Trained Medical Practitioners Research Articles

Reflection in the training of general practitioners in clinical practice settings: a scoping review protocol.

The objective of this scoping review is to explore formalized methods of reflection that are used in clinical settings in general practice when training medical students, postgraduate trainees, general practitioners, and family physicians. Medical professionals are increasingly required to demonstrate competency in their ability to reflect on clinical practice. To accommodate this, the teaching of reflection is common in medical programs; however, there is a lack of clarity in the literature on how reflection is taught. This review will seek evidence describing the tools and approaches to reflection used by medical students, postgraduate trainees, and other registered medical professionals in general practice. The review will also include any evidence from those who teach reflection in a general practice setting. Evidence regarding reflection in training programs for other medical specialties will not be considered for inclusion. This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), and the JBI methodology for scoping reviews. Databases to be searched will include MEDLINE (Ovid), Emcare (Ovid), Embase (Ovid), Web of Science, Scopus, and the Cochrane Database of Systematic Reviews. Extracted evidence will be presented using figurative, tabular, and accompanying narrative synthesis in line with the review questions. Open Science Framework https://osf.io/uxw7d.

Foreign Practices: Immigrant Doctors and the History of Canadian Medicare. Sasha Mullally and David Wright

In Foreign Practices: Immigrant Doctors and the History of Canadian Medicare, Canadian historians of health Sasha Mullally and David Wright examine the interconnected history of Canadian healthcare and immigration. In documenting the relationship between the healthcare system and foreign-born and trained medical practitioners, Mullally and Wright demonstrate the profound impact that these physicians had on the success of Medicare and, in turn, on the shaping of Canadian identity in the mid-twentieth century. This text fills a significant gap in the historiography; the authors note that the social history perspective has long been lacking and the history of this multifaceted relationship has been dominated instead by policy histories, resulting in the absence of health care providers’ voices. This is remedied in Foreign Practices through both a micro and macro analysis, as chapter by chapter the authors first narrow the lens using existing and newly collected oral histories, published memoirs, and obituaries, and then broaden it using institutionally created sources such as published journals and the records of government offices. Through this methodology, the authors not only examine the relationship between Canadian institutions and foreign-trained physicians but also contribute to a growing pool of transnational histories studying the ways immigration policies were shaped across the global north and how immigrant physicians have in turn shaped the healthcare systems in their new home countries. While approaching this topic from the national and global perspectives, the authors skillfully negotiate the nuances that have shaped regional identity as they explore the motivations of immigrant physicians to settle or migrate within Canada after their arrival.

Seropositive Neuromyelitis Optica in a Case of Undiagnosed Ankylosing Spondylitis: A Neuro-Rheumatological Conundrum

Seropositive Neuromyelitis Optica in a Case of Undiagnosed Ankylosing Spondylitis: A Neuro-Rheumatological Conundrum

Predicting Cancerous Genes through an In-Silico Approach

Abstract: In Sequence alignment, the chains of DNA, RNA, or protein are aligned and compared to recognize homogeneous portions which could be the result of functional, organizational, or evolutionary connections between the chains. This process gives similar sequences as its result. Similar sequences often have the same biological function. This knowledge can be used to draw further conclusions that we can ascertain the function of a query DNA sequence by comparing it with a target sequence performing a known function. In this article, we use this idea to develop an Advanced Java-based web application where the user interface allows the user to enter an unknown DNA sequence. Using pattern-matching algorithms, the application can calculate how similar the sequence is with genes stored in a database. Based on the result, a trained medical practitioner will be able to determine whether the unknown gene can be cancerous

