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health care for doctors

Ji Wu, Xien Liu, Xiao Zhang, Zhiyang He, Ping Lv
Mastering of medical knowledge to human is a lengthy process that typically involves several years of school study and residency training. Recently, deep learning algorithms have shown potential in solving medical problems. Here we demonstrate mastering clinical medical knowledge at certificated-doctor-level via a deep learning framework Med3R, which utilizes a human-like learning and reasoning process. Med3R becomes the first AI system that has successfully passed the written test of National Medical Licensing Examination in China 2017 with 456 scores, surpassing 96...
October 19, 2018: Nature Communications
Mark Taubert, James Norris, Sioned Edwards, Veronica Snow, Ilora Gillian Finlay
BACKGROUND: A national Do Not Attempt Cardiopulmonary Resuscitation policy was rolled out for the National Health Service in Wales in 2015. A national steering group led on producing information videos and a website for patients, carers and healthcare professionals, forming part of a quality improvement program. Videos were planned, scripted and produced with healthcare professionals and patient/carer representatives, and were completed with both English and Welsh language versions. The TalkCPR videos encourage and promote open discussion about Cardiopulmonary Resuscitation (CPR) and DNACPR in palliative care situations...
October 19, 2018: BMC Palliative Care
Carolina Abarca, Cecilia Gheza, Constanza Coda, Bernardita Elicer
According to the World Health Organization, suicide has become a public health problem of global dimensions. Forty-five percent of suicide fatalities had consulted with a primary care doctor in the month preceding the event, but no suicide risk assessment had been conducted. Although suicide is an avoidable event, there is no standardized scale for assessment of suicide risk in the primary health care setting, where mental health care competencies vary and decisions are often guided by clinical judgment. A search and review of the best available evidence was carried out to identify scales for assessment of suicide risk for the nonspecialist doctor (i...
September 20, 2018: Medwave
David Cochran, Joseph Swartz, Behin Elahi, Joseph Smith
Emergency Room (ER) crowding is one of the more complex issues in the healthcare system worldwide. Crowding gives rise to long ER waiting times, patient dissatisfaction, and negative effects on a healthcare systems' performance. This paper focuses on the utilization of the Collective System Design (CSD) methodology to optimize the performance of an ER, which is of principal importance both from a life-threatening and an economic standpoint. The CSD technique is applied to detect areas of deficiency and to identify the functional requirements of the system to address those issues...
October 18, 2018: Journal of Medical Systems
Saba Savul, Zahid Naeem, Sajida Naseem
Objective To evaluate the satisfaction levels of female patients with the availability and quality of health care services provided at the Community Health Centre (CHC) in Nurpur Shahan, a deprived peri-urban locality in Islamabad. Methods This cross-sectional study was carried out among 346 randomly selected female patients who attended the CHC in Nurpur Shahan from January to March, 2018. Data was collected by face to face interviews using a pre-tested self-designed questionnaire. Data was analysed using SPSS version 23 (IBM Corp...
August 4, 2018: Curēus
Kaynan Doctor, Kristen Breslin, James M Chamberlain, Deena Berkowitz
OBJECTIVES: Rising costs in healthcare have focused attention on interventions to optimize efficiency of patient care, including decreasing unnecessary diagnostic testing. The primary objective of this study was to determine the variability of laboratory and radiology testing among licensed independent providers (LIPs) with different training backgrounds treating low-acuity patients in a pediatric emergency department (PED). METHODS: We performed a retrospective review of the electronic health records of all encounters with patients 21 years or younger, triaged as low-acuity, visiting 2 urban, academic PEDs from January 2012 to December 2013...
October 17, 2018: Pediatric Emergency Care
Sonia Chanchlani, Daniel Chang, Jeremy Sl Ong, Aresh Anwar
OBJECTIVE: To explore the value of a peer mentoring program for first year medical interns and to assess the demand for and benefits of such a program in an Australian hospital. DESIGN, SETTING AND PARTICIPANTS: Randomised controlled study of the impact on first year interns of peer-led mentoring by second and third year interns, undertaken during 2015 at the Royal Perth Hospital, a tertiary teaching hospital. Methods and main outcome measure: Interns were recruited and randomised 1:1 to being assigned or not assigned a mentor...
