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PubMed2006

How do providers assess antihypertensive medication adherence in medical encounters?

BACKGROUND: Poor adherence to antihypertensives has been shown to be a significant factor in poor blood pressure (BP) control. Providers' communication with patients about their medication-taking behavior may be central to improving adherence. OBJECTIVE: The goal of this study was to characterize the ways in which providers ask patients about medication taking. DESIGN: Clinical encounters between primary care providers and hypertensive patients were audiotaped at 3 Department of Veterans' Affairs medical centers. PARTICIPANTS: Primary care providers (n=9) and African-American and Caucasian patients (n=38) who were diagnosed with hypertension (HTN). APPROACH: Transcribed audiotapes of clinical encounters were coded by 2 investigators using qualitative analysis based on sociolinguistic techniques to identify ways of asking about medication taking. Electronic medical records were reviewed after the visit to determine the BP measurement for the day of the taped encounter. RESULTS: Four different aspects of asking about medication were identified: structure, temporality, style and content. Open-ended questions generated the most discussion, while closed-ended declarative statements led to the least discussion. Collaborative style and use of lay language were also seen to facilitate discussions. In 39% of encounters, providers did not ask about medication taking. Among patients with uncontrolled HTN, providers did not ask about medications 33% of the time. CONCLUSION: Providers often do not ask about medication-taking behavior, and may not use the most effective communication strategies when they do. Focusing on the ways in which providers ask about patients' adherence to medications may improve BP control.

Antihypertensive Agents↗

PubMed2005

Patterns and predictors of prescription medication use in the management of headache: findings from the 2000 Medical Expenditure Panel Survey.

OBJECTIVE: The primary objectives were to examine national trends of prescription medication use for headache and explore patterns of variation in the use of these medications across social and demographic levels. BACKGROUND: Despite widespread use of prescription medication for management of headache, little is known about utilization patterns or patient characteristics associated with receiving this type of treatment. METHODS: This study conducted a secondary analysis of data obtained during the 2000 Medical Expenditure Panel Survey, a representative survey of the U.S. noninstitutionalized population. Weighted descriptive statistics and logistic regression models were used to evaluate patterns and rates of overall prescription medication use in patients reporting headache as a household condition. RESULTS: An estimated 9.7 million people 18 years or older reported suffering from headache in 2000. Of these, 46% reported using at least one medication for the treatment of headache. Migraine-specific abortive medication (ie, selective serotonin receptor agonists and ergotamine derivatives) was the most frequently reported medication class, used by 36% of participants. Opiate analgesics and butalbital-containing products also experienced extensive prescribing reported by 22% and 17% of survey respondents, respectively. After adjustment for covariates, wide variation in the use of prescription medication was observed across sociodemographic characteristics including age, ethnicity, and insurance status. CONCLUSION: The observed variation in prescription medication use by drug class and sociodemographic characteristics suggests strategies are needed for improving current prescribing patterns in this patient population.

Adult↗

PubMed2001

Comparing syntactic complexity in medical and non-medical corpora.

With the growing use of Natural Language Processing (NLP) techniques as solutions in Medical Informatics, the need to quickly and efficiently create the knowledge structures used by these systems has grown concurrently. Automatic discovery of a lexicon for use by an NLP system through machine learning will require information about the syntax of medical language. Understanding the syntactic differences between medical and non-medical corpora may allow more efficient acquisition of a lexicon. Three experiments designed to quantify the syntactic differences in medical and non-medical corpora were conducted. The results show that the syntax of medical language shows less variation than non-medical language and is likely simpler. The differences were great enough to question the applicability of general language tools on medical language. These differences may reduce the difficulty of some free text machine learning problems by capitalizing on the simpler nature of narrative medical syntax.

Artificial Intelligence↗

PubMed2003

Medical and non-medical expenses for treating babies born to HIV-infected and non-HIV-infected mothers.

