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PubMedDate not supplied

A study of stress in medical students at Seth G.S. Medical College.

BACKGROUND: It is usually observed that medical students undergo tremendous stress during various stages of the MBBS course. There is a high rate of suicide among them. METHODS: To determine incidence of stress and factors controlling stress in medical students at various stages of MBBS course at Seth G S Medical college, 238 students (First year 98, Second 76, Third 64) were asked to complete a questionnaire on personal data (gender, stay at hostel, mode of travel, time spent in travel every day, medium of study in school, place of school education.), Stress inducing factors, Zung's depression scale, ways of coping, stress relievers, perceived social support and personality type. Statistical tests used were ANOVA, critical ratio and Student's 't' test. RESULTS: Majority of medical students (175/238--73%) perceived stress. Stress was found to be significantly more in Second and Third MBBS students rather than First MBBS levels (p < 0.05). Stress was not found to differ significantly on the basis of sex, stay at hostel, model of travel, time spent in travel every day, medium of study in school, place of school education. Stress was found to be significantly more in students having more than 95% of marks at 12th Standard as compared to others. Academic factors were greater perceived cause of stress in medical students. There was no significant difference in the students at different levels of MBBS regarding academic factors and social factors as a stress inducing factors. Physical factors were found to be significantly more in Second and Third MBBS students as compared to First MBBS students. Emotional factors were found to be significantly more in First MBBS students as compared to Second & Third MBBS students. Stress was more common in medical students who have dominant strategy of coping as positive reappraisal, accepting responsibility and planful problem solving. Stress was less common in medical students at Seth G S Medical College who have dominant strategy of coping as escaping and distancing from difficult situation. Family and Friend as perceived social supports were more in Second MBBS than First MBBS medical students. Stress was not found to be significantly more in students having their personality factor contributing to stress (Type A--52/67) as compared to others (Type B--123/171). This indicates that the stress was not trait oriented but was process oriented (p = NS). CONCLUSION: Stress in medical students is common and is process oriented. It is more in second and third year. Academic factors are greater perceived cause of stress in medical students at Seth G S medical college. Emotional factors are found to be significantly more in First MBBS. It is dependent on person's ways of coping and social support.

Adaptation, Psychological↗

PubMed2004

Medical health and medication use in elderly dental patients.

The objectives of this study were to obtain information on the medical conditions and medications used among elderly Thai dental patients and to investigate the relationship between the findings in relation to age and sex. The information regarding medical conditions and medication use was obtained from interviews of 510 dental patients aged 60 years and older. The incidence of medical conditions was 82.5%; women had a significantly higher incidence of medical conditions (86.5%) than men (76.5%). The incidence of medical conditions did not differ among the three age groups. Overall, cardiovascular disease was the leading problem (33.7%) with hypertension being the major component (26.1%). The prevalent problems were bone/joint disorders (32.4%), allergies (18.2%), diabetes mellitus (14.5%), and eye and ear problems (14.3%). In our sample, 65.5% reported taking medications, with an average of 1.5 drug groups per person. The average number of medications taken increased as age increased. Women took medications more frequently than men (70% vs. 58.5%). The four most prevalent drugs were cardiovascular agents (32%), endocrinologic drugs (14.5%), nutritional therapeutics (12.9%), and drugs acting on the musculoskeletal system (11.4%). The present study supports the findings of previous reports in that the presence of medical conditions is high in the elderly and the incidence of medication use increases with advancing age.

Age Factors↗

PubMed1992

Recommendations of the German Association for Medical Informatics, Biometry and Epidemiology for education and training in medical informatics.

In the fields of health care and medicine there is an immense demand for a systematic application of methods of information processing and for the use of computers. Obviously, to that end well-trained scientists and qualified personnel must be available. With the present recommendations on education and training in medical informatics the German Association for Medical Informatics, Biometry and Epidemiology (GMDS) proposes structure and contents of medical informatics curricula and courses. The recommendations describe a 2-dimensional educational framework with different education levels in one dimension and various types of educational needs and orientation in the other one. The recommendations comprise at the university level education as well specialized curricula covering the total spectrum of medical informatics as well as informatics curricula with medical informatics as integrated applied subject or subsidiary subject, respectively. Besides these informatics-oriented approaches medical-oriented programs of education in medical informatics are recommended, e.g., post-graduate education in medical informatics for physicians based on foundations in medical informatics as part of their initial training in medicine. At the level of polytechnical schools curricula of medical documentation and informatics and at the level of professional schools training in medical documentation are recommended. This report is a translation of its German original. Although considered by the GMDS as recommendations for the Federal Republic of Germany, the text may also contribute to the development of an international, especially European framework of training in medical informatics.

