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PubMed2002

[The relationship between undergoing a basic health checkup based on the Health and Medical Services Law for the Aged and medical expenditure covered under the National Health Insurance in Japan].

OBJECTIVES: This study examined the relationship between undergoing the basic health checkup based on the Health and Medical Services Law for the Aged among urban residents and medical expenditure covered under the National Health Insurance in Japan. METHODS: The subjects were all residents of a city with a population of three hundred and fifty thousand, covered by National Health Insurance and over forty years of age. Medical expenditure was compared by age and sex between examinees who had undergone the basic health checkup for the past three years running and non-examinees who had had no checkup. In addition, from the results of a questionnaire survey of randomly sampled citizens, we compared the living habits of the above two groups, the examinees and non-examinees. RESULTS: For outpatients, the medical expenditure per case, the medical expenditure per capita for seniors, and the medical expenditure per day were lower, and the number of examination days per case and the examination rate (the number of receipts per capita) were higher in the examinee group than in the non-examinee group. For inpatients, the medical expenditure per case, the medical expenditure per capita, the medical expenditure per day for seniors, the number of examination days per case, and the examination rate were lower in the examinee group compared to the non-examinee group. The increase in medical expenditure with age was less in the examinee group than in the non-examinee group. In men, the examinees had significantly better living habits (especially exercise and meals) than the non-examinees. No differences in living habits were found in women. CONCLUSIONS: Medical expenditure was lower among examinees than non-examinees. In men, regular examinees had better living habits than non-examinees.

Adult↗

PubMedDate not supplied

Underuse of controller medications among children with persistent asthma in the Ohio medicaid population: evolving differences with new medications.

BACKGROUND: Despite innovations in asthma care, morbidity and mortality have increased significantly. Underuse of controller medications is a major contributor to increased morbidity and mortality. OBJECTIVE: To determine the extent of underuse of asthma controller medications among Ohio Medicaid children and to determine if there are racial differences in controller medication claims. METHODS: We conducted a retrospective analysis of Ohio Medicaid claims data. The source data included all institutional, medical service, and pharmacy claims for fee-for-service patients between January 1, 1997, and December 31, 2001. We identified children with persistent asthma using Health Employer Data Information System criteria. The primary outcome was a controller medication claim. We used multivariable logistic regression to identify risk factors for underutilizing asthma controller medications and applied generalized estimating equations to account for repeated measures. RESULTS: The proportion of children with claims for a controller medication increased from 53% in 1997 to 67% in 2001. Although there were no racial differences in medication claims in 1997, a smaller proportion of African American children had a claim for a controller medication in 2001 (64.8% vs 67.8%, P < .001). Leukotriene antagonists (LTAs) were driving this difference. Individuals residing in urban areas were significantly less likely to have claims for LTAs when compared with those who resided in nonurban areas. CONCLUSIONS: Overall use of asthma controller medications among Ohio Medicaid children was poor. There was a widening racial difference in controller medication claims over the 5-year study. Regional differences in LTA claims were driving this racial difference.

Adolescent↗

PubMed2002

The Medication Adherence Model: a guide for assessing medication taking.

The Medication Adherence Model (MAM) was developed to describe the process of medication adherence and guide health care providers in assessing medication-taking in individuals with hypertension. The MAM was structured with the idea that two types of nonadherence contribute to inconsistent medication taking, the intentional decision to miss medications, and the unintentional interruptions that cause medications not to be taken. The three core concepts identified in the model are: (a) Purposeful Action, (b) Patterned Behavior, and (c) Feedback. Patients' initiating and sustaining medication adherence are dependent on the deliberate decision to take medications based on perceived need, effectiveness, and safety (Purposeful Action). Then they establish medication-taking patterns through access, routines, and remembering (Patterned Behavior). Individuals use information, prompts, or events (Feedback) during the appraisal process to evaluate health treatment that, in return, influences individuals' levels of Purposeful Action and Patterned Behavior (Johnson, 2002; Johnson, Williams, & Marshall, 1999). The MAM depicts the dynamic process of initiating and maintaining medication adherence from the hypertensive patient's perspective. The model describes the key components of existing cognitive and self-regulatory models, and identifies an additional behavioral component. The succinct organization of the MAM may facilitate health care providers' ability to evaluate and individualize interventions for promoting medication taking.

Cognition↗

PubMedDate not supplied

Effectiveness of different medication management approaches on elders' medication adherence.

