Medical Care Practices Research Articles

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.

A critical ethnographic study of discriminatory social practice during clinical practice in emergency medical care

BackgroundPost-apartheid, South Africa adopted an inclusive education system that was intended to be free of unfair discrimination. This qualitative study examines the experiences and perceptions of racial discrimination between Emergency Medical Care (EMC) students, clinical mentors, and patients within an Emergency Medical Service (EMS) during clinical practice. Understanding the nature of such discrimination is critical for redress.MethodsWithin the conceptual framework of Critical Race Theory, critical ethnographic methodology explored how discriminatory social practice manifests during clinical practice. Semi-structured interviews enabled thematic analysis. We purposively sampled 13 undergraduate EMC students and 5 Emergency Care (EC) providers.ResultsEMC student participants reported experiences of racial and gender discrimination during work-integrated learning (WIL) as they were treated differently on the basis of race and gender. Language was used as an intentional barrier to isolate students from the patients during WIL because EC providers would intentionally speak in a language not understood by the student and failed to translate vital medical information about the case. This conduct prevented some students from engaging in clinical decision-making.ConclusionsUnfair discrimination within the pre-hospital setting have an impact on the learning opportunities of EMC students. Such practice violates basic human rights and has the potential to negatively affect the clinical management of patients, thus it has the potential to violate patient’s rights. This study confirms the existence of discriminatory practices during WIL which is usually unreported. The lack of a structured approach to redress the discrimination causes a lack of inclusivity and unequal access to clinical education in a public clinical platform.

The Formation of the Historical Identity of Korean Doctors

In modern society, doctors are a representative example of professionals—that is, doctors are members of an occupation with high barriers to entry. For doctors, long-term education, training, and licensing are factors that make it difficult to enter medical practice. These external characteristics, which have mainly arisen in the modern era, play an important part in the professional identity of doctors. Nonetheless, the core of the doctor’s identity is the identity of the healer. In today’s Korean society, the universal identity of doctors as healers results from a combination of the special historical identity of professionals with high entry barriers. Korean society currently demands a high level of ethical awareness from doctors. These demands are partly derived from the nature of the practice of medical care, but they also reflect demands for strong social responsibility as professionals. It is difficult to cultivate professional ethics simply by imposing legitimate virtues, presenting an ideal model, or emphasizing moral education that is not fully realistic. A deep-rooted sense of professional ethics stems from a clear awareness of professional identity. Education plays an important role in the formation and awareness of doctors’ professional identity, and various types of content and methods can be used in education. However, since the identity of an entity is formed through the process of historical experience, it is thought that the historical process of the formation of doctors as a profession should be included as an important part of education.

訪問診療実習を通して得た，医学生の学びの解析―KH Coderによるテキストマイニングから―

訪問診療実習を通して得た，医学生の学びの解析―KH Coderによるテキストマイニングから―

The interdisciplinary and psychosocial gap in cancer survivorship: A longitudinal study in a Latin American Cancer Center.

There is lack of information on the quality of care provided to the rapidly increasing population of cancer survivors in Latin America. Our study attempts to address this gap and to identify areas needed to be improved. A random sample of 210 breast and colorectal cancer survivors were selected from a hospital-based registry in Chile. Cancer registry information, electronic chart review, and personal interviews were used to assess medical and nonmedical care over a 5-year period. Survivorship care practices were compared to a standardized reference based on the US Institute of Medicine domains and the American Cancer Association guidelines. Over 80% of breast and colorectal cancer survivors received appropriate medical care, ongoing testing surveillance and risk factors assessment. Only a third of survivors were assessed for psychosocial disorders and 25% of them received interdisciplinary care. Overall, 66.1% of breast and 58.6% of colorectal cancer survivors reached the expected quality level of cancer survivorship care according to the reference standard (p < .001). Medical care practices reached a high standard in a leading cancer center in Latin America. However, a much stronger psychosocial assessment and interdisciplinary care is needed to improve survivorship cancer quality care.