BACKGROUND: Most human immunodeficiency virus (HIV) infections among children under 5 years are transmitted perinatally. These children require more medical attention and hospitalization than non HIV-infected children. The expenses of HIV-infected children are mostly related to opportunistic infections. OBJECTIVE: To compare the medical and non-medical expenses of treating babies born to HIV-infected and non-HIV-infected mothers at the Queen Sirikit National Institute of Child Health (QSNICH). METHODOLOGY: Consecutive children of HIV-infected and non HIV-infected mothers born at Rajavithi Hospital, Bangkok, were recruited from 1993 to 1995. All of them were followed at QSNICH for free medical services. The demographic and pregnancy data of mothers and the characteristics of the babies of the two groups were compared as well as the number of the hospital visits and reported medical and non-medical expenses. RESULTS: 58 children of HIV-infected mothers and 119 children of non-HIV-infected mother were recruited during this period. Only 30 (51.7%) children of HIV-infected mothers could complete the 18-month requirement, while 90 (75.6%) of the babies born to non-HIV-infected mothers finished the 18 months follow-up period. The two groups did not differ much in terms of demographic characteristics, except that the infant fathers were younger and serology for syphilis was higher in the HIV-infected mothers. This indicated that the HIV-infected mothers had earlier sexual activity. Babies born to the HIV-infected mothers tended to have a lower birth weight and were small for gestational age (SGA). Nine out of 30 babies (30%) born to the HIV-infected mothers were found to be HIV positive at the 18th month of follow-up. The mean medical, non-medical, and total expenses of the babies of the infected group were 2,525.90 +/- 4,328.75, 1,323.07 +/- 1,452.41, 3,848.97 +/- 5,308.90 baht respectively, or were 2.4, 2.0, and 2.2 times those of the non-infected group. These expenses did not include antiretroviral therapy. CONCLUSION: The total medical and non-medical expenses excluding antiretroviral therapy of the children of the infected group were 2.2 times those of the non-infected group. Under the limitation of financial resource and fast growing health care expenditures, the preventive measure for HIV infections including public information, education, communication, and condom promotion should be emphasized.

Adult↗

PubMed1995

[The structural analysis of inpatient medical cost of the aged in 81 secondary medical areas of 12 Prefectures in Japan].

In order to understand the structure of the per capita medical care expenditure of inpatients aged 70 years and over, correlational and principal component analyses were performed using several medical cost indices for fiscal 1991 in 81 secondary medical areas of 12 prefectures. Requests were sent to all of 777 municipalities in the 12 prefectures, and there were 763 responses for the response rate of 98.2%. A total of 1,647,187 residents who had been inpatients based on receipts for inpatient medical care expenditure were surveyed. There were 389,456 who responded that they had been inpatients at least once in the preceding 12 months, in 1991. The main results were as follows: 1) Of the residents aged 70 and over, 32.0% of men and 29.7% of women surveyed had at least one episode of hospital admission in the preceding 12 months in 1991. 2) Large differences in the medical care expenditure per inpatient per year for those aged 70 years and over exist in the secondary medical areas in 12 prefectures. 3) In both sexes, per capita expenditures for inpatient care per year are positively correlated with the bed-days in hospitals per inpatient per year, the bed days per receipt, the medical care expenditure per receipt, and the number of receipts per inpatient per year. On the other hand, for women it is negatively correlated with per capita medical care expenditure per day, but it is not statistically significant. 4) The medical care expenditure per inpatient per day is significantly negatively correlated with bed-days in hospital per receipt, the number of receipts per inpatient per year, bed-days in hospital per inpatient per year for both sexes. On the other hand, it is significantly positively correlated with medical care expenditure per receipt for both sexes.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed2003

Medication reconciliation: a practical tool to reduce the risk of medication errors.