This pilot study investigated the effects of three different medication management approaches on medication adherence and resource utilization. Sixty-one participants living in an independent elder community in South Florida were randomly assigned to one of the three medication management approaches: (1) a pillbox method, (2) a voice-activated method, and (3) self-administration of medications as they had in the past. One outcome was measured by recording the number of doses of medications ingested over a 1-, 3-, and 6-month period. Adherence to medications also was measured by the impact on the medical diagnosis. For example, the hypertensive group was defined adherent by a sustained normotensive pressure. Participants' medical records were examined as to the number of physician office visits, hospitalizations, and home health visits. There were significant differences in the mean number of doses missed, with the fewest in the voice-activated group to the highest in the self-administration (control) group. Additionally, the group that self-administered their own medications had more frequent physician office visits and increased hospitalizations. Because the elder population is prone to medication mismanagement for a variety of reasons, nurses are in a unique position to identify populations at risk and suggest interventions that may improve medication adherence.

Aged↗

PubMed1997

[The standardization of medical care and the training of medical personnel].

The medical specialist training at all levels (medical orderly, doctor's assistant, general practitioner, doctors) should be based on the medical care standards. Preliminary studies in the field of military medicine standards have demonstrated that the medical service of the Armed Forces of Russia needs medical resources' standards, structure and organization standards, technology standards. Military medical service resources' standards should reflect the requisitions for: all medical specialists' qualification, equipment and material for medical set-ups, field medical systems, drugs, etc. Standards for structures and organization should include requisitions for: command and control systems in military formations' and task forces' medical services and their information support; health-care and evacuation functions, sanitary control and anti-epidemic measures and personnel health protection. Technology standards development could improve and regulate the health care procedures in the process of evacuation. Standards' development will help to solve the problem of the data-base for the military medicine education system and medical research.

First Aid↗

PubMedDate not supplied

A 10-year experience in the use of air medical transport for medical scene calls.

OBJECTIVE: The objective of this retrospective descriptive study was to evaluate the use of air medical services in response to medical scene calls for transport to tertiary care in the rural setting. METHODS: This study is a retrospective descriptive review of all medical scene calls during a 10-year study period. The cases were analyzed for demographics, transport time, medical indication, procedures, role of ground EMS services, effects on community hospitals, and patient outcomes. A case-by-case review by emergency medicine (EM) physicians was conducted to determine necessity of air medical transport. RESULTS: A total of 8106 medical flights were conducted during the study period. Of these, 103 were scene calls for which 85 charts were available for review. The breakdown of medical scene calls is cardiac (29%), poisoning (17%), co poisoning (11%), neurologic (11%), and other (32%). Ground EMS was involved in 80% of the cases; ground advanced life support (ALS) was present in 58%. In 86% of the flights reviewed, an EM resident was aboard the helicopter. Of the 85 patients whose charts were available, 41 required admission to the ICU, five required hyperbaric oxygen (HBO) treatment, and 14 died before admission. CONCLUSION: Evacuation of the rural patient with a medical emergency accounts for an extremely small percentage of an air medical service's use. ALS services, including emergency procedures at the scene and rapid transport to a tertiary care, were provided. Seventy-one percent of the flights reviewed required transport to a tertiary care facility, indicating that air medical transport was appropriate. Physician guidelines to ensure effective and cost-efficient use of these services should be developed. Responding for victims in cardiopulmonary arrest appears to provide little benefit with respect to outcome.

Air Ambulances↗

PubMed1998

An international database on medical education: the European Medical School Information System (EMSIS).

An electronic database containing the curricula and other information of more than 200 medical schools from 40 different countries has been compiled and made accessible via the World Wide Web (http:@yi.com/emsis), with the aims of providing an overview and to enable a comparison of the curricula of Medical Schools in Europe, of facilitating the cooperation between Medical Schools in Europe and allowing medical students to plan their studying period abroad. The database contains the addresses of medical schools, general information about each medical school (number of students, hospital beds available for teaching, etc.), exchange information (exchange networks the medical school is participating in) and extensive curriculum information, consisting of more than 10,000 course descriptions. All information has largely been entered by the medical schools themselves. Medical schools may update the database directly via the Internet at any time. Users may perform simple queries, for example by country or city, or may perform more complex searches such as 'show all medical schools teaching gynaecology in the fourth year'.

Curriculum↗

PubMed2004

Does medical school cause health anxiety and worry in medical students?