Germany↗

PubMed1996

What happens to expired medications? A survey of community medication disposal.

Improperly disposed-of expired medications pose a significant risk to children. To determine how expired medications are disposed of, 500 callers to our poison information center, 100 community and hospital pharmacies, the state Boards of Pharmacy, and the FDA and EPA were surveyed about medication disposal habits. Of the 500 people polled, 1.4% returned medications to a pharmacy, 54% disposed of medications in the garbage, 35.4% flushed medications down the toilet or sink, 7.2% did not dispose of medications, and 2% related they used all medications before expiration. Of the 100 pharmacies surveyed, all but 3% had specific policies on the disposal of undispensed expired medications, which were usually returned to the producer. Alternative disposal means used for nonreturnable medications were incineration (15%), hazardous waste disposal contracts (17%), and conventional solid waste disposal or down the toilet (68%). Only 5% of the 100 pharmacies had consistent recommendations for their customers on drug disposal; 25% of the pharmacies indicated questions on drug disposal were handled by individual pharmacists only upon consumer request. A variety of drug disposal techniques were encountered in our survey. Pharmacies had specific policies for expired undispensed pharmaceuticals, but lacked uniform guidelines. Little information on the safe disposal of medications was routinely passed on to the public. Uniform guidelines need to be created for the safe disposal of expired medications and should be included in routine consumer education provided by poison information centers and pharmacies.

Data Collection↗

PubMed2003

Perceptions of medical school deans and state medical society executives about physician supply.

CONTEXT: Physician shortages are appearing, yet controversy about their significance and uncertainty about their remedy exist. OBJECTIVES: To sample the perceptions of medical school deans and state medical society executives about the adequacy of physician supply, to determine the perceived impact of any shortages on medical schools, and to assess the capacity of medical schools to expand. DESIGN, SETTING, AND PARTICIPANTS: Medical school deans in the United States and Puerto Rico were surveyed by means of a structured questionnaire, and officials of US state medical societies were queried by means of open-ended telephone interviews. Information was obtained from 58% of medical school deans and 86% of state medical society executives. MAIN OUTCOME MEASURE: Reported perceptions of shortages or surpluses of physicians by specialty and plans to increase medical school class size. RESULTS: Approximately 85% of both deans and medical society respondents perceived shortages of physicians, usually in multiple specialties, while 10% perceived surpluses, usually coexisting with shortages. Among deans reporting shortages, 83% described a negative impact on their schools. Recent or planned increases in class size were reported by 27% of deans and expansion capacity by another 34%, but 7% noted recent decreases in class size. Applied generally, these changes in class size could yield 7.6% additional matriculants annually. CONCLUSIONS: Physician shortages are prevalent and they are negatively affecting medical schools. Little capacity exists to alleviate these shortages through class size expansion.

Administrative Personnel↗

PubMed1993

New York Medical College: an early center of excellence in American medical education.

Originating in 1850, the New York Medical College was one of the earliest medical schools to adopt the educational reforms advocated by the American Medical Association. This college lengthened the school term, employed more professors than usual and established a separate Board of Censors to approve students for their medical degrees. In addition, the New York Medical College initiated bedside clinical teaching using a 27 bed hospital under its own control. In an era when many medical schools were little more than diploma mills, the New York Medical College created educational reforms that were not adopted by other schools until many years later. Due to a combination of causes the New York Medical College only existed from 1850 to 1864. However, the effort to reform medical education was significant and should not be overlooked. Incidentally, the New York Medical College of 1850 to 1864 was in no way related to the currently existing medical school of the same name.