October 22, 2018: Medical Journal of Australia
Sarah Samantha Richtering, Pauline Darbellay Farhoumand, Monica Escher
Doctors are responsible for code status discussions with patients in the hospital setting. However, several barriers are associated with these discussions, relating to both doctors and patients. Inadequate or insufficient communication can lead to inappropriate care, contrary to patients' preferences and, subsequently, to a suboptimal use of health care resources. Ways to improve these discussions have been identified, such as doctor-targeted educational programs and inserting decisions about code status within a more general discussion of patients' goals of care...
October 17, 2018: Revue Médicale Suisse
Rosane Sonia Goldwasser, Maria Stella de Castro Lobo, Edilson Fernandes de Arruda, Simone Audrey Angelo, Eliana Claudia de Othero Ribeiro, José Roberto Lapa E Silva
OBJECTIVES: To determine the optimal number of adult intensive care unit beds to reduce patient's queue waiting time and to propose policy strategies. METHODS: Multimethodological approach: (a) quantitative time series and queueing theory were used to predict the demand and estimate intensive care unit beds in different scenarios; (b) qualitative focus group and content analysis were used to explore physicians' attitudes and provide insights into their behaviors and belief-driven healthcare delivery changes...
July 2018: Revista Brasileira de Terapia Intensiva
Philip Shadd, Joshua Shadd
Whether institutions and not just individual doctors have a right to not participate in medical assistance in dying (MAID) is controversial, but there is a tendency to frame the issue of institutional non-participation in a particular way. Conscience is central to this framing. Non-participating health centres are assumed to be religious and full participation is expected unless a centre objects on conscience grounds. In this paper we seek to reframe the issue. Institutional non-participation is plausibly not primarily, let alone exclusively, about conscience...
October 16, 2018: Bioethics
Uba Backonja, Sarah C Haynes, Katherine K Kim
BACKGROUND: There exists a challenge of understanding and integrating various types of data collected to support the health of individuals with multiple chronic conditions engaging in cancer care. Data visualization has the potential to address this challenge and support personalized cancer care. OBJECTIVE: The aim of the study was to assess the health care practitioners' perceptions of and feedback regarding visualizations developed to support the care of individuals with multiple chronic conditions engaging in cancer care...
October 16, 2018: JMIR Human Factors
Emily Reeve, Jennifer L Wolff, Maureen Skehan, Elizabeth A Bayliss, Sarah N Hilmer, Cynthia M Boyd
Importance: Use of harmful and/or unnecessary medications in older adults is prevalent. This can lead to avoidable harms such as adverse drug reactions, falls, hospitalization, and mortality. Primary care physicians report that patient resistance to discontinuing medication use is a significant barrier to deprescribing. Objective: To describe the attitudes of older adults toward deprescribing and to determine whether individual characteristics are associated with these attitudes...
October 15, 2018: JAMA Internal Medicine
Massimo Maurici, Michele Arigliani, Valentina Dugo, Carlo Leo, Valentina Pettinicchio, Raffaele Arigliani, Elisabetta Franco
BACKGROUND: In an era of hesitance to use vaccines, the importance of effective communication for increasing vaccine acceptance is well known. This study aimed to assess the impact of a three-day residential course concerning empathy and counselling abilities on patients' ratings of the level of empathy of physicians and nurses working in vaccination centers. METHODS: The empathy of healthcare providers was evaluated using the Adapted Consultation and Relational Empathy (CARE) Measure...
October 16, 2018: Human Vaccines & Immunotherapeutics
Seth D Heldenbrand, Lindsey E Dayer, Bradley C Martin, Catherine O'Brien, Angie N Choi, Paul O Gubbins, Janna Hawthorne, Morgan Ramey, Kelsey Willis, Schwanda K Flowers
Objective. To determine factors associated with advanced pharmacy practice experience (APPE) performance in the pre-pharmacy and Doctor of Pharmacy (PharmD) curriculum and establish whether performance on the multiple mini interview (MMI) independently predicts APPE evaluation scores. Methods. A multi-case MMI has been used in the admissions process since 2008. Students are scored anywhere from 1 to 7 (unsatisfactory to outstanding) on each interview. Traditional factors (GPA, PCAT, etc.) are also used in the admissions determination...