Una reflexión ética sobre la telemedicina

Recognizing the role of technology in the development of medicine and the impact of telecommunication advances, we reflect on the meaning and ethics of the use of Telemedicine, both in its general dimension for the use and distribution of knowledge, as well as in the delivery of health actions, scientific research, and data management. Teleconsultation is discussed in greater detail, analyzing its process and application, reviewing its possible advantages and disadvantages, from the point of view of providers and patients. We highlight the need to carry out an appropriate evaluation of each instance, from the point of view of both the patient and the professional who uses it. The importance of maintaining a doctor-patient relationship in agreement with the nature and practice of Medicine, respecting people's dignity, is emphasized. We mention the ethical conditions that must be bore in mind for the proper use of telemedicine. We discuss the eventual influence that this practice will have on the concept and practice of medical care, while suggesting the need to legislate on the matter.

High Capacitive Secure Image Transmission Over Wireless Channels

Expansion of internet connectivity and its usage globally has increased various demands of providing security for the data transmission. Telemedicine is a modern way of medical care that can be extended to any remote place across the globe. This medical care practice is a result of the deployment of communication systems and information technology into healthcare system. With this technology the diagnosed data can be shared with physician and take his consultation remarks and also physicians can access to diagnostic archive and share for medical practice and learning. However, this exchange of information is confined with several risks of data theft when they are shared in open networks and hence they are to be protected with high security algorithms. This paper provides a high capacitive security algorithm for protecting the images with hidden confidential information. The approach provides a two-way security by encrypting the clinical information initially and embedding it imperceptibly in the concerned image so that the user on other can obtain both the visual and text data at same instance

Use of complementary and alternative medicine and factors affecting their use among Libyan children with rheumatic diseases at Tripoli Children's Hospital 2019

Background: Complementary and alternative medicine (CAM) is defined as a group of diverse medical and health care systems, practices, and products that are not presently considered as conventional medicine. Aim of the study: To determine the prevalence, types, and factors affecting use of complementary and alternative medicine among Libyan children with rheumatic diseases. Methodology: A descriptive cross-sectional study was conducted in rheumatology clinic at Tripoli Children's Hospital, in which parents of children with different rheumatic diseases were interviewed by using a pre formed questionnaire at their routine visits. Data were managed and analyzed by SPSS data base (version 19). Result: Of 103 interviewed parents, 71(69%) were mothers with mean age of 41.21 years, 39% of whom had a university degree, and 50% of whom were employed. 31% were fathers with mean age of 47.7 years, 74% of whom were employed and 38% of whom had a university degree. 65\103(63%) of parents were living outside Tripoli. Majority of patients were females (75%) with a mean age of 12.8 years, 95% of the patients living with both their father and mother together. 63% of patients had juvenile idiopathic arthritis. Overall, 83% of patients were CAM users, 77% of theme was females and 65% had been diagnosed as JIA. The most frequently used CAM were Natural health products (69.8%) as honey and Meringa. Almost all CAM users (96.5%) did not change or stop their conventional therapy nor did they deviate from their scheduled visits in the rheumatology clinic. Conclusion &amp; recommendation: CAM use was common among patients followed in the pediatric rheumatology clinic; Natural health products were the most commonly used CAM. Very little is known about the benefits or potential harms of CAM despite its widespread use. Education and counseling programs to patients and parents about CAM use can help in the management of such chronic diseases.

Pregnancy-related liver pathology: hyperemesis gravidarum, cholestatic hepatosis of pregnancy, preeclampsia/eclampsia, HELLP-syndrome, acute fatty liver of pregnancy

Liver disease associated with pregnancy affects up to 3% of women and is a common cause of dysfunction during pregnancy. Severe liver dysfunction is associated with high rates of maternal and infant morbidity and mortality.Therefore, it is important to know about liver diseases the woman suffered before pregnancy in order to adequately manage the pregnancy and reduce the number of complications during delivery. Research and recent advances in medicine tend to improve the consequences, but so far they have not shown significant reduction of the maternal and perinatal morbidity rates against the background of this pathology. Liver diseases that are characteristic for pregnancy can be classified into those of early pregnancy (hyperemesis gravidarum) and those of late pregnancy (preeclampsia/eclampsia, intrahepatic cholestasis of pregnant women; hemolysis, increased activity of liver enzymes) HELLP-syndrome, acute fatty liver disease of pregnant women - AFLP, liver rupture / infarction).The results of modern studies used in the practice of medical care for pregnant women with concomitant pathology have significantly improved the pregnancy and delivery outcomes, but the number of complications among the mother and the fetus is still high. In this article, we offer an overview of liver diseases complicated by pregnancy with a detailed presentation of their aetiology, pathogenesis, diagnosis, and treatment. The risk groups of pregnant women with the potential possibility of liver dysfunction development have also been identified.