Education, Medical↗

PubMed1987

Medical students' evaluations of different levels of medical ethics teaching: implications for curricula.

Although medical ethics has become a part of the curriculum of almost every medical school, medical students' perceptions of the value of medical ethics have not been documented. This paper reports the evaluations given by 137 preclinical and 216 clinical medical students to different levels of medical ethics teaching at the College of Human Medicine and the College of Osteopathic Medicine of Michigan State University. The results indicate (1) that students' satisfaction with medical ethics teaching is directly linked to how much they receive, (2) that students overwhelmingly prefer the input of both ethicists and doctors to teaching by either alone, and (3) that a preclinical medical ethics course followed by explicit medical ethics teaching in clinical training is a promising model for achieving an adequate level of medical ethics teaching within medical education.

Attitude of Health Personnel↗

PubMed2004

Western medical ethics taught to junior medical students can cross cultural and linguistic boundaries.

BACKGROUND: Little is known about teaching medical ethics across cultural and linguistic boundaries. This study examined two successive cohorts of first year medical students in a six year undergraduate MBBS program. METHODS: The objective was to investigate whether Arabic speaking students studying medicine in an Arabic country would be able to correctly identify some of the principles of Western medical ethical reasoning. This cohort study was conducted on first year students in a six-year undergraduate program studying medicine in English, their second language at a medical school in the Arabian Gulf. The ethics teaching was based on the four-principle approach (autonomy, beneficence, non-malfeasance and justice) and delivered by a non-Muslim native English speaker with no knowledge of the Arabic language. Although the course was respectful of Arabic culture and tradition, the content excluded an analysis of Islamic medical ethics and focused on Western ethical reasoning. Following two 45-minute interactive seminars, students in groups of 3 or 4 visited a primary health care centre for one morning, sitting in with an attending physician seeing his or her patients in Arabic. Each student submitted a personal report for summative assessment detailing the ethical issues they had observed. RESULTS: All 62 students enrolled in these courses participated. Each student acting independently was able to correctly identify a median number of 4 different medical ethical issues (range 2-9) and correctly identify and label accurately a median of 2 different medical ethical issues (range 2-7) There were no significant correlations between their English language skills or general academic ability and the number or accuracy of ethical issues identified. CONCLUSIONS: This study has demonstrated that these students could identify medical ethical issues based on Western constructs, despite learning in English, their second language, being in the third week of their medical school experience and with minimal instruction. This result was independent of their academic and English language skills suggesting that ethical principles as espoused in the four principal approach may be common to the students' Islamic religious beliefs, allowing them to access complex medical ethical reasoning skills at an early stage in the medical curriculum.

Cohort Studies↗

PubMed2004

Implementation of integrated medical curriculum in Japanese medical schools.

Recently, various integrated medical curricula, which can be defined as courses with subject matter classified by organ systems rather than according to departments such as surgery and internal medicine, are beginning to be introduced to bedside-learning in Japan. For example, in such an integrated medical curriculum, lectures in the course on neurological diseases would be given by a team that would include neurosurgeons, neurologists, and pathologists. Using medical education on neurological diseases as an example of an integrated medical curriculum, we analyzed the factors related to the neurological disease course as an example of an integrated medical curriculum in the clinical medicine course at our school. We also compared our course with those of all private medical schools in Japan, using the syllabuses of these private medical schools for the comparison, and considered elements that measured interdisciplinary participation in presenting the curriculum. For an integrated medical curriculum to gain interdisciplinary acceptance, the curriculum should be constituted using all medical disciplines related to the specific organ involved in the disease process under study, including both basic medicine and clinical medicine. In addition, teachers should be informed of the rationale for such a curriculum to promote their participation and a textbook on the integrated medical curriculum is needed. A curriculum committee should play an important role in promoting this type of medical education.

Curriculum↗

PubMed2001

Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients.