A CALL TO BUILDING RESILIENT MEDICAL EDUCATION SYSTEMS IN AFRICA, NOW AND BEYOND COVID-19

Background Certain factors have affected medical education significantly most recently. One is the rapidly evolving landscape of medical education, globally. This has created a spectrum of impacts on not just how medical education is being delivered but, on the definitions, and characterizations of competencies required of trained medical practitioners across the globe. The second factor is the event of the Covid-19 pandemic, which has not only affected the methods of delivery of medical education but that has also affected resource allocations. Proposition The impacts of these two factors have in most recent time created dynamics that will influence the quality of delivery of medical education in African institutions. Building resilient systems, therefore, becomes vital to sustainability. Resilience becomes associated with not just efforts to keep medical schools open and running but also the extent to which quality can be sustained, with quality prospects for continuous improvement so that Africa can leapfrog in the attempts to increase the quality of medical education. This will translate to improvements in the quality of delivery of care. Conclusion This commentary, therefore, considers three major themes that stakeholders must focus on in their efforts to build resilient medical education systems that can withstand the impact of the two main forces that are largely responsible for the current dynamics. The first theme centers on pedagogy and assessment. The second theme emphasizes infrastructure and resources. The third theme considers critically institutional philosophy, the cultures of teaching and learning, and the need to critically rethink medical education on the continent.

Automated Characterization of Cyclic Alternating Pattern Using Wavelet-Based Features and Ensemble Learning Techniques with EEG Signals.

Sleep is highly essential for maintaining metabolism of the body and mental balance for increased productivity and concentration. Often, sleep is analyzed using macrostructure sleep stages which alone cannot provide information about the functional structure and stability of sleep. The cyclic alternating pattern (CAP) is a physiological recurring electroencephalogram (EEG) activity occurring in the brain during sleep and captures microstructure of the sleep and can be used to identify sleep instability. The CAP can also be associated with various sleep-related pathologies, and can be useful in identifying various sleep disorders. Conventionally, sleep is analyzed using polysomnogram (PSG) in various sleep laboratories by trained physicians and medical practitioners. However, PSG-based manual sleep analysis by trained medical practitioners is onerous, tedious and unfavourable for patients. Hence, a computerized, simple and patient convenient system is highly desirable for monitoring and analysis of sleep. In this study, we have proposed a system for automated identification of CAP phase-A and phase-B. To accomplish the task, we have utilized the openly accessible CAP sleep database. The study is performed using two single-channel EEG modalities and their combination. The model is developed using EEG signals of healthy subjects as well as patients suffering from six different sleep disorders namely nocturnal frontal lobe epilepsy (NFLE), sleep-disordered breathing (SDB), narcolepsy, periodic leg movement disorder (PLM), insomnia and rapid eye movement behavior disorder (RBD) subjects. An optimal orthogonal wavelet filter bank is used to perform the wavelet decomposition and subsequently, entropy and Hjorth parameters are extracted from the decomposed coefficients. The extracted features have been applied to different machine learning algorithms. The best performance is obtained using ensemble of bagged tress (EBagT) classifier. The proposed method has obtained the average classification accuracy of 84%, 83%, 81%, 78%, 77%, 76% and 72% for NFLE, healthy, SDB, narcolepsy, PLM, insomnia and RBD subjects, respectively in discriminating phases A and B using a balanced database. Our developed model yielded an average accuracy of 78% when all 77 subjects including healthy and sleep disordered patients are considered. Our proposed system can assist the sleep specialists in an automated and efficient analysis of sleep using sleep microstructure.

Patient-Centred Care for Patients With Diabetes and HIV at a Public Tertiary Hospital in South Africa: An Ethnographic Study.

Background: Healthcare systems across the globe are adopting patient-centred care (PCC) approach to empower patients in taking charge of their illnesses and improve the quality of care. Although models of patient‐centredness vary, respecting the needs and preferences of individuals receiving care is important. South Africa has implemented an integrated chronic disease management (ICDM) which has PCC component. The ICDM aims to empower chronic care patients to play an active role in disease management process, whilst simultaneously intervening at a community/ population and health service level. However, chronic care is still fragmented due to systemic challenges that have hindered the practice of PCC. In this article, we explore provider perspectives on PCC for patients with comorbid type 2 diabetes and HIV at a public tertiary hospital in urban South Africa. Methods: This study utilizes ethnographic methods, encompassing clinical observations, and qualitative interviews with healthcare providers (n=30). Interview recordings were transcribed verbatim and data were analyzed inductively using a grounded theory approach. Results: Providers reported various ways in which they conceptualized and practiced PCC. However, structural challenges such as staff shortages, lack of guidelines for comorbid care, and fragmented care, and patient barriers such as poverty, language, and missed appointments, impeded the possibility of practicing PCC. Conclusion: Health systems could be strengthened by: (i) ensuring appropriate multidisciplinary guidelines for managing comorbidities exist, are known, and available, (ii) strengthening primary healthcare (PHC) clinics by ensuring access to necessary resources that will facilitate successful integration and management of comorbid diabetes and HIV, (iii) training medical practitioners on PCC and structural competence, so as to better understand patients in their sociocultural contexts, and (iv) understanding patient challenges to effective care to improve attendance and adherence.