Understanding the Daily Experiences and Perceptions of Homebound Older Adults and Their Caregivers: A Qualitative Study.

More than 7.3 million older adults in the United States have difficulty leaving their homes or are completely homebound, yet little data exist on the experiences of homebound older adults and their caregivers. We conducted 30 semi-structured qualitative interviews with homebound older adults and caregivers recruited through home-based medical care practices in Baltimore and San Francisco. Thematic template analyses revealed that homebound older adults experience varying degrees of independence in activities of daily living, although their degree of dependence increases over time. Caregivers have a multifaceted, round-the-clock role. Both patients and caregivers experience burdens including social isolation and guilt. Navigating medical care and caregiving was further complicated by the complexity of the U.S. health care system; however, home-based medical care was viewed as a high-quality alternative to hospitals or nursing homes. Our findings suggest that providers and health care systems should expand the availability and accessibility of home-based care and improve caregiver support opportunities.

Pharmacological Neuroenhancement: Current Aspects of Categorization, Epidemiology, Pharmacology, Drug Development, Ethics, and Future Perspectives.

Recent pharmacoepidemiologic studies suggest that pharmacological neuroenhancement (pNE) and mood enhancement are globally expanding phenomena with distinctly different regional characteristics. Sociocultural and regulatory aspects, as well as health policies, play a central role in addition to medical care and prescription practices. The users mainly display self-involved motivations related to cognitive enhancement, emotional stability, and adaptivity. Natural stimulants, as well as drugs, represent substance abuse groups. The latter comprise purines, methylxanthines, phenylethylamines, modafinil, nootropics, antidepressants but also benzodiazepines, β-adrenoceptor antagonists, and cannabis. Predominant pharmacodynamic target structures of these substances are the noradrenergic/dopaminergic and cholinergic receptor/transporter systems. Further targets comprise adenosine, serotonin, and glutamate receptors. Meta-analyses of randomized-controlled studies in healthy individuals show no or very limited verifiability of positive effects of pNE on attention, vigilance, learning, and memory. Only some members of the substance abuse groups, i.e., phenylethylamines and modafinil, display positive effects on attention and vigilance that are comparable to caffeinated drinks. However, the development of new antidementia drugs will increase the availability and the potential abuse of pNE. Social education, restrictive regulatory measures, and consistent medical prescription practices are essential to restrict the phenomenon of neuroenhancement with its social, medical, and ethical implications. This review provides a comprehensive overview of the highly dynamic field of pharmacological neuroenhancement and elaborates the dramatic challenges for the medical, sociocultural, and ethical fundaments of society.

Patients Fail to Disclose Their Symptoms During A Visit to Their Primary Care Physician

Patient-physician communication is Associate in Nursing integral a part of clinical observe. once done well, such communication produces a therapeutic result for the patient, as has been valid in controlled studies. Formal coaching programs are created to reinforce and live specific communication skills. several of those efforts, however, specialise in medical faculties and early postgraduate years and, therefore, stay isolated in educational settings. Thus, the communication skills of the busy medical practitioner typically stay poorly developed, and also the want for established physicians to become higher communicators continues. during this article, the authors concisely review the why and the way of effective patient-physician communication. they start by reviewing current information on the advantages of effective communication within the clinical context of physicians caring for patients. The authors then supply specific steering on the way to attain effective communication within the patient-physician relationship. However, there's very little empirical proof relating to the role of patients in distinguishing and preventing medical damage[1]. For hospitalized patients, the technical complexness of treatment and also the acute nature of their sicknesses undermine their ability to acknowledge issues. In ambulant patients, many studies document poor understanding of treatment recommendations or medication regimens[2].Two recent reports address patients’ ability to spot medication-related errors and injuries in medical care. within the ambulant Quality Improvement Project, eighteen of patients in eleven medical care practices according a tangle because of medications within the previous year, however solely three-dimensional of patients’ charts recorded this finding.11 A limitation of the study was the dearth of certification by physicians of patient-reported medication symptoms. The goal of the current study was to know the medication-related symptoms old by members of this patient cohort yet because the contribution of poor patient-physician communication to ADEs. we have a tendency to theorized that if patients and physicians communicated additional effectively concerning medication-related symptoms, then the intensity or period of symptoms can be quenched. Specifically, we have a tendency to wanted to answer the subsequent questions: (1) What square measure the frequency, type, and severity of patient-identified medication symptoms? (2) however typically do clinicians accept as true with patients’ attribution of symptoms to their medications? (3) What factors square measure related to patients’ choices to inform physicians concerning symptoms? (4) What factors square measure related to physicians’ choices to handle patient-reported medication symptoms?