September 2018: American Journal of Pharmaceutical Education
Nitika Pant Pai, Jana Daher, H R Prashanth, Achal Shetty, Rani Diana Sahni, Rajesh Kannangai, Priya Abraham, Rita Isaac
OBJECTIVES: In rural pregnant Indian women, multiple missed antenatal screening opportunities due to inadequate public health facility-based screening result in undiagnosed HIV and sexually transmitted bloodborne infections (STBBIs) and conditions (anaemia). Untreated infections complicate pregnancy management, precipitate adverse outcomes and risk mother-to-child transmission. Additionally, a shortage of trained doctors, rural women's preference for home delivery and health illiteracy affect health service delivery...
October 15, 2018: Sexually Transmitted Infections
Kaja Põlluste, Elise Kosunen, Tuomas Koskela, Kari J Mattila, Willemijn L A Schäfer, Wienke G W Boerma, Margus Lember
INTRODUCTION: Since the early 1990s, the Estonian and Finnish health systems have undergone various changes which are expected to have impacted the type and range of services provided by general practitioners (GPs). OBJECTIVE: To compare GP services between Estonia and Finland in 1993 and 2012 and draw a parallel with transformations occurred in the health systems of both countries during these two decades. METHODS: Data were collected through surveys among 129 and 288 GPs from Estonia and Finland in 2012 and 139 Estonian and 239 Finnish GPs in 1993...
October 9, 2018: Health Policy
Ikenna C Eze, Maria Foraster, Emmanuel Schaffner, Danielle Vienneau, Harris Héritier, Reto Pieren, Laurie Thiesse, Franziska Rudzik, Thomas Rothe, Marco Pons, Robert Bettschart, Christian Schindler, Christian Cajochen, Jean-Marc Wunderli, Mark Brink, Martin Röösli, Nicole Probst-Hensch
Transportation noise leads to sleep disturbance and to psychological and physiological sustained stress reactions, which could impact respiratory health. However, epidemiologic evidence on associations of objective transportation noise exposure and also perceived noise annoyance with respiratory morbidity is limited. We investigated independent associations of transportation noise exposure and noise annoyance with prevalent respiratory symptoms and incident asthma in adults. Using 17,138 observations (from 7049 participants) from three SAPALDIA (Swiss Cohort Study on Lung and Heart Diseases in Adults) surveys, we assessed associations of transportation noise exposure and noise annoyance with prevalent respiratory symptoms, and with incident asthma (in 10,657 nested observations from 6377 participants)...
October 12, 2018: Environment International
Karen Sue Hoyt, Dian Dowling Evans, Jennifer Wilbeck, Elda Ramirez, Donna Agan, Diane Tyler, Lorna Schumann
The role of the Emergency Nurse Practitioner (ENP) has evolved as a specialty and is appreciated within the context of the 2008 Consensus Model document (APRN Consensus Work Group & National Council of State Boards of Nursing APRN Advisory Committee, 2008). The first in a series of five articles, this article describes the appraisal of the ENP role as well as the specialty and the distinctive role of the ENP. The second article, Emergency Nurse Practitioner Practice Analysis: Report and Implications of the Findings, presents research to support the scientific basis of emergency specialty practice and content validity for a national certification program...
October 2018: Journal of the American Association of Nurse Practitioners
Redempta Mbatia, Jessica Cohen, Martin Zuakulu, Appolinary Bukuku, Shikha Chandarana, Eliudi Eliakimu, Sisty Moshi, Elysia Larson
Background: Poor health system experiences negatively affect the lives of poor people throughout the world. In East Africa, there is a growing body of evidence of poor quality care that in some cases is so poor that it is disrespectful or abusive. This study will assess whether community feedback through report cards (with and without non-financial rewards) can improve patient experience, which includes aspects of patient dignity, autonomy, confidentiality, communication, timely attention, quality of basic amenities, and social support...
2018: Frontiers in Public Health
Maryanne Ong'udi, Pegotty Mutai, Irene Weru
Introduction Cancer is not only a burden in the country but also a global burden with among the highest rate of mortality. In spite of the great strides made by the conventional therapy, many cancer patients have resorted to using complementary and alternative medicine (CAM) as human beings have an innate urge to try new and alternative ways to relieve their suffering. Objectives There is a need for us to establish if the cancer patients at Kenyatta National Hospital, Nairobi use CAM, to establish the socio-demographic characteristics of patients in the oncology clinic, to establish the types and patterns of CAM use, to establish the reasons and factors that may contribute to CAM use and if the primary health care provider is aware that they are using CAM...
October 14, 2018: Journal of Oncology Pharmacy Practice
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