OBJECTIVES: The aim of this study was to investigate the self-reported experience of health anxiety and worry in medical students compared with control subjects. It was hypothesised that medical students would experience more health anxiety as a consequence of being exposed to medical education, compared to students who are not routinely exposed to such knowledge. DESIGN: The design was cross-sectional. SETTING: Participants were recruited from London University (Guy's, King's & St Thomas' School of Medicine and King's College). PARTICIPANTS: Medical students (n = 449) and non-medical students (n = 485) were recruited across Years 1-4. Questionnaires relating to health anxiety and worry were completed at the end of their lectures. MAIN OUTCOME MEASURES: Health anxiety was measured using a questionnaire known as the Health Anxiety Questionnaire (HAQ). Worry was assessed using the Anxious Thoughts Inventory (ANTI). RESULTS: Health anxiety was significantly lower in medical students in Years 1 and 4 than in controls (P = 0.017 and P < 0.001, respectively). Worry was significantly lower in the medical students in all years of study. CONCLUSIONS: Medical students are not a cohort of preselected health-anxious people, nor are they 'worriers'. Medical education at a clinical level was shown to mitigate health anxiety in the medical student population.

Anxiety↗

PubMed1993

Attending rounds on in-patient units: differences between medical and non-medical services.

The objective of this cross-sectional observational study was to quantify communication patterns between teachers and trainees on in-patient attending ward rounds and assess trainees' perceptions of the effectiveness of teaching interactions. Sixty-nine in-patient ward rounds on medical and non-medical teaching services at a university hospital and its affiliated VA Medical Center were studied. Teaching rounds were observed and audiotaped, and trained raters coded verbal interchange for its location, speaker identity and topic of the exchange. One to three days following the teaching rounds, residents and students were interviewed and completed a questionnaire concerning recollections of the content of the session. Medical rounds lasted a mean of 90 minutes, while non-medical rounds averaged 38 minutes. Medical teams spent more time than non-medical teams on case presentations and discussions of diseases not directly related to patient care. Both groups averaged approximately 10 minutes directly interacting with patients, and equal times were spent speaking by the teacher and trainees. The role of postgraduate year 1 residents and medical students primarily was to recite details of patients' clinical condition. Twenty-nine per cent of trainees were unable to recall a specific teaching point from rounds when interviewed 1-3 days later. Duration and content of in-patient rounds differed on medical and non-medical services. For both, discourse tended to be hierarchical, with those at different training levels adhering to specific roles. Bedside patient interactions were limited. The content recalled by students and house staff suggests that new, more effective educational paradigms are needed.

Clinical Competence↗

PubMed1980

He who pays the piper: foundations, the medical profession, and medical education reform.

The development of modern medical education was shaped by the medical profession's own reform strategies and by material and ideological support from the corporate class. This article examines how the Rockefeller medical philanthropies, the largest single source of funds for medical education reform from 1910 through the 1930s, forced the adoption of a specific reform--full-time clinical faculty--to make medicine serve the needs of capitalist society rather than the interests of the medical profession. Memorandums and letters from archival files demonstrate that foundation leaders believed the full-time plan would separate medical schools from the grip of practitioner-dominated medical societies, bringing all medical faculty under the control of foundations and university boards of trustees. This policy was to be a first step in rationalizing medical care and distributing the technical benefits and social-control functions of medicine to all segments of the population. The author traces the development of the full-time plan, its adoption as foundation policy, and the struggle over its implementation.

Academic Medical Centers↗

PubMed2004

Patient education and the Internet: do patients want us to provide them with medical web sites to learn more about their medical problems?

This study was performed to assess inner city Emergency Department (ED) patients' use of the Internet to obtain medical information, and patients' interest in being provided medical links by their ED physician to learn more about their medical condition. A convenience sample of inner city ED patients were surveyed regarding computer/Internet access, past searches for medical information, and whether they desired medical links provided with discharge paperwork. Of 328 patients completing the survey, 178 (54%) had computers, whereas 150 (46%) had access to the Internet. Seventy-nine (24%) had previously used the World Wide Web (WWW) to obtain medical information, and 26 (33%) of these reported difficulty in obtaining useful information. One hundred ninety-two (59%) were interested or very interested in being provided links to medical sites. Patients more likely to want medical links were younger, college educated, and in higher salary ranges. There was no difference in desire to be provided links based on number of past medical problems or duration of symptoms. In conclusion, almost half the inner city ED patients in this survey have Internet access and over half were interested in being provided quality medical links as a part of their discharge paperwork.

Adolescent↗

PubMed2005

Comparative impact of hospital-acquired infections on medical costs, length of hospital stay and outcome between community hospitals and medical centres.