BACKGROUND: Use of anticholinergic (ACH) medications is a biologically plausible and potentially modifiable risk factor of delirium, but research findings are conflicting regarding its association with delirium. OBJECTIVES: To evaluate the longitudinal association between use of ACH medications and severity of delirium symptoms and to determine whether this association is modified by the presence of dementia. PATIENTS AND METHODS: A total of 278 medical inpatients 65 years and older with diagnosed incident or prevalent delirium were followed up with repeated assessments using the Delirium Index for up to 3 weeks. Exposure to ACH and other medications was measured daily. The association between change in medication exposure in the 24 hours preceding a Delirium Index assessment was assessed using a mixed linear regression model. RESULTS: During follow-up (mean +/- SD, 12.3 +/- 7.0 days), 47 medications with potential ACH effect were used in the population (mean, 1.4 medications per patient per day). Increase in delirium severity was significantly associated with several measures of ACH medication exposure on the previous day, adjusting for dementia, baseline delirium severity, length of follow-up, and number of non-ACH medications taken. Dementia did not modify the association between ACH medication use and delirium severity. CONCLUSION: Exposure to ACH medications is independently and specifically associated with a subsequent increase in delirium symptom severity in elderly medical inpatients with diagnosed delirium.

Aged↗

PubMed2006

Children who are medically fragile in North Carolina: using Medicaid data to estimate prevalence and medical care costs in 2004.

OBJECTIVES: The purpose of this paper is to demonstrate a method of using medical insurance paid claims and enrollment data to estimate the prevalence of selected health conditions in a population and to profile associated medical care costs. The examples presented here use North Carolina Medicaid data to produce estimates for children ages 0-19 who are medically fragile. These children with serious health conditions are a small subset of all children with special health care needs. METHODS: The children who are medically fragile were identified through selected procedure and durable medical equipment codes. We profiled the expenditures for all medical services provided to these children during 2004. RESULTS: 1,914 children ages 0-19 enrolled in Medicaid were identified as medically fragile (0.22 percent). The amount paid by Medicaid for these children during 2004 for all medical services was $133.8 million, or $69,906 per child. By comparison, the average expenditure by Medicaid during 2004 for a randomly selected group of children receiving well-child care visits was $3,181 per child. The $133.8 million of Medicaid expenditures for the children who are medically fragile represents 6.8 percent of the nearly $2 billion spent by Medicaid in 2004 for all medical services for all children ages 0-19. CONCLUSIONS: This study presents a standard methodology to identify children with specific health conditions and describe their medical care costs. Our example uses Medicaid claims and enrollment data to measure prevalence and costs among children who are medically fragile. This approach could be replicated for other health care payer data bases and also in other geographic areas.

Child↗

PubMed2002

Selection of potencies by medical and non-medical homeopaths: a survey.

OBJECTIVES: To examine the differences between medical and non-medical practitioners with regard to the selection of potency. DESIGN: Postal survey to medical homeopaths belonging to the Faculty of Homeopathy, and to non-medical homeopaths, members of the Society of Homeopaths. PARTICIPANTS: One hundred medical homeopaths and 100 non-medical homeopaths. RESULTS: Homeopaths from both groups agreed on certain fundamental concepts. Medical and non-medical homeopaths differ in the prescription of potency most significantly on greater use of LM potencies and greater consideration of pathology by non-medical homeopaths and greater use of a lower potency in the case of an aggravation in medical homeopaths. CONCLUSIONS: Despite the differences in education of medical and non-medical homeopaths, there appears to be general agreement on the philosophical aspects of potency prescription.

Attitude of Health Personnel↗

PubMed1993

An exploratory analysis of medication utilization in a medical intensive care unit.