Design of a portable retinal imaging module with automatic abnormality detection

Regular eye examinations are required for the early identification of retinal diseases, but the non-availability of medical resources and time are the main concerns in semi-urban areas with the scenario becoming more critical in rural areas. This paper discusses on the design of a cost-effective universal retinal fundus camera and the development of a novel algorithm for the identification of two prominent vision threatening diseases such as Diabetic Retinopathy (DR) and Age-related Macular Degeneration (AMD) employing the state-of-the-art, Convolutional Neural Networks (CNN) for higher classification accuracy. Furthermore, the proposed system is capable of predicting the disease severity level as well as providing suggestions as to whether an ophthalmic consultation is required for the subject under consideration. Experiments were conducted on images from publicly available databases and hospital repository. The condition Normal-DR-AMD and their severity levels were predicted. The performance scores employed were accuracy (95.83 %), sensitivity (0.93) and specificity (0.97), where the values corresponds to the average scores across different datasets. Furthermore, the developed system predicts the retinopathy stages with an average computational time of about 3.98 s. Both the scores clearly indicate the effectiveness of the proposed algorithm both in terms of correctness of the finding and speed of the generating the medical inference. This model can be extremely useful for rural campaign, where availability of trained medical practitioners is less as well as space for setting up and maintaining an eye care facility are not feasible.

Male Circumcision: A Practice Survey from Saudi Arabia

The study aims to evaluate the various techniques used to perform circumcision in Saudi Arabia. In September 2018, this cross-sectional survey was performed. A questionnaire was sent to all pediatric surgery units across the Kingdom. The responses to the questionnaire were analyzed and categorized. A total of 176 questionnaires were send and more than half (56.3%) of the practitioners filled the questioners, 62 (63%) were consultants, 19 (19%) were specialists and 19 (19%) were trainee in pediatric surgery fellowship program. Circumcisions were performed in Maternity and Children hospitals (32.3%), tertiary hospitals (32.3%), private hospitals (16%) and in general or academic hospitals (19%). The most commonly used method for circumcision was Gomco clamp (n = 39; 39.6%) followed by Plastibell (n = 30; 30%) and bone cutter (n = 25; 25.4%). The optimal time for circumcision was in neonatal period. Eighty-six percent of the surgeons agree that 2.5 to 5 kg is the optimal weight for the baby to do circumcision. In Saudi Arabia circumcision is a religious practice done for every Muslim male. It should be done by trained medical practitioner and circumcision done by non-medical personal should be avoided. Circumcision should be performed in the neonatal period and attention should be given to analgesia.

Role of ultrasound in the diagnosis and management of gestational trophoblastic disease in Rwanda Rural health facilities- A case report