State policy of development of resort business in Russia: legal and organizational aspects, including those in an emergency

To analyze the normative and regulatory support of the state policy of development of health resort business in Russia and organizational and methodological aspects of its implementation, including those in emergency and coronavirus pandemic. The following current methods of community hygienic and medical-organizational research were applied: analytical, statistical, best practice study, monographic, etc. Data from state and departmental official sources, statistical books, scientific publications, and other sources were studied. The main normative, regulatory, organizational and methodological aspects of the strategy implementation, developed in accordance with the order of the Government of the Russian Federation «On approval of the development strategy of the health-resort complex of the Russian Federation» dated 26.11.18 №2581-p were analyzed. Some discrepancies in the state and departmental statistics of health-resort organizations were found. The nomenclature of the health-resort area was reviewed, and the used term «health-resort treatment» was criticized, which does not correspond to the parts of this type of daily practice medical care, unlike the concepts «health-resort care» or «health-resort business». The article presents the author's vision of the issue of normative and organizational support of health-resort organizations in an emergency such as COVID-19 pandemic since 2020. It is shown that the national and local experience of coronavirus infection control contributed to the development of a considerable number of federal regulatory documents in a short time frame. The publication describes an analysis and systematic review of the most important documents, including those related to the spa resorts. Addressing the demanding challenges of further development of the country's health-resort complex largely relies on the state of its facilities and resources. However, its objective analysis is hindered by the identified significant discrepancies in the state and departmental statistic data concerning the number of functioning health-resort organizations and its change over time. As opposed to the concept of «health-resort treatment», the term «health-resort care» most accurately describes its complexity.

The Role of Lifestyle Modification on Health Care Outcomes and Medical Practice Quality

The Role of Lifestyle Modification on Health Care Outcomes and Medical Practice Quality

Use of complementary and alternative medicine in Type 2 Diabetes in Eastern Nepal

Background: The chronic and progressive nature of Diabetes Mellitus often leads people to use complementary and alternative medicines (CAMs) which may be defined as a group of medical and health care systems, practices and products that are not considered to be part of conventional medicine.&#x0D; Methods: This descriptive cross-sectional study was done in a tertiary care hospital in Eastern Nepal from 15th June 2018 to 15th September 2019 to determine proportion of type 2 diabetic patients who have tried complementary and alternative medicines (CAMs) exclusively prior to presentation to endocrine OPD (Outpatient department). Consecutive sampling was done after informed verbal consent.&#x0D; Results: Out of 401 participants, 60.6 percent were male and 39.4 percent were female. Mean age of participants was 52.21 ± 11.42 years. Regarding use of CAMs, 11 percent sad tried some form of CAMs exclusively without any allopathic antidiabetic medicines for some period in their lifetime prior to presentation to endocrine OPD. More specifically, 10.3 percent had tried products under brand of ayurvedic medicines from local practitioners. Similarly, 0.2 percent had tried medicine from Homeopathic Practitioner and rest (0.5 percent) had tried homemade herbal remedies like garlic, fenugreek, aloe vera and bitter melon.&#x0D; Conclusion: A significant proportion of type 2 diabetics in our community are still using CAMs. The associated factors behind this and long term effects of such products in diabetic patients need to be explored further in details.

The role of compassion in ethical frameworks and medical practice

Medicine has made great strides with advances in technology and outcomes. However, compassion is an element that often is missing from medical care and ethics. The paper discusses why compassion is the ideal physician and why it is important to medicine. The benefit of compassion in biomedical ethics by exploring three ethical frameworks is also explored. Compassion is an important concept that has a place in both medical care and ethical practice.