Preventable adverse drug events are associated with one out of five injuries or deaths. Estimates reveal that 46% of medication errors occur on admission or discharge from a clinical unit/hospital when patient orders are written. This study was performed to reduce medication errors in patient's discharge orders through a reconciliation process in an adult surgical intensive care unit (ICU). A discharge survey was implemented as part of the medication reconciliation process. The admitting nurse initiated the survey within 24 hours of ICU admission and the charge nurse completed the survey on discharge. Baseline data were obtained through a random sampling of 10% of discharges in first 2 weeks of the study (July 2001-May 2002). Medical and anesthesia records were reviewed, allergies and home medications verified with patient/family and findings compared with orders at time of ICU discharge. Baseline data revealed that 31 of 33 (94%) patients had orders changed. By week 24, nearly all medication errors in discharge orders were eliminated. In conclusion, use of the discharge survey in this medication reconciliation process resulted in a dramatic drop in medications errors for patients discharged from an ICU. The survey is now a part of our electronic medical record and used in 4 adult ICUs and 2 medicine floors.

Continuity of Patient Care↗

PubMed2005

[Implementation of the new Federal Medical Licensing Regulations for doctors in the interdisciplinary subject "Rehabilitation, physical medicine, naturopathic treatment" by the German medical faculties].

The introduction of the new interdisciplinary subject "Rehabilitation, Physical Medicine, Naturopathic Treatment" based on the 9th revision of the Federal Medical Licensing Regulations (Approbationsordnung fur Arzte) implies new opportunities and challenges for teaching. In order to investigate the transfer of the new subject to teaching practise, a written questionnaire was sent to all German medical faculties. With regard to the implementation of new teaching structures and procedures in the subject, a range of different indicators was examined. 50 % of the medical faculties have been planning for comprehensive teaching sessions as compared to distribution over the whole semester. Lectures predominate with an average of more than half of the teaching time available for the subject. For examination purposes written tests are used in 83 %, compared to only 17 % Objective Structured Clinical Examinations. Considering the diversity among the medical faculties, there is room for improvement in many universities concerning more patient- and practice-oriented medical training as intended by the Federal Medical Licensing Regulations. However, in spite of increased demands, supplementary funds for additional equipment or manpower are rarely provided for. In the future, enhanced allocation of resources based on performance-related evaluation within the medical faculties and teaching competition between universities may provide significant stimuli for advances in medical training also in the new interdisciplinary subject. Further improvement of general teaching conditions is necessary in order to utilize all the opportunities offered by the new Federal Medical Regulations.

Complementary Therapies↗

PubMed1988

A comparison of nutrition knowledge of freshmen and senior medical students: a collaborative study of southeastern medical schools.

It has been documented previously that nutrition knowledge of senior medial students at ten southeastern medical schools varies and is positively correlated with student assessment of the quantity and quality of nutrition education. To determine whether the differences in knowledge are related to the medical educational experience or are simply a reflection of differences in the students' knowledge on entry to medical school, the same examination was administered to entering freshmen at eight of the medical schools. The knowledge scores of freshmen were remarkably homogeneous from school to school (53 +/- 1%, range 51-55%), and nutrition knowledge was significantly higher for seniors than for the freshmen at all schools (mean 69 vs 53%, p less than 0.0001). On the basis of responses to survey items on the examination, the freshman medical students were more inclined than senior students to take a nutrition elective (62 vs 34%, p less than 0.0001), and more freshman rated nutrition as being important to their careers (74 vs 59%, p less than 0.05). These data indicate that 1) entering freshman medical students at the different schools studied have comparable levels of nutrition knowledge and are receptive to nutrition education, and 2) differences in medical training programs most likely explain the previously documented variability in nutrition knowledge of graduating medical students. These findings have important implications for professionals planning curricula for medical-nutrition education.

Education, Medical, Undergraduate↗

PubMed1998

Medical students' evaluations of curriculum innovations at ten North American medical schools.