Introduction Gestational trophoblastic disease (GTD) is a rare kind of proliferative disorder of trophoblastic cells which develops from the placenta in early pregnancy and the complete hydatidiform mole (CHM) sub-type which limited to endometrium is most common. It has excellent prognosis if early appropriate diagnosis and management are done. A well performed ultrasound(US) play a primordial role in the diagnosis of maternal health disorders during routine prenatal care. This helps in avoiding complications and consequently aids in achieving the objectives of the Millennium Development Goals (MDGs) in Rwanda. Aim To understand the definition of Gestational trophoblastic disease(GTD); To recognize key diagnostic findings of complete molar pregnancy on ultrasound and appropriate management in maternal follow up and To review the differential diagnosis for ultrasound findings seen with GTD. Methods The case has been referred in ultrasound unit for scan from outpatient department and follow up US was ordered and done during management period while the patient lies on a bed while operator moves the 3,5 MHz lubricated transducer of frequency with gel on the abdomino- pelvic region with full urinary bladder and Mindray ultrasound Machine has been used. Results There was a large moderately hyperechogenic mass completely filling the endometrial cavity with numerous small cystic spaces of different size. Post 5 days under treatment, anechoic area within endometrial cavity and myometrium well outlined was discharged and in 3rd medical visit after 2 weeks, US were normal. Conclusion Ultrasound is the first modality to be used in all rural health facilities for diagnosis of suspected Gestational trophoblastic disease (GTD) for better results. It is available and free of radiation. Recommendation -The US is the baseline modalities to be used in 1st trimester in pregnancy women with GTD suspicion bleeding. -All rural health facilities should have empowered and capable trained Medical imaging practitioners for appropriate carrying out the ultrasonographic investigation for better care service delivery on GTD(Medical imaging practitioners Role extension project after formal training by Prof. Kawooya).

A Framework for Improving the Engagement of Medical Practitioners in an E-Training Platform for Tuberculosis Care and Prevention

We propose a new framework to improve the engagement of medical practitioners in a planned e-training platform for the successful identification and effective management of presumptive cases of tuberculosis (TB) in Pakistan. Our work is aligned with the World Health Organization’s TB-DOTS (Directly Observed Treatment Short-course) strategy for promoting the effective management of tuberculosis. We start by presenting previous work done at Mercy Corps Pakistan for training medical practitioners, then present the results of a recent survey we administered to a random sample of medical practitioners in Pakistan to learn about their requirements and readiness to embrace a new e-training platform and methodology. Informed by feedback from the survey, we formulated a detailed requirement analysis of the five key learning areas (or phases) that we believe are fundamental to the success of a TB e-training platform. Moreover, survey results revealed that an on-spot, on-demand, and competency-based learning tool can potentially improve the engagement of medical practitioners in the process. Building on the insights gained from the survey, we finally describe our initial UX (user experience) prototypes for phase 1, which corresponds to the identification of presumptive tuberculosis cases.

Sitting position and wheelchair appropriateness in patients with spinal cord injury: Assessment of professional practices in a specialist unit

Skill profiles of a wheelchair, notably leading to the initial choice after a spinal cord injury (SCI), include the patient's comfort, his/her safety as well as physical and social performances. The multidisciplinary team of first rehabilitation within a spinal unit wondered about the quality of the patients’ positioning. The team consequently wished to create an indoor reference document as well as a simple helping tool, so as to choose correctly the wheelchair, to settle any patient in a convenient manner and to check this settling. Frontal and profile photos were taken of SCI individuals in the sitting position in a manual or a powered wheelchair. A multidisciplinary specialist team working in a spinal unit (doctors, nurses, physiotherapists, occupational therapists and caregivers) analyzed each patient positioning within his/her wheelchair, mentored by trained medical quality practitioners. A review of the literature relating any component and accessories of the wheelchairs was then carried-out and compared with data from the previous analysis. An illustrated reference notebook was created, describing the choice of the wheelchair according to the motor level of the SCI patient, then according to the characteristics of his/her positioning and the adaptation of components and accessories. A checklist form was also developed to make easier the procedure of settling and then its revision, as a potential tool for the transmissions of detected anomalies between the various professionals. Both documents will be assessed by using them for the analysis of a new series of photos. The whole staff of the neurological PMR department will then be trained with these documents that will afterwards be placed in the documentary management system of our University Hospital. They could be useful as information tools for already involved staffs either or as training tools for professionals newly dealing with SCI patients.

Prevalence of anal, oral, penile and urethral Human Papillomavirus in HIV infected and HIV uninfected men who have sex with men.