To understand the impact of hospital-acquired infections on mortality and medical costs in modern medical care systems in different healthcare settings, we performed a case-control study at a medical centre and two community hospitals. A total of 144 and 129 adult case-control pairs who received care in a 2000-bed tertiary referral medical centre and two 800-bed community hospitals, respectively, between October 2002 and December 2002 were enrolled. Prolongation of hospital stay, extra costs and complications associated with hospital-acquired infections were analysed. Patients in the medical centre had more severe underlying disease status (P < 0.001), more malignancies (P < 0.001), more multiple episodes of hospital-acquired infection (p = 0.03), and more infections with multidrug-resistant bacteria (P < 0.001) than patients in community hospitals. The additional length of hospital stay and extra costs were similar for patients with hospital-acquired infections in the community hospitals and the medical centre (mean 19.2 days vs. 20.1 days, P = 0.79; mean 5335 US dollars vs. 5058 US dollars, P = 0.83; respectively). The additional length of hospital stay and extra costs in both the medical centre and the community hospitals were not related to the sites of infection or the bacterial pathogens causing hospital-acquired infections, although medical costs attributable to hospital-acquired fungal infections due to Candida spp. were much higher for patients in the medical centre. Prevalence of hospital-acquired-infection-related complications, such as adult respiratory distress syndrome, disseminated intravascular coagulation, organ failure or shock, was similar between the two groups, but patients in the medical centre had a higher mortality rate because of their underlying co-morbidities.

Adolescent↗

PubMed1997

The search for the elusive electronic medical record system--medical liability, the missing factor.

Over the past few years, the traditional paper-based medical record system has come under close scrutiny by every participant in the healthcare industry. Some groups, especially federal agencies such as Medicare and Medicaid, HMOs, and other third party payors, have begun to demand changes in medical record documentation, and have become very assertive as to what goals and objectives will be met. In contrast, the medical liability insurance industry has remained almost invisible during this period of transition. At a recent electronic medical records (EMR) conference participants attending a software development workshop were asked if they had their systems reviewed from a medicolegal standpoint by a malpractice insurance carrier. In response to this inquiry, not one software vendor raised their hand to indicate this had been accomplished, or was even contemplated. In the author's opinion, the key missing factor in the current quest for a paperless medical office system rests in the domain of those who represent the medical liability industry. All of these gate-keepers of medical loss and risk prevention will eventually be called upon, either by choice or necessity, to validate every working EMR system that is used in medical practices in the future. This article will explore the best information published from this currently silent sector of the industry, and proposes an active involvement by the medical liability industry in the current EMR design and development processes taking place. In addition, there are 10 minimum EMR design criteria contained in this article that are recommended for implementation based upon 16 years of medical malpractice experience and loss prevention input.

Humans↗

PubMed1998

Contribution of medical student research to the Medline-indexed publications of a German medical faculty.

Medical students in Germany have to write a research thesis to acquire the title of medical doctor. This study evaluates the contribution of student research to the Medline-indexed publications of a German medical faculty. A 1993-1995 Medline-publication list, on which medical students among authors should be marked, was sent to medical faculty staff of the University of Würzburg, Germany (n = 238). Faculty members responded (106, 45%), 66 were working at a clinic, 26 at a clinic-associated institute and 14 at a basic science institute. Between 1993 and 1995, 1128 Medline-indexed papers were published by these faculty members, who on average supervised 4.5 medical students (n = 477). Medical students were among the authors of 316 (28%) and were the first authors of 88 papers (7.8%). For 66% of medical students their research resulted in a Medline-indexed publication. Medical student research activity can significantly influence the published output of a medical faculty.

Faculty↗

PubMed2004

[How do young physicians assess their medical studies in retrospect? Results of a medical graduates' survey in Germany].

OBJECTIVE: German medical graduates were asked to assess their medical studies in retrospect after their final academic exam. The survey's findings should provide clues for improvements in medical teaching. METHOD: Between April 2002 and December 2002 n = 671 medical graduates from 7 Universities in Germany were interviewed. By means of a questionnaire the subjects were asked to specify their study motivation and occupational aims; furthermore they were required to give a retrospective assessment of their medical studies. FINDINGS: The main motive for the decision to study medicine and to be a doctor is the desire to work with people and to be helpful to them. Regarding their occupational aims, most graduates wish to be a medical specialist, especially an internist or a general practitioner. As to the medical teaching, the subjects of the clinical study period are considered much more relevant for the future professional practice than the subjects of the pre-clinical study period. Much criticism focuses on the lack of practice-related medical teaching. The study participants judge the imparting of both practical and psycho-social skills as extremely deficient. Only 37.9 % of the young physicians feel well or very well prepared to future clinical tasks after their final academic exam. DISCUSSION: The findings confirm that the medical curriculum should be reconsidered with greater emphasis on teaching more practical skills. Medical teaching should comprise training modules and methods that are more closely connected with clinical practice. In particular, basic skills training of doctor-patient relationship and problem-oriented classes should be implemented, integrating clinical and psychosocial aspects.