The authors recount medical educators' calls in the 1980s to reform general professional medical education by supplementing the standard lecture-lab biomedical curriculum with new biopsychosocial pedagogy and emphases. They then report selected medical students' evaluations of corresponding curriculum reform efforts that were in place by 1990 at eight U.S. and two Canadian medical schools known for being innovators. From interviews conducted in 1992-93 with a group of three to nine medical students at each school, the authors report two findings. First, the students' positive evaluations converged: at all ten schools they invariably appreciated curriculum reform efforts of any sort that encouraged individuation, connection, and diversity. Second, the students' negative evaluations diverged: specifically, those enrolled at the smaller schools with more distinctly teaching-service missions, schools where innovation was more wholesale, even extending across the entire curriculum, objected to curricula that provide too much in the way of new pedagogy and emphases and too little standard instruction; conversely, those enrolled at the larger schools with more comprehensive teaching-research-service missions, schools where innovation must be more piecemeal, often course by course, objected to curricula that provided too little in the way of new pedagogy and emphases and too much standard instruction. Suggesting that the smaller schools studied may be over-supplementing--and the larger schools under-supplementing--standard biomedical with new biopsychosocial pedagogy and emphases, the authors make two recommendations: first, that medical educators at schools of every size and sort contemplating curriculum reform of any scope recognize that medical students invariably appreciate educational opportunities for individuation, connection, and diversity; second, that the same educators, but especially those at the smaller teaching-service medical schools considering more wholesale innovation, recognize that medical students must soon compete for residencies and posts in a rapidly changing health care environment and thus want effective instruction per se, whether it be delivered by a lecturer or a tutor, in class or in tutorial, on a ward or in a clinic. That would be the meaning, they conclude, of student-centered learning, however it were tailored.

Canada↗

PubMed2003

The Centre for Medical Humanities, Royal Free and University College Medical School, London, England.

The Centre for Medical Humanities is based within the Royal Free and University College Medical School. With a student body of more than 2,000, this large United Kingdom medical school benefits from being a fully integrated component of University College London. With its strong humanities and science faculties, University College London was founded more than 175 years ago to make education available to wider social and religious groups. With this background, it is logistically and ideologically well suited to sustaining a medical humanities program. The Centre's aims are to raise awareness of the field of medical humanities, to develop resources for the academic and teaching communities, and to build a broad and well-grounded educational program supported by sound educational principles and innovative research. Since 1998, the Centre and its predecessor, the Medical Humanities Unit, which was established by a group of medical educators with a diverse range of interests in the arts and humanities, has built interdisciplinary links and collaborative relationships with individuals and institutions within the university and beyond, nationally and internationally. These links and relationships have provided invaluable contributions and stimulus to the Centre's activities. The undergraduate educational program described in this article includes core and optional teaching throughout the curriculum, and a 1-year intercalated Bachelor of Science in Medical Humanities degree. For postgraduates, the Centre offers the United Kingdom's first continuing professional development accredited 2-day course in medical humanities, and an annual residential retreat open only to graduates of the course.

Curriculum↗

PubMed1977

U. S. medical graduates versus foreign medical graduates. Are there performance differences in practice?

This study has attempted to determine the relationship between physicians' medical education and their performances (technical quality and utilization of medical care resources) in offices and hospitals. The sample consisted of 506 physicians of Hawaii, involving 18 specialty categories. The study finds little evidence of the influence of the type of medical schools on physicians' technical quality and utilization of medical resources in practice. The mean differences between the categories of medical schools were not statistically significant (except for the quality when specialists practiced within their own areas of specialization). There is no evidence that all categories of U.S. medical graduates provided a higher quality care and better utilization than all categories of foreign medical graduates. There was no consistent pattern of performances within the categories of U.S. medical schools and of foreign medical schools in these dimensions of performances.

Clinical Competence↗

PubMed1995

The Educational Commission for Foreign Medical Graduates: global efforts in graduate medical education.

In addition to its certification programme, which assesses the readiness of foreign medical graduates to enter graduate medical education programmes in the USA, the Educational Commission for Foreign Medical Graduates (ECFMG) is involved in a number of other programmes in international medical education. These include: (1) continuing to provide sponsorship for exchange visitors in graduate medical education programmes in the USA; (2) the development of a clinical skills assessment that is currently being introduced in pilot projects in the USA and abroad and will eventually become a component of the ECFMG certification process; (3) funding and administration of two fellowship programmes that provide foreign scholars (clinicians and basic scientists) with the opportunity to spend up to one year in a US medical school; (4) collaboration with the World Health Organization on the upcoming revised edition of the World Directory of Medical Schools; and (5) co-sponsorship, with the World Health Organization, of a consultation on quality medical education oriented towards attaining a global consensus on the definition and the elements of quality in medical education and on the most appropriate ways to evaluate quality.