OBJECTIVES: To evaluate patterns of medication use in a medical intensive care unit (ICU) and to explore relationships between drug use, patient age, admitting diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE II) scores, length of stay, and survival. DESIGN: Combination prospective and retrospective study. SETTING: Medical ICU in a large teaching institution. PATIENTS: Patient admissions (n = 191) to a medical ICU during a 4-month study period. INTERVENTIONS: The following data were collected: age, length of stay, diagnosis, physiologic variables necessary for APACHE II scores, medications administered, and survival. MEASUREMENTS AND MAIN RESULTS: The mean length of stay of the study patients was 5.2 +/- 9.8 days. Overall mortality rate was 33%. The mean age of survivors, 62.7 yrs, was significantly (p < .05) lower than that value for nonsurvivors (68.6 yrs). Postcardiopulmonary resuscitation (CPR) or -stroke patients had a mortality rate that was higher than the overall mortality rate (p < .05). APACHE II scores of > 19 were associated with a reduced survival rate when compared with the overall mortality rate. The mean daily and mean total number of medications administered per patient were 7.5 +/- 3.4 and 12.1 +/- 7.6, respectively. Antihypertensives/vasodilators and gastrointestinal prophylaxis medications were administered most commonly in 69% and 65% of patients, respectively. The median total drug use per patient was significantly greater in nonsurvivors vs. survivors (13 and 10, respectively, p < .02). There was a positive linear relationship between total medication use and log length of stay (r2 = .62). Patients admitted post-CPR or with seizures received the highest number of medications (p < .05). CONCLUSIONS: Patients admitted to the medical ICU receive multiple medications from a variety of pharmacologic classes. Prolonged length of stay, certain admitting diagnoses, and death are associated with increased medication administration. Age, certain admitting diagnoses, and APACHE II scores are significantly related to survival.

Adolescent↗

PubMed2001

Patterns of adherence with antiretroviral medications: an examination of between-medication differences.

OBJECTIVE: To determine whether adherence with one antiretroviral medication reliably predicts adherence with other antiretroviral medications. DESIGN: Cross-sectional repeated-measurement analysis. SETTING: Cohort study enrolling patients from Massachusetts and Rhode Island. PATIENTS: Total of 454 patients using antiretroviral medications for HIV infection. METHODS: For each antiretroviral medication, we asked patients to report how many days in the last week they had 1) missed a dose of the medication and 2) been off schedule with a dose of the medication. The reliability coefficient was used to compare between-person variance in adherence rates with total variance, which is the sum of between-person and within-person variance. RESULTS: The mean age of patients was 42 years; 28% were women and 37% were nonwhite. Sixty-six percent of patients were on three or more antiretroviral medications. Perfect adherence was reported by 42% of patients, and patients reported missing a dose on a mean of 1.5 days per week for each antiretroviral medication currently being taken. The reliability coefficient for days in the last week that the medication was missed was 0.85 (95% confidence interval [CI]: 0.83-0.87), and for days off-schedule in the last week, it was 0.88 (CI: 0.86-0.89). CONCLUSIONS: Most of the variability in antiretroviral adherence in this study was accounted for by between-patient differences in overall adherence rather than by within-patient differences in adherence patterns across medications. These data support the theory that when patients skip or are off schedule with doses, they skip or are off schedule with all the antiretroviral medications taken at that time. In the course of exploring patients' adherence issues, clinicians may find it useful to inquire about problematic dosing times. Researchers assessing adherence may not need to separately monitor adherence with each antiretroviral medication in a regimen.

Adult↗

PubMed1994

Effect of the use of sleep medication in Dutch hospitals on the use of sleep medication at home.

Insomnia is an important nursing problem in hospitals. Although the use of sleep medication is often criticized, it is one of the commonest interventions with regard to sleep problems. In this study, the effect of the administration of sleep medication in Dutch hospitals on the use of sleep medication at home is investigated. Only patients were included who had never used sleep medication before admittance in hospital. Results show that patients who used sleep medication for at least 5 days in hospital (n = 233) used sleep medication more often at home after discharge than patients who did not use sleep medication in hospital (n = 55). Furthermore, the study showed that those patients who used at least 5 days' sleep medication, especially those patients who used sleep medication more often in hospital, also used sleep medication more often at home. This is in line with the addictive effects of sleep medication. From these results it can be concluded that the administration of sleep medication is not without danger. Therefore, it is recommended to search for alternative interventions, especially for patients who are in hospital for a longer period.

Adult↗

PubMed1998

[Psychosocial evaluation on the correct recollection of periodic medical checkups of workers. 2. Long-term change in the recalled results of medical checkups].