Aims of the study were to evaluate Human Papillomavirus (HPV) and type-specific prevalence in four anatomical sites in HIV infected men who have sex with men (MSM) compared with HIV uninfected MSM. Participants were recruited among the attendees of Infectious Diseases Clinics in Central Italy. A trained medical practitioner collected by interview sociodemographic data and information on medical history, sexual behavior, and drug use. Swabs from anal canal, oral cavity, urethral mucosa, and coronal sulcus were tested for HPV DNA and genotyping. Ninety MSM were enrolled, 45 subjects within each group. Overall, 48.9% MSM were HPV positive and prevalence was higher in HIV infected men (60.0% vs 37.8%, P = 0.035). HPV at multiple anatomic sites occurred in 59.1% MSM, with 34.1% and 22.7% at two and three sites, respectively. Prevalence of anal, coronal sulcus, oral, and urethral HPV was 96.3%, 37%, 21.6%, and 18.5% in HIV infected MSM, and 70.6%, 70.6%, 29.4%, and 23.5% among HIV uninfected. A similar proportion of HIV infected and uninfected MSM (59.2% and 58.8%) carried at least one high-risk genotype. Prevalence of types covered by nonavalent vaccine was 77.8% in HIV infected compared with 82.3% in HIV uninfected MSM. HPV 58 and 16 were mostly detected in HIV positive (43.7% and 31.2%) and negative MSM (50.0% and 40.0%). HPV detection rate underlined the high vulnerability of MSM to acquire multisite infections, characterized by various genotype combinations. Since nonavalent vaccine could have prevented 80% of HPV infections, study findings support the implementation of vaccination programs among MSM.

Medicine outside the Clinic: The Growing Need for Physicians in Sexual Education Policy

Sex and sexuality are both topics of immense social and personal importance, owing their openness or constraint in large part to the society in which they are discussed. In homogenous groups it may be possible to reach firm consensus on what is, or is not, appropriate to consider a sexual norm and use an overarching set of religious or spiritual morals to reaffirm this decision. However, in western society and specifically in the United States, a theme of integration and amalgamation of wildly different cultures has presented an interesting case study in searching for common ground on basic social issues. Notable amongst these is the question of sexual education and the role of government, religion, and family in determining the way and extent to which information is presented to individuals during their formative years. However, suspiciously absent in these discussions is the role of trained medical practitioners in vetting these curricula and participating in the education process.

Epidemiology Of Injury In Race-day Jockey Falls In Flat Horse Racing In Ireland, 2011–2014

Horse racing is a high risk physically demanding sport with a high incidence of falls and injury previously reported. In recent years in Ireland, a number of health and safety interventions have been implemented, including the raising of the stipulated minimum competition weights, implementation of improved helmet safety standards and the introduction of a new concussion assessment protocol. Despite this, the impact of the implementation of these measures on the incidence of falls and injuries in horse racing remain unknown. PURPOSE: To provide an up to date analysis of the falls and injury incidence in flat horse racing jockeys in Ireland by evaluating and reporting injury data from 2011-2014. Also to evaluate the impact of the introduction of the new health and safety measures on the frequency of the falls and nature of injuries both in terms of incidence and type. METHODS: In a four year prospective epidemiological study, the total number of falls and injuries that occurred during all official flat horse race meetings were recorded. A standardised injury report form was utilised to record all falls and injury data from each race meeting. All data were collated by a trained medical practitioner on duty at the particular race course and stored using a centralised database coordinated by the Turf Club Senior Medical Officer. RESULTS: The falls rate per 1,000 rides was 4.0 [95% CI: 4.01-4.02]. Injury incidence per 1,000 falls was noted to be 347.8 [95% CI: 346.9-348.6] and per 1,000 race meetings was 96.2 [95% CI: 96.0-96.4]. Soft tissue injuries were predominant (60.94%), with fractures and concussions accounting for 18.75% and 12.5% of injuries respectively. While lower limb injuries (37.50%) were the most common region of injury noted, the head and face (21.88%) were the most frequent location of injury. CONCLUSION: Compared to previous studies reporting falls and injury incidence in flat horse racing, there has been an increase in fall rate, but a reduction in injury rate during 2011-2014, which in part may possibly reflect the impact and effectiveness of the health and safety interventions implemented. Further research on the design, implementation and feasibility of injury prevention intervention strategies and their impact on the incidence of falls and injury risk are required.