Extending the Domain of Care in Philippe Forest

This article explores the connection between care and loss in Philippe Forest’s work by drawing on the etymological origins of care and on contemporary French writing on the ethics of care. On the one hand, care in Forest comes to stand for the technical taking care of a patient in the medical setting as well as for caring for and about his dying child specifically. On the other hand, the practice of writing about the loss of his daughter turns into a form of long-term caring for both his dead daughter and her surviving father. This continued attention to a relationship built around loss is, according to Forest, missing in practices of medical care supposedly meant to acknowledge death. The article argues that engaging with loss is key to the practice of care, even if, as Forest’s more recent work shows, this engagement also entails documenting a gradual forgetting of the dead.

The role of the nurse in providing practice medical care in pancreatitis

The article presents data showing that the number of patients with chronic gastroenterological diseases is growing every year. Only 40 % of patients manage to achieve complete disappearance of symptoms and the onset of recovery. In 60 % of patients, drug therapy can temporarily weaken the manifestations of the disease. Often the consequence of the transition of the disease into a chronic form is self-medication, which only aggravates the course of the disease, bringing only a temporary improvement in the patient’s condition. Modern diagnostic methods in gastroenterology (ultrasound diagnostics, esophagoscopy, gastroscopy, laparoscopy, rectoscopy, radiological examinations, a large number of laboratory techniques, and others) make it possible to identify diseases of the digestive system in the early stages and to carry out effective prevention and treatment.

Abstract PO-205: The impact of DSRIP and practice transformation on cancer screening outcomes for Medicaid, low income, and uninsured patients in Texas

Abstract Background In 2011, Texas received federal approval of the 1115 Healthcare Transformation waiver, which went to support the Texas Delivery System Reform Incentive Payment Program (DSRIP) pool, incentivizing the transformation of service delivery practices to improve quality, health status, patient experience, coordination, and cost-effectiveness. To date, no research has described the impact DSRIP has had on cancer screening outcomes on the Texas Medicaid, low income, and uninsured (MLIU) patient population. Objective To describe the impact of practice transformation at an academic medical center primary care practice towards a value- based care delivery model on breast, cervical, and colorectal cancer screening for its MLIU patient population as a result of 1115 Healthcare Transformation Texas waiver. Study Design Retrospective analysis of electronic health record data from 1/1/2017 through 12/31/2018. Participants MLIU patients who received care at an academic medical center primary care practice during the study time frame and met the criteria for colorectal, cervical, and/or breast cancer screenings. Main Measures The primary outcomes for these analyses were proportions of the patient population who received or did not receive the recommended cancer screenings. Key Results After controlling for relevant confounders, we found significantly improved rates of cervical and colorectal cancer screening among Medicaid, low income, and uninsured patients. Conclusions Practice transformation, specifically integrating primary care, quality, and health information technology, resulted in higher rates of cervical and colorectal cancer screening among a high-risk vulnerable group of patients in one year. Further research should be conducted to determine if the findings are reproducible and if the return on investment equals or surpasses the cost of upfront and sustaining costs of practice transformation. Citation Format: Rebecca Jones, Amelie Ramirez, Ramon Cancino. The impact of DSRIP and practice transformation on cancer screening outcomes for Medicaid, low income, and uninsured patients in Texas [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-205.

REVIEW ON COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) IN ORAL HEALTH

Background: Complementary and Alternative Medicine (CAM) is a cluster of heterogeneous medical and health care systems, practices and products that can be used along with conventional medicine. This review article is about CAM system that is being used in oral health, challenges of such uses and the need for global regulations while using CAM products as medicines.&#x0D; Discussion: These systems are integral part of culture. Ayurvedic therapies are used for alleviating various oral conditions. Herbal mouth rinses and dentifrices are used for plaque control which is the basic process in oral care. Though deficiency exists regarding reports of controlled studies of Homeopathic medicines in pain conditions, Homeopathy is effective in the treatment of idiopathic trigeminal neuralgia. Last decade had witnessed an increasing interest in medicinal plants thereby promoting them as alternatives to standard conventional medicines.&#x0D; These therapeutics are gaining importance in a global scale. Limited access to conventional oral care, lower costs and general belief of minimal toxicity enhances the use of Ayurveda, Herbal and Homeopathic medicines and therapies in oral diseases. Budgetary allocations for this traditional system care of different countries, designing research programs to focus on traditional medicines and implementation of laws for propagation of CAM systems reflects the global inclination towards this system of healthcare.&#x0D; Conclusion: Considering the broadened scope of CAM therapeutics in dental healthcare, it is recommended that a dental professional be consulted prior to using these products in an attempt to reduce the probability of side effects or drug interactions.