team brought diverse professional backgrounds and perspectives to the exploration of data on gendered encounters. Combining the observational and interview data, five themes were generated, which suggested gender-related differentials in social and cultural capital that the participants acquired in the CLE. Experiences of discriminatory behaviour and stereotypical thought processes impacted the female students' engagement and drive towards learning, implying an adverse influence on habitus. In contrast, the valuable influence of gendered role-models in building confidence and self-efficacy signified a positive transformation of habitus. The research participants displayed considerable internalisation of the gendered processes in the CLE that appeared to be linked to the transient nature of clinical placements. This research reveals that despite constituting the majority demographic of medical school, female students struggle to gain social and cultural capital. Gendered hierarchies that structure clinical workplaces disadvantage female students and doctors, and the differential experiences transform their habitus. Based on our theoretically informed investigation, we advocate for role-models given their positive impact on students' and doctors' habitus. Additionally, medical educators may consider extended clinical placements that provide opportunities for female students and early-career doctors to secure social and cultural capital through integrating better in health care teams and building meaningful interprofessional relationships.

HEALTH PROBLEM ANALYSIS OF CLOSE CONTACT MANAGEMENT OF DIPHTHERIA DISEASE IN MADIUN CITY IN 2023

Background: Diphtheria is an infectious disease caused by the bacterium Corynebacterium diphtheriae that can be prevented by immunization. Purpose: The purpose of this research is analyze health problems in the PD3I surveillance program at the Madiun City PP &amp; KB Health Service in 2023. Methods: This research is a descriptive observational research. Prioritize problems using methods of Capability, Accessibility, Readiness, Leverage (CARL). The priority of the problems found is to identify the causes of the problem using fishbone analysis. The root cause of the problem that is found will create alternative solutions to the problem. Results: Management of close contact chemoprophylaxis and re-immunization diphtheria with a CARL score of 400 is a top priority health problem in Madiun City. Four cases of diphtheria have been identified during the year 2023 for a period of six months (January-June 2023), so the next action is to administer chemoprophylaxis to close contacts. The provision of chemoprophylaxis in Madiun City still has problems, namely the activities of drug-taking supervisors who are not health workers and the behavior of dropping out of drug-taking in close contacts due to the side effects of the drug erythromycin. Recommendations: Health workers need to monitor medication supervisors who are not health workers online through WhatsApp groups. Promotion of taking erythromycin medication with meals or after meals to minimize side effects of erythromycin. Promotion of medication adherence in close contacts.

The grievances of medical supervisors against medical residents

The grievances of medical supervisors against medical residents

Robust Framework for Diagnosing Novel Corona Virus from CT images using Support Vector Binary Classifier

The novel coronavirus (commonly abbreviated as CoVID-19) has emerged as a threat to the entire global civilization and has emerged as one of the most infectious and, at times, deadly viruses. Prompt discovery of this infection can assist medical supervisors in taking preventive actions to control the spread. Usually, radiologists and medical specialists require an average time of ~31 minutes to test the CT images and confirm the infection. A large dataset of more than 1000 patients has been gathered and randomly chosen for this experiment. In this research, a ready-to-deploy computer-aided diagnosis (CADx) to detect COVID-19 infection is introduced. A variety of deep learning architectures have been experimented to discover the most reliable predictive model for the diagnosis. This research uses the Densely Connected Convolution Network (DenseNet-121 architecture) along with a boosting support vector binary classifier to tell the difference between someone who has the coronavirus and someone who is healthy. The combination put forward in this work achieved 93% ± 1.8% accuracy, 94.9% ± 2.6% recall, 98% ± 1.5% precision, and an F1 score of 94% ± 1.7%. The model takes less than 1 second to process one image. On the grounds of the above findings, it can be concluded that the proposed approach can be used to diagnose novel coronavirus infections.

Learning strategies for the advanced trainee in specialist training

Background A significant factor of clinicians’ learning is based on their ability to effectively transfer acquired knowledge, skills, and attitudes from specialty-specific clinical courses to their working environment. Material and method We conducted semi-structured interviews with 20 anaesthesiologist trainees (i.e. residents) in four group and five individual interviews using SRL principles as sensitizing concepts. Data were collected and analyzed iteratively using thematic analysis. Results Advanced trainees are highly motivated to explore what they have learned in specialty-specific courses, but they often face several barriers in implementing their learning in the workplace environment. Four themes emerged from the interview data: ’Be ready to learn’, “Take the ‘take-home-messages’ home’, “Be ready to create your own opportunities’, and “Face it, it’s not entirely up to you’. Understanding the challenges regarding transferring knowledge from courses to the working environment is an important lesson for assisting trainees set their learning goals, monitor their progress, and re-evaluate their SRL processes. Conclusion Even for advanced trainees, successfully transferring knowledge from specialty-specific courses often requires adequate commitment and support. Medical supervisors and other relevant stakeholders must be aware of their shared responsibility for creating individual environments that support opportunities for trainees to self-regulate their learning.

‘We Need to Get Paid for Our Value’: Work-Place Experiences and Role Definitions of Peer Recovery Specialists/Community Health Workers

ABSTRACTDespite growing research on peer recovery specialists and community health workers (CHWs) in fields such as substance use disorder (SUD) treatment and recovery support, their workplace experiences are little understood. Through semi-structured interviews with 21 CHWs and peer recovery specialists working within substance use disorder treatment and/or traditional health care settings, we identified six prevalent themes: Benefits/Pleasures of the Role; Reciprocity; Challenges; Duality of Lived Experience; Relationships with Medical Professionals and Supervisors; and Defining Metrics. These themes reveal a complex narrative of system failures, organizational hierarchies, and experiential realities in which shared experiences and personal connections with clients undergird both positive and negative aspects of the role. In the words of one study participant: “We have not taken a vow of poverty, we need to get paid for our value.”