Education, Medical, Graduate↗

PubMed2003

Medical school attended as a predictor of medical malpractice claims.

OBJECTIVES: Following earlier research which showed that certain types of physicians are more likely to be sued for malpractice, this study explored (1). whether graduates of certain medical schools have consistently higher rates of lawsuits against them, (2). if the rates of lawsuits against physicians are associated with their school of graduation, and (3). whether the characteristics of the medical school explain any differences found. DESIGN: Retrospective analysis of malpractice claims data from three states merged with physician data from the AMA Masterfile (n=30288). STUDY SUBJECTS: All US medical schools with at least 5% of graduates practising in three study states (n=89). MAIN OUTCOME MEASURES: Proportion of graduates from a medical school for a particular decade sued for medical malpractice between 1990 and 1997 and odds ratio for lawsuits against physicians from high and low outlier schools; correlations between the lawsuit rates of successive cohorts of graduates of specific medical schools. RESULTS: Medical schools that are outliers for malpractice lawsuits against their graduates in one decade are likely to retain their outlier status in the subsequent decade. In addition, outlier status of a physician's medical school in the decade before his or her graduation is predictive of that physician's malpractice claims experience (p<0.01). All correlations of cohorts were relatively high and all were statistically significant at p<0.001. Comparison of outlier and non-outlier schools showed that some differences exist in school ownership (p<0.05), years since established (p<0.05), and mean number of residents and fellows (p<0.01). CONCLUSIONS: Consistent differences in malpractice experience exist among medical schools. Further research exploring alternative explanations for these differences needs to be conducted.

Education, Medical↗

PubMed2003

Chat reference service in medical libraries: part 2--Trends in medical school libraries.

An increasing number of medical school libraries offer chat service to provide immediate, high quality information at the time and point of need to students, faculty, staff, and health care professionals. Part 2 of Chat Reference Service in Medical Libraries presents a snapshot of the current trends in chat reference service in medical school libraries. In late 2002, 25 (21%) medical school libraries provided chat reference. Trends in chat reference services in medical school libraries were compiled from an exploration of medical school library Web sites and informal correspondence from medical school library personnel. Many medical libraries are actively investigating and planning new chat reference services, while others have decided not to pursue chat reference at this time. Anecdotal comments from medical school library staff provide insights into chat reference service.

Cooperative Behavior↗

PubMed2006

[Undergraduate medical students' expectative of their desired profile as medical doctors].

BACKGROUND: During the last few years, multiple new medical schools have emerged in Chile, associated to the constant preoccupation to provide a good quality medical care. This created the need to evaluate medical training programs and to open a discussion about the attributes that a good physician should have. AIM: To evaluate the medical student's perception of the ideal medical doctor profile. MATERIAL AND METHODS: An analytical, descriptive and cross sectional study was designed. Eleven second year, 11 third year, nine fourth year, 13 fifth year, 6 sixth year and 8 seventh year students were studied. Data collection was gathered by focus groups. Codes and triangulation were used for data analysis. RESULTS: As attitudes and moral-ethical values, students valued the absence of discrimination a listening attitude and empathy. Among job related issues, they valued responsibility and punctuality. Emotional and legal self-care were valued as self related attitudes. Among skills, competences and capacities, a value was given to communicational skills, team work and professional easiness. Knowledge about medical and non medical topics was appraised. The valued attributes among duties and activities were patient diagnosis, treatment and education, team leadership and continuous medical training. CONCLUSIONS: These findings should help to design new curricula for medical schools.

Adolescent↗

PubMed2004

How medical students use the computer and Internet at a Turkish military medical school.