Aesthetic Practice in Nepal

DOI: http://dx.doi.org/10.3126/kumj.v11i2.12483 Kathmandu University Medical Journal Vol.11(2) 2013: 109

Training medical practitioners: which comes first, the generalist or the specialist?

Training medical practitioners: which comes first, the generalist or the specialist?

Contraceptive Knowledge Attitude and Practice (KAP) among Women who were seeking for Termination of Pregnancy

Objective: To determine the knowledge, awareness and the practice of various contraceptive methods in the women who wanted termination of pregnancy during I trimester. Materials and Methods: The study is a descriptive, questionnaire-based prospective study, conducted amongst 50 consecutive termination-ofpregnancy seekers during their first trimester who attended our hospital. The interview for this study was conducted by a trained medical practitioner and involved a face-to-face interview using pre-tested, structured questionnaire. Results: Out of 42 women who had been included in the study, maximum of them 14 (33.3%) were of 23-25 years age group, while 8 (19%) of 26-28yrs,8 (19%) of >32 yrs, 6 (14.2%) 19-22yrs and 2 of them were of less than 18yrs. Among all these women 10 (23.8%) had no knowledge regarding any method of contraception while 32(76.1%) women had knowledge and awareness about contraceptive methods. Conclusion: This study concludes that there is considerable level of knowledge and awareness about contraception in the women working in small scale industries but actual practice of those methods is low.

Inpatients' Knowledge about Primary Liver Cancer and Hepatitis

To assess the level of an inpatient population's awareness about hepatitis and primary liver cancer (PLC), the most common type of which is hepatocellular carcinoma (HCC), and then to initiate education of this group. A survey was conducted with 1300 participants within the inpatient unit in representative tertiary hospitals in the Chaoshan area of China. Structured questionnaires contained demographic data and statements about different aspects of liver cancer and hepatitis. The questionnaires were completed by trained medical practitioners after they had conducted the interviews. One way ANOVA showed that the sample population lacked adequate knowledge about HCC and hepatitis. Stepwise multiple regression analysis demonstrated that the participant's level of education had the greatest impact on their total knowledge score when other variables remained constant. The study demonstrated: a general lack of awareness amongst the participants about the preventative strategies, and the management options available for people with primary liver cancer and hepatitis; education level was an important factor affecting knowledge levels. The demonstrated deficiencies in people's knowledge about hepatitis and HCC, and their lack of subsequent protective behaviours are likely to play an important role in HCC and hepatitis transmission or prevention.

Orientation invariant ECG-based stethoscope tracking for heart auscultation training on augmented standardized patients

Auscultation, the act of listening to the heart and lung sounds, can reveal substantial information about patients’ health and other cardiac-related problems; therefore, competent training can be a key for accurate and reliable diagnosis. Standardized patients (SPs), who are healthy individuals trained to portray real patients, have been extensively used for such training and other medical teaching techniques; however, the range of symptoms and conditions they can simulate remains limited since they are only patient actors. In this work, we describe a novel tracking method for placing virtual symptoms in correct auscultation areas based on recorded ECG signals with various stethoscope diaphragm orientations; this augmented reality simulation would extend the capabilities of SPs and allow medical trainees to hear abnormal heart and lung sounds in a normal SP. ECG signals recorded from two different SPs over a wide range of stethoscope diaphragm orientations were processed and analyzed to accurately distinguish four different heart auscultation areas, aortic, mitral, pulmonic and tricuspid, for any stethoscope’s orientation. After processing the signals and extracting relevant features, different classifiers were applied for assessment of the proposed method; 95.1% and 87.1% accuracy were obtained for SP1 and SP2, respectively. The proposed system provides an efficient, non-invasive, and cost efficient method for training medical practitioners on heart auscultation.