The Role of The Pharmacist in The Success of Tuberculosis (Tb) Treatment in Jeneponto Regency

Tuberculosis (TB) is an infectious disease caused by the bacterium called Mycobacterium tuberculosis leading to the inflammation of the lung parenchyma. This study aims to determine the effect of counseling on drugs and disease on TB patients and Medication Supervisors (PMO) as well as to determine the effect of PMO in increasing TB patient compliance with monitoring of each respondent. This study used two instruments, the first instrument was the TB-P10 instrument to measure the knowledge of respondents and PMO with pre and post-monitoring. The second instrument was MARS-5, given to the respondent and PMO to see how the respondent's compliance after therapy. Based on the results of the analysis of the paired t-test, it is known that the significance so it can be concluded that there is an average difference between the pre-test and post-test knowledge levels of PMO, which means that there is an effect of pharmacist counseling interventions to respondents and PMO in improving their knowledge. Meanwhile, the performance of PMO in increasing patient medication compliance showed a good performance with 48 patients (96%) who adhered to taking medication, while the poor performance was 2 patients who did not adhere to taking medication (4%). Based on the results of the analysis of the Wilcoxon test, it is known that the significanc, so it can be concluded that there is a relationship between PMO performance on patient medication compliance with clinical outcomes in the presence of patient weight gain and negative final of AFB results.

“Publish or Perish”: barriers to research publication in an undergraduate medical research program

ObjectivesPublication is one of the crucial parameters in research, and the inability to publish has been noted in many medical students’ projects due to different reasons. This cross-sectional study aimed to determine the obstacles that prevented medical students in a health science university from publishing their research from 2018 to 2021. First, an online survey was distributed to assess the obstacles to publication perceived by the medical students. Second, a total of 81 research projects were evaluated by scientific reviewers and their final decision about the publication was recorded.ResultsIn total, 162 students filled out the survey. The barriers faced by the students were various. They included an unsupportive research supervisor, a lack of time, an insufficient sample size, and many others. In the reviewer’s evaluation, out of 81 projects, 70 projects (86.4%) were recommended to be published after minor or major modifications, while 11 projects (13.6%) were rejected due to poor writing style, poor results interpretation, and incorrect methodology.ConclusionArticulating the barriers to undergraduate medical research publication is important in boosting publication rates and research experience of graduating medical students. Medical research educators and research supervisors should strongly consider creating a framework that tackles existing obstacles and any future matters.

Medical Specialty Interest Survey (MSIS): understanding career interest and specialty training in commencing Australian medical interns

AimTo assess specialisation interests in commencing interns and create a standardised survey to aid medical schools, supervisors and health services in quantifying, understanding and supporting medical career development to improve...

Dukungan Keluarga dan Peran Pengawas Minum Obat dengan Kepatuhan Minum Obat pada Penderita TB Paru

Tuberculosis (TB) is a bacterial infection caused by Mycobacterium Tuberculosis. The most deadly infectious illness on the globe is still pulmonary tuberculosis. Southeast Asia accounts for up to 58% of all TB cases. India, Indonesia, and China have the greatest number of TB cases in the globe, accounting for 23%, 10%, and 10% of global incidence, respectively. The overall goal of this study is to examine the association between family support and the function of medication supervisors in pulmonary tuberculosis patients at the Putri Ayu Health Center in Jambi City. This is a cross-sectional quantitative study. The investigation was conducted in the operating area of the Putri Ayu Health Center in Jambi City in August 2022. This study included all active tuberculosis patients at the Putri Ayu Health Center, a total of 66 individuals. The study's sample size was 60 people (after deducting 6 respondents of the initial survey). Total sampling is the sampling technique used. The analysis performed is both univariate and bivariate. The chi square test was applied, with a meaningfulness threshold of 95% (alpha = 0.05). The study revealed a link between family support (p-value: 0.021) and the role of supervisors taking medications (p-value: 0.010) and adherence to taking drugs in pulmonary TB patients at the Putri Ayu Health Center in Jambi City. It is expected that the Puskesmas Putri Ayu Jambi City would also educate families and emphasise the need of family support for active Tb patients' rehabilitation and develop a PMO optimization program to prevent drop out.

Persistence of inadequate consent training for interns.

Informed consent is a continuous process of communication with the patient and not merely the signing of a form. The Irish Medical Council's Guide to Good Practice and Ethics state that no part of the consent process should be delegated to an intern unless the procedure is a minor with which the intern is very familiar and all relevant information has first been explained to the intern. We aimed to evaluate whether practices regarding interns and consent had changed in the past five years. An anonymous Google Forms survey was distributed to interns from all intern networks between 24-August and 26-November 2021. Of 854 interns, there were 147(17.2%) survey responses. 129(87.8%) participants had consented for a procedure. 111(86%) responded that they had consented for procedures that they had not witnessed before. 92(71.3%) reported that their medical supervisor did not explain procedures to them prior to obtaining consent. 128(99.2%) of interns were not usually observed by a more senior doctor when obtaining consent. 116(89.9%) were expected to obtain consent from patients on a regular basis, with 78(60.5%) feeling pressured into doing so on at least one occasion. Results were largely unchanged compared to when the same survey was circulated in 2016. Interns remain routinely involved in the consent process without adequate training or supervision. This is unfair on our most junior doctors and on patients. Steps must be taken to ensure the IMC guidance is adhered to and this deficiency must be highlighted to Senior Clinicians.