The aim of this study was to determine how medical students use the computer and World Wide Web at a Turkish military medical school and to discuss characteristics related to this computer use. The study was conducted in 2003 in the Department of Public Health at the Gulhane Military Medical School in Ankara, Turkey. A survey developed by the authors was distributed to 508 students, after pretest. Responses were analyzed statistically by using a computer. Most of the students (86.4%) could access a computer and the Internet and all of the computers that were used by students had Internet connections, and a small group (8.9%) had owned their own computers. One-half of the students use notes provided by attending stuff and textbooks as assistant resources for their studies. The most common usage of computers was connecting to the Internet (91.9%), and the most common use of the Internet was e-mail communication (81.6%). The most preferred site category for daily visit was newspaper sites (62.8%). Approximately 44.1% of students visited medical sites when they were surfing. Also, there was a negative correlation between school performance and the time spent for computer and Internet use (-0.056 and -0.034, respectively). It was observed that medical students used the computer and Internet essentially for nonmedical purposes. To encourage students to use the computer and Internet for medical purposes, tutors should use the computer and Internet during their teaching activities, and software companies should produce assistant applications for medical students. Also, medical schools should build interactive World Wide Web sites, e-mail groups, discussion boards, and study areas for medical students.

Computers↗

PubMedDate not supplied

[Scientific-Pedagogic School of Biological and Medical Chemistry of the O. O. Bogomolets National Medical University (on the 160th year of its founding)].

In this work the most important stages of the scientific-pedagogic school of biologic and medical chemistry formation in Bogomolets National Medical University starting from the period of foundation as early as in 1863 till nowadays the Chair of Medical Chemistry and Physics as a part of Medical Faculty of Saint Volodymyr Emperor University in the city of Kyiv have been estimated and generalized. The especial attention is attracted to the fact, that it was Kyiv University where firstly the Chair of Biochemistry was created in order of stuyding the regularities of biochemical processes running in the human organism and metabolism disturbances inducing the pathologic processes at some diseases. The scientific and scientific-pedagogical trends of the chair work in different periods of its development are presented, simltneously the leading role of famous Ukrainian scientists--biochemicians in foundation and development of biologic and medical chemistry scientific school in the University are emphasized. Nowadays the Chair is the educational and scientific center supporting and developing the best traditions on training the specialists of different qualification levels: physicians Masters of Science, Philosophy Doctors and Doctors of Science in Medicine and Biology. The Chair is considered to be a basic one among the Ukraine higher medic and pharmaceutic educational institutions having the III-IV accreditation rate on the problems of teaching-organizational, educational-methodical and scientific work. On the Chair base there is functioning the Scientific Problem-Solving Commission of Ministry of health Protections of Academy of Medical Sciences of Ukraine "Biological and medical Chemistry" (the chairman is the Corresponding-Member of Academy of Medical Sciences of Ukraine, Prof. Yu.I. Gubsky. The Chair personnel compiled and issued the contemporary manuals in Ukraine language on Biologic and Bioorganic Chemistry.

Biochemistry↗

PubMed2004

Education of medical informatics at Medical Faculty of Sarajevo.

The medical informatics as the separate medical discipline very quickly gets developed, both in Bosnia and Herzegovina. In our country, the medical informatics is a separate subject for the last ten years, regarding to the Medical curriculum at the biomedical faculties in Bosnia and Herzegovina is in accordance with the project of the education related to Bologna declaration and the project EURO MEDICINA. Last year the Chair of the Medical Informatics of the Medical Faculty in Sarajevo celebrates ten years of its existence. The research was performed using the separate questionnaire patterns data carriers with the defined characteristics for the quality assessment of the performed course. The total attitude of the assessed students speaks about dominantly expressed satisfaction with the majority of the parameters that are important for assessment of the quality and the tuition contents which were evaluated during the questionnaire. The education in the field of the medical informatics is based at the concept which is used in the developed countries of the world, and according the recommendations of the working groups of the European and world association of the medical informatics. The theoretical and practical teaching and training performance in the wholeness is performed by use of the computer equipment, and the final knowledge check of the students also is performed using the Data Base Management System MSAccess specifically designed to cover full teaching and training material by using questions set in the data base which encircled nearly 1500 questions combinations. In this paper author presents ten years of experience of medical informatics education at biomedical faculties in Bosnia and Herzegovina.

Bosnia and Herzegovina↗