A self-administered questionnaire study of 333 workers (male 253, female 80) in a manufacturing company was carried out one month after informing the workers of the results of their medical checkups in 1993. The questionnaire included several items such as recalled abnormal findings of health examination and ways of overcoming the abnormal findings, recalled results of their medical checkups in 1992, self-confidence in their recollection of the results, and the usefulness of medical checkups. The following were investigated: the relationship between actual as well as recalled results of medical checkups in 1992 and the recollection of them after one year, the effects of examinations after medical checkups in 1992 on their recollection of the checkup results after one year, the effects of actual as well as recalled 1992 checkup results on the recollection of the results one month after informing the workers of the results of their medical checkups in 1993, assurance of correct recollection of the results, the relationship between the usefulness of medical checkups, explanation of abnormal findings and the percentage of correct answers to the results of medical checkups in 1993 one month after informing the workers of their results. It was found that the percentage of correct answers to the results after one year was significantly lower than that after one month in 1992. The rate decreased with the increase in the number of abnormal items in medical checkups. Moreover, the rate also decreased when the results were abnormal. Further examinations in addition to the medical checkups influenced their recollection somewhat after one year. The results that the workers still remembered in 1992 had a stronger effect on their recalling the results one month after informing them in 1993 than the actual results in 1992. The workers' confidence in their recollection of the results was untrustworthy in the same way as their recollection of the results, and they were not able to maintain the recollection of the correct results, although many of the workers realized the usefulness of the medical checkups. Our results suggest that explanation of abnormal medical findings in 1993 was effective because the percentage of partial concordance between actual and recalled results was much higher in the workers who received the explanation than in the workers who did not receive it.

Adult↗

PubMed1993

[An application of a study of medical history to clinical medicine - for better understanding of medical history and its application to clinical medicine].

A study of medical history aims to correctly understand the progress in basic and clinical medical science and to effectively offer better medical service to our patients. The study of medical history has several important advantages, such as; 1) to understand the present medical science in depth and to shorten the duration of time needed to understand the present medicine, 2) to understand the disadvantages of the present medical sciences realizing that they are not perfect, 3) to correctly understand literature and historical documents on medical science, 4) to make and maintain accurate medical records and documents, 5) to create new concepts and 6) to prevent us from developing a rigid way of thinking. Two cases of the application of medical history to clinical medicine are shown. The first is in regard to perioperative blood transfusion. As it was suggested to me by a report that preoperative blood transfusion caused suppression of immune response in kidney transplantation, I thought a routine use of blood transfusion for surgical patients with malignant tumors would lead to a high postoperative recurrence rate of malignancy. Therefore, such a routine use of blood has been avoided inn our institution for these twenty years. The second case is in regard to excitement during the induction of inhaled anesthetics. At present the excitement is considered to be caused by inhibition of the cerebral cortical function. However, our recent clinical study based on Dr. Maeda's report published in 1935 has revealed that the excitement observed during the induction of inhaled anesthesia is caused mainly by stimulation of the trigeminal nerves. The importance of medical history should be much more stressed for medical training of students and residents as well as physicians. It should be widely and deeply applied to the clinical practice of medicine, though it is not so easy to do this. Otherwise, the study of medical history may be considered as only a hobby for retired physicians.

Clinical Medicine↗

PubMed1997

[Geographic distribution of medical supplies and the numbers of hospital inpatients in the secondary medical areas in Japan].

A secondary medical area is defined as a medical administrative area under the Medical Care Law by which every prefectural government is expected to provide general medical care supplies such as beds for inpatients. This study evaluated the distribution in medical supplies among the secondary medical areas in Japan and the correlation between medical supply and demand. The numbers of hospital inpatients (residence of patients), physicians, and general beds excluding those for mental disorders and tuberculosis were analysed in relation to the population in all secondary medical areas in Japan. Those data were obtained from surveys conducted by the Ministry of Health and Welfare. The main results were as follows; 1) The distribution of physicians and general hospital beds among the secondary medical areas was not equal. 2) Even adjusted for the sex and age distribution, the highest hospital inpatients/population ratio among the secondary medical areas was four times as large as that of the lowest. 3) With multiple regression models, two independent variables (normal hospital beds/population ratio and aged 65 and over/total population ratio) accounted about 60% of the variance in hospital inpatients/population ratio. 4) The differences in medical supplies among the secondary medical areas may cause the differences in hospital inpatients/population ratio.

Age Factors↗