Career Choice↗

PubMed2001

Effect of an integrated nutrition curriculum on medical education, student clinical performance, and student perception of medical-nutrition training.

BACKGROUND: Ninety-eight percent of medical schools report nutrition as a component of medical education. However, most schools do not have an identifiable nutrition curriculum. Medical schools that do include nutrition have not evaluated its effect on clinical skills. OBJECTIVE: The objective was to determine the efficacy of an integrated undergraduate medical curriculum to increase the quantity of nutrition instruction and to advance nutrition clinical skills demonstrated by medical students. DESIGN: A quasiexperimental design was constructed to determine whether an integrated nutrition curriculum increased the performance on nutrition-oriented clinical examinations of medical school classes that received 1, 2, or 3 y of the curriculum. The evaluation of the curriculum focused on 3 areas: 1) hours of nutrition instruction, 2) the application of nutrition within a clinical setting, and 3) perceptions about the nutrition curriculum. The Objective Structured Clinical Examination (OSCE) nutrition score was compared between graduating classes by use of analysis of variance. Data from the American Association of Medical Colleges were analyzed to determine the change in the proportion of students who reported that the amount of time devoted to nutrition was adequate. RESULTS: The implementation of the integrated nutrition curriculum resulted in a doubling of the total hours of required instruction in the medical curriculum (35 compared with 75 h). The mean (+/-1 SEM) OSCE nutrition score significantly improved after the implementation of the curriculum (41.7 +/- 0.9% compared with 50.6 +/- 1.1%) and the percentage of students who reported that the amount of nutrition taught during medical school was inadequate decreased (68.4% compared with 11.5%). CONCLUSION: Medical students improved their clinical nutrition practice skills through participation in an integrated nutrition curriculum.

Adult↗

PubMed2001

Comparison of surrogate with self-respondents regarding medical history and prior medication use.

BACKGROUND: The self-report of medical history and medication use is a common feature of epidemiological research. METHODS: In a unique re-interview study, we evaluated the concordance of medical conditions and past medication use reported in two similar interviews 5 years apart. RESULTS: In 196 re-interviews with the subjects themselves, and in 107 with next-of-kin of subjects who died after the first interview, agreement was good or excellent (kappa > or =0.40) for 90% (9/10) of the conditions asked about in the personal medical history for both next-of-kin and self-respondents. Agreement was excellent (kappa >0.75) for two conditions, high blood pressure and hysterectomy, among self-respondents. Self- and surrogate respondents also showed similar reproducibility for prescription medications, but next-of-kin respondents tended to have poor agreement (kappa <0.40) for over-the-counter (OTC) medications such as antacids, antihistamines, and analgesics. Next-of-kin also less reliably reported a family history of cancer. When analyses were stratified by type of surrogate respondent, concordance between the two interviews was generally higher for spouses than for other surrogate respondents. CONCLUSIONS: This research demonstrates that personal medical history and prescription medication use may be as reliably reported by next-of-kin as self-respondents, but suggests that additional information may be needed to validate measures of OTC medication use and family history of cancer for next-of-kin respondents, possibly through the review of hospital records.

Adult↗

PubMed1999

Educational technology to facilitate medical students' learning: background paper 2 of the medical school objectives project.

The present article is the second in a series of Background Papers prepared as part of the AAMC's Medical School Objectives Project (MSOP). This report provides information about and insight into U.S. medical schools' use of educational technology in 1998. The authors define educational technology as the use of information technology to facilitate students' learning. They note that in the last two decades, a number of reports have recommended that medical schools incorporate educational technology into their teaching programs. To gain insight into the effects of these recommendations, particularly those of the ACME-TRI Report in 1992, the authors analyzed the responses of administrators at 125 U.S. medical schools to relevant items of the 1997-98 Liaison Committee on Medical Education Part II Medical School Questionnaire and students' responses to relevant items of the 1998 AAMC Medical Student Graduation Questionnaire. In addition, site visits were made to six medical schools believed to be among the more advanced ones in the use of educational technology, to see what was happening on the "cutting edge" of educational technology applications. Data from 20 other schools were also used. The authors found that by 1998, medical schools as a group had made limited progress in accomplishing the recommended educational technology goals, and that there was a much greater use of such technology in basic sciences courses than in clinical clerkships. However, great variability existed across schools in the use of such technology and in the administrative arrangements for it. They observe that the use of educational technology in medical schools is increasing rapidly, and recommend that each school develop a strategic approach that will guarantee that it can meet the future educational technology needs of its students.

